Discuss Alexander farca m.D. Ret. 5/08's answer to: What is the medical necessity in terms of the ICD-9 CM and CPT coding systems

Icd and cpt coding are generally updated every year.Its use is specifically for insurance companies (all of them) to proccess billing paymenty for the medical providers.Some companies require a match of the icd code (name of illness) with the procedure code  (cpt).If they do not match the provider will not get paid.Your responsability is only to pay whatever copay your carrier has and also requires of you to review the explanation of benefits form which is mailed after payment to the provider where some times fraud occurrs as the provider adds codes or procedures not done and it is your obligation to report it.Thankfully this is uncommon but when it hapens it indicates to you that although the provider may be very good at doing what you need it is not acceptable to commit fraud.