What Is a PIP Code?

Medical treatments that are the result of an auto accident need to be tracked and noted for payment purposes by both the patient and the patient's insurance provider. For protection of health and well being, a doctor's office will complete treatment and make notes regarding the types of services provided so that an account's receivable department may bill for, and receive, payment for the treatment given to a particular patient. A patient's physician must be able to produce a bill that can be understood by the insurance carrier responsible for payment. To accomplish the task of billing insurance companies whose insured received treatment, the type of service, cost, and time period in which the service was performed is noted by the doctor and the services are translated into medical codes. PIP coverage is for a patient who was injured by a vehicle covered by this type of insurance coverage. Because it requires only that a person was injured and treated to be accepted for payment, the medical codes used must be of the type of service the insurance will pay for. Medical codes allow a PIP provider quick access to the medical information it needs to make payment for approved treatments that are the result of an injury received in an auto accident where PIP insurance was paid for by the car's owner.

Identification

• PIP coverage is an addendum to auto insurance that may or may not be required by a state in order to legally drive on the road. This extra benefit pays for medical treatment with "no-fault" determined. It immediately protects the injured who receive medical treatment as the result of an accident. Physician billing that is received by the PIP provider will be compared to a list of medical codes to be sure the treatment is of a type that the insurance will cover. Medical coding is how a doctor's office will communicate the medical information in a way that other third parties can understand. Using medical coding for PIP payment ensures the insurance provider can track what was treated, when it was treated and why it was treated. To identify the medical coding of PIP insurance claims, look for the standardized codes listed in the services provided area of the physician's bill.

History

• The American Medical Association began receiving requests from the Health Care Financing Administration (HCFA) of begin to standardize its billing from physicians who request payment from insurance carriers. It was then that the medical profession began to follow guidelines and use coding to normalize their billing. The updating of new codes and formalized revenue returns on services billed for is continually updated as new treatments become available. PIP insurance is auto coverage that immediately pays for medical treatment performed on an insured party of an accident where PIP payments are expected. While the codes available for treatment may expand over time, the insured may receive treatment for relevant injuries from the accident and not other types of treatment as well. The HCFA has been updating this list since the very start of medical coding in America.

Function

• Medical coding for PIP insurance coverage is the same as coding for other forms of physician payment. The insurance company will receive a bill from the treating doctor who has listed the types of treatments received, the patient's information and insurance notations, which will which connect the bill to the insurance policy that is being requested for payment under the insurance policy guidelines. The insurance companies account's payable department will match the medical codes to the types of treatments given and pay for what is allowable under the insurance policy's liability claim. It is here that the insurance company can determine if the treatment was as a result of the accident and determine how much of the bill the coverage will pay for. The use of medical codes for PIP coverage is regulated by both the American Medical Association and the Health Care Financing Administration to insure that proper billing and payments are being performed on behalf of insured patients.

Warning

• It has been known to happen that some physicians will not bill an insurance company properly. Use of the wrong medical codes by an inexperienced medical coder can result in non payment of insurance claims, including PIP insurance coverage. When correct medical information is forwarded to the insurance provider, payment can be made quickly on treatments for injuries that were the result of an accident covered by a PIP insurance policy. When the medical coding of PIP treatment is performed incorrectly the payment may not be sent, and the claim goes unpaid.

Considerations

• The best hospitals and doctors use updated medical coding for all of their patient's treatment. State run hospitals are knowledgeable on all the medical codes that are required by insurance companies in order to receive payment for treatment performed on insured patients. Patients who seek out medical treatment from established medical institutions and physicians can feel comfortable knowing that their doctor will be able to communicate with the insurance company well enough to get paid. Some doctor's offices have a hard time accomplishing this task and may need to be avoided in insurance claims. Go to the most recognized doctor's office when getting treatment for an injury that is covered by PIP and be assured that you get the best treatment, and have the bills paid for quickly by the PIP insurance provider.

Geography

• PIP medical codes can be expected in the states that require PIP insurance coverage. Insurance carriers in Texas, Utah, North Dakota, New York, New Jersey, Minnesota, Massachusetts, Michigan, Hawaii, Florida and Delaware can expect to pay out PIP insurance claims using the medical codes PIP provides payment for.