That's to ensure that the service provided (procedure code) matches the diagnosis.
For example, the procedure (HCPCS) code "71045" corresponds with the procedure "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW" for billing purposes.
If you were to match that up with the diagnosis code (ICD10) S80.211 for "Abrasion, right knee" there would be a mismatch between the diagnosis and the procedure. This happens all the time due to human error and often results in insurance denials, which sadly take a long time to fix since now you have to get MORE HUMANS involved.
You’re not wrong! I for one am very excited about the potential benefits these Transparency in Coverage have for patients. Just the ability to shop the best rates for common procedures can save thousands per year for some.
Sadly, I’ve noticed most businesses utilizing this price transparency data are primarily selling to hospitals/providers so they can negotiate better contracted rates with insurance plans.
For example, the procedure (HCPCS) code "71045" corresponds with the procedure "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW" for billing purposes.
If you were to match that up with the diagnosis code (ICD10) S80.211 for "Abrasion, right knee" there would be a mismatch between the diagnosis and the procedure. This happens all the time due to human error and often results in insurance denials, which sadly take a long time to fix since now you have to get MORE HUMANS involved.