Medical Billing Codes Explained: What CPT, ICD-10, and HCPCS Codes Mean for Patients
description says, and why you believe it does not match the service you received. Ask them to review the code against your medical record. Many coding errors are corrected at this stage simply by having a coder review the documentation and resubmit with the correct code.
If the provider insists the code is correct and you still disagree, contact your insurance company and explain the discrepancy. Ask them to review the claim and the supporting documentation. If the error led to a claim denial, follow the formal appeal process described in our guide on How to Appeal a Medical Bill Denial.
Using Your EOB to Catch Coding Errors
Your Explanation of Benefits is your primary tool for catching coding errors between what was billed and what was processed. Compare the codes on your EOB to the codes on your itemized medical bill — they should match exactly. Any discrepancy may indicate an error in how the claim was submitted or processed. For complete guidance on reading your EOB, see our guide on What is an Explanation of Benefits.
Frequently Asked Questions About Medical Billing Codes
Can I request the specific codes used in my billing? Yes. You are entitled to an itemized bill showing all procedure and diagnosis codes. Request this specifically from the provider’s billing department.
What is the most common billing code error? Upcoding of evaluation and management codes (office visit codes) is widely considered the most common and most impactful billing code error in outpatient settings.
Does insurance verify billing codes? Insurance companies perform automated edits and clinical reviews to catch some coding errors, but many errors pass through without detection. Patient review is an important additional layer of error catching.
Conclusion
Medical billing codes are not mysterious symbols — they are standardized descriptions of medical services and diagnoses that you can look up, verify, and question. Taking time to review the codes on your bills can reveal errors that save you hundreds or thousands of dollars. Start by reading our guide on How to Read Your Medical Bill and Spot Errors, understand your Explanation of Benefits, and know how to Appeal a Medical Bill Denial when errors lead to incorrect charges.
