Healthsharing is a special and unique way of caring for your health, and taking an active part in your healthsharing membership will help you be a successful member. As empowered, educated healthcare consumers, our members often ask questions to better understand how our healthsharing process works and what it means to be a good healthsharing member.
One question that our members frequently ask is why Liberty HealthShare requests CPT and ICD codes to be on all submitted expenses. We want to help our members and providers better understand why and how our ministry uses these industry medical codes to facilitate the sharing of our members’ eligible medical expenses.
Understanding Diagnosis Codes
Before we explain how these codes assist our community in the sharing process, we want to help you understand what procedure and diagnosis codes are and what they are used for.
There are two types of health code systems: the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes. These codes are used by all healthcare providers across the world to classify medical visits.
ICD codes are used to record the patient information of a medical visit. Symptoms, conditions, diseases, and other visit information are added to a patient’s medical chart after each medical visit. CPT codes are used to report the medical services completed by a healthcare provider. Tests, surgeries, and procedures all fall under this system.
These coding systems work together. If a patient is treated for a health condition, then both the ICD and CPT codes will align with the treatment a provider performed. This way of classifying medical information and services protects the doctor, patient and medical biller.
Eligibility for Sharing
When our members submit a medical expense to our sharing community, the expense goes through a step-by-step process to determine eligibility. One of the items that our analysts look at is the diagnosis code. When the diagnosis code is listed on the submitted expense, the condition or treatment is then reviewed in our agreed upon Sharing Guidelines.
These guidelines outline what is eligible for sharing according to the expenses that Liberty HealthShare members have agreed to share into. Sometimes members fail to include the requested codes or submit an incorrect diagnosis code on their expense which can delay the sharing process. An incorrect diagnosis code can not only delay sharing, but can also make an expense ineligible for sharing. Submitting correct codes on your medical expenses is very important as it helps to facilitate an eligible expense for sharing.
Fair and Reasonable Pricing
As self-pay patients, it is our right and responsibility to ask for fair and reasonable pricing. CPT codes determine if your sharing community is paying a fair price for medical expenses.
Healthcare prices in the Unites States have significantly increased over the years for healthcare services, as there is no set pricing standard for health services. As a result, there is an inconsistency in the amount that is charged for a service or treatment and these unpredictable prices can vary by thousands of dollars for one service. For instance, a comparison search on HealthCare Bluebook shows that the cost of a knee MRI in Saint Paul, Minnesota varies from $798 to $4,161.
Scheduling a service with the closest healthcare provider may not be the most cost effective way for you or your healthsharing community to save money on medical expenses. This is why we encourage all members to use our cost savings tools for pricing transparency, like HealthCare Bluebook, which can help you compare prices and choose providers and services that will help you get fair pricing.
It is our duty to responsibly steward the collective resources of our sharing community. Including the proper procedure and diagnosis codes on medical expense submissions safeguards our members from paying for unnecessary expenses. It keeps our SharePower healthy, allowing more members to share with one another in times of need. When we work together to protect our resources, we can give and share more.