Cracking the Code: How Medical Billing Mistakes Cost You Money

Since the beginning of the year, I’ve practically been receiving new bills every week from the hospital. I dislocated my shoulder in January in a bouldering accident, and I was recommended to go to a sports medicine doctor just to make sure everything was okay. I stopped following up with the doctor a month and a half ago, but even just last week, I received another bill in the mail for $50. As I was reviewing the bills on my desk, I noticed that every charge was accompanied by a 5 digit number, a CPT code, which is the universal language hospitals use for medical billing.

Most adults simply do not have the time to investigate their medical bills thoroughly, unlike many adults with full-time jobs and demanding schedules, I’m a college student who has the flexibility to research this, which is why I want to share some of the basics of CPT codes.

It's no secret that the American healthcare system has problems, but in addition to the larger systemic issues, a major issue is general education about the healthcare system among patients. Hospitals are required to give you information on your rights, but most of the time, the pamphlet they hand out gets buried under the truckload of paperwork that's given to you at the beginning of a visit. The fast paced and overwhelming experience of going to the doctor inadvertently upholds the systemic injustices of the medical system, where less educated and lower income patients are exploited in their moments of vulnerability.

Through this vulnerability, doctors are able to offer more and more ‘care’ to the patient, and they will never directly tell them about the costs of this ‘care’. Patients who know their rights are more likely to reject a doctor's upselling, which would leave them less of a financial burden than they would have if they accepted every part of the doctor's care.

The Forgotten Side of Patient Education

Although it's extremely important to know your rights in the hospital, discussions about patient rights are often hyper focused on hospital care. While billing rights are acknowledged, they are often less accessible or harder to navigate. Patients are given legal protections, such as the right to dispute charges or request financial assistance, but these processes can be confusing and time-consuming, leaving many people unaware of how to exercise their rights effectively.

This lack of education becomes especially relevant when it comes to billing codes, a major part of how hospitals charge for services. Knowing how CPT codes work, and how mistakes or misunderstandings in this system can lead to higher bills, is essential for navigating the financial side of healthcare.

Medical charges are always sent through different codes. The way it works is that as your doctor gives you care, they tally up the service they give you, and then send that tally to a medical coder, who sends the code to the billing department, who sends it to your insurance. For hospitals, the coding process is like clockwork, but as you can see, there are 4 separate parts of the process that could mess up, and any slight issue in the codes can cause an increase in your bill.

Doctor provides care → Tally of services → Medical coder assigns CPT codes → Billing department processes → Insurance reviews and pays (or denies)

Whether it's intentional or not, mistakes in medical coding is one of the most common ways patients get overbilled.

In my case, each of my doctor visits went basically the same. I checked into the hospital to meet with the specialist, he moved my shoulder around for a bit, and told me he needed to see me again in two weeks. Something odd that I noticed was that each of the codes for each of the dates of service were slightly different. After looking into it, I learned I was coded for three different common CPT codes: 99212, 99213, and 99214.

These codes are used for outpatient office visits with an established patient (someone who has seen the provider before). The difference between them lies in the level of complexity and time spent with the patient.

1. CPT Code 99212 – Low Complexity Visit

• Time Spent: ~10-19 minutes

• Medical Decision-Making (MDM): Straightforward

• Example: A patient with a minor issue like seasonal allergies or a mild rash. The doctor quickly examines them, provides a prescription or advice, and the visit ends.

2. CPT Code 99213 – Moderate Complexity Visit

• Time Spent: ~20-29 minutes

• MDM: Low complexity

• Example: A patient with a controlled chronic condition like mild asthma or hypertension. The doctor reviews symptoms, adjusts medications if needed, and discusses management.

3. CPT Code 99214 – High Complexity Visit

• Time Spent: ~30-39 minutes

• MDM: Moderate complexity

• Example: A patient with multiple chronic conditions (e.g., diabetes and high blood pressure) that require significant medication adjustments and detailed treatment planning.

Simply put, the higher the code (99212 → 99214), the more expensive the visit becomes. If a provider upcodes (charges for a more complex visit than what actually happened), it leads to higher charges for the patient.

My physician, or someone along the chain of command, coded me for different levels of complexity for each visit, when in reality, each visit went the same.

In addition to upcoding, one of the most common medical billing mistakes is unbundling, where hospitals separate services that should be billed together at a lower combined rate, leading to higher charges. For example, some CPT codes for surgeries already include anesthesia, but patients may be billed for a separate anesthesia code for the same procedure.

Patients may also be billed for services they never received, often due to clerical errors or miscommunication between hospital departments. Understanding CPT codes is essential for patients to identify errors in their medical bills, dispute incorrect charges, and ultimately save themselves from being ripped off by the medical system.

Requesting a Coding Review: A Simple Step to Save Money

Many patients don’t catch mistakes in medical coding because they don’t know how the system works, and even if they do, they often don’t know what steps to take. One of the most effective tools at your disposal is the right to request a coding review. Hospitals and clinics are legally required to conduct a review if a patient requests one, and this process can be beneficial in multiple ways. If a service was upcoded or miscoded, a review can correct it, potentially lowering your bill. The review process can take up to a business week, and some providers even pause the due date of your bill until the review is complete, which helps by giving you extra time if you need it before making a payment. Even if the coding isn’t changed, requesting a review costs nothing and ensures transparency in your medical charges. If you ever receive a hospital or doctor’s bill, it’s worth taking a few minutes to call and ask for a coding review. A simple request could save you hundreds of dollars.

Never Pay Full Price at the Hospital!

At PPP, we provide medical bill scripts to help you request a coding review, negotiate hospital bills, dispute unfair charges, and apply for financial assistance. Learn to advocate for yourself! Inform. Inspire. Justice.