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Step 4 - Checking the ICD Diagnostic Codes on Your Medical Bill


Updated August 22, 2013

Diagnostic Codes, also called ICD-9 or ICD-10 codes, will also be listed on your medical bill.
You'll get some clues about what the doctor is thinking.

Diagnostic codes (ICD-9 or ICD-10 codes) will give you clues about what you have been tested for.

Trisha Torrey

Your doctor or other provider won't get paid by your insurance company or other healthcare payer unless he or she provides a diagnostic code to go along with the services. The reason is that only certain services can be performed for specific diagnoses. For example, your doctor could not run a heart test if your problem was a rash on your leg.

Those diagnoses are represented by ICD codes (International Classification of Diseases), either version 9 or version 10. Most current billing reflects ICD-9 codes but during the next few years, all medical providers will transition to ICD-10. You may want to learn more about these diagnostic codes and the shift to the new ones.

In some cases, there will be several diagnostic codes used, as there are in this example. That indicates the doctor is unsure of what is causing a symptom, and usually represents the reasons for tests that are given.

You may be interested in looking up the ICD codes. This bill contains an ICD-9 code 785.1, which represents heart palpitations, and 272.0 which is the code for pure hypercholesterolemia.

Why would you want to look up the ICD codes? If you have visited your doctor with symptoms and are unsure about what he or she was looking for, you might get some clues from these codes.

If the codes don't make any sense to you, if you know you don't have the problems listed, then it could indicate you have received the wrong bill, or that fraud is involved in some way, including the possibility of medical identity theft. Contact your provider's office immediately for clarification.

Last: we'll take a look at the pricing on this bill.

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