Why Medical Coding Matters in an Injury Case?
Medical billing codes and diagnosis codes play a major role in how insurance companies value injury claims because their software systems literally use those codes to calculate what they think your case is worth. Understanding how those codes are used — and when you are not required to hand them over — can make a difference in how much money you ultimately recover.
What Are Diagnosis and Billing Codes?
Every injury, treatment, and medical procedure is assigned a standardized “code.” Injury lawyers deal with these codes all the time. They help the medical providers’ billing departments communicate with insurance companies for reimbursement. These codes do not describe your pain, suffering, stress, financial hardship, or how the accident has changed your life — they are simply short label numbers that categorize injuries and treatment. For example, there is a code for a sprain, a code for a fracture, a code for an MRI, and a code for physical therapy.
Why Insurance Companies Care About Those Codes
Insurance companies place heavy weight on these codes because they plug those numbers into valuation software programs that are designed to spit out an estimated settlement range. They compare your medical codes to other similar claims they have paid in the past, and then claim that the computer model is what your case is “worth” financially. Obviously, no software can measure real life pain, lifestyle impact, or loss of enjoyment. But they try to hide behind these code values to minimize what they owe.
Do You Have to Give the Codes to the Insurance Adjuster?
No — you are not legally obligated to provide the raw CPT or ICD codes during the negotiation stage if you do not want to. Sometimes adjusters will say, “We can’t make an offer until we get the medical codes.” That is simply not true. They do not actually need the codes. They already have access to the medical records, itemized billing, radiology reports, and treatment summaries. Every diagnosis is listed in the provider’s chart in plain language. Every charge is reflected on the itemized bill. The code is just a shorthand internal billing label.
When It Makes Sense to Refuse to Provide the Codes
Sometimes refusing to provide codes is strategic. If the insurance company is being unreasonable, unreasonable, stalling, or refusing to negotiate without them, then filing suit is often the correct move. Once suit is filed, they can obtain codes in formal discovery anyway — but the point is they cannot use withholding their offer as leverage to block you pre-suit.
