After your doctors see you, they tell your insurance company their conclusions about what’s wrong with you – one or more diagnoses. But you might not recognize this information in the medical records they keep about you, on a summary of your visit they give you, or on your bill. Does your doctor say, “Nancy has diabetes”? No, your doctor instead notes a three-digit code that may also include one or two numbers after a decimal point. Sometimes the format varies slightly and includes a letter before the numbers.
If Nancy developed diabetes during pregnancy, her doctor might report 648.00, which means “diabetes mellitus of mother complicating pregnancy, childbirth, or the puerperium (the period of roughly six weeks after childbirth), unspecified as to episode of care.”
What difference does it make what codes your doctor puts in your records? If the codes are incorrect, you could be labeled as having a medical condition you don’t have, which could lead to mistakes in your care and potentially even prevent you from getting long-term care insurance or life insurance in the future.
The codes can be surprisingly specific. For example, if you were chatting on your cell phone while crossing a street under construction, and walked right around a barrier the workers had put up to keep you out, your doctor might have reason to use code E883.2, which means “accidental fall into storm drain or manhole.”
Suppose that your friend Jim turned a corner on a green light, not seeing that someone was walking across the street ten yards past the crosswalk. If his car hit the pedestrian, who then crashed into a bicyclist while falling, the bike rider’s doctors might record code E814.6, which means “motor vehicle traffic accident involving collision with pedestrian, injuring pedal cyclist.”
If you see new doctors and they notice a discrepancy between very specific diagnostic codes in your official medical records and your explanations (when you may have forgotten the specifics), rather than asking you questions or trying to understand why the two versions of history are different, they may assume that you are lying, a conclusion that can destroy trust between you and them, and make it harder to get the care you need.
Knowing exactly what diagnoses show up in your medical records can help you get the right care, avoid unjustified insurance denials, and get on the same sheet of music with your doctors.
The federal Center for Medicare and Medicaid Services (CMS) has made it easy to look up the meaning of these ICD (International Classification of Diseases) codes. Search online for: CMS ICD Code Lookup. The current version of the codes is ICD-9; an updated version called ICD-10 will launch shortly.
