Comments on: Decoding Coding http://distractible.org/2009/01/07/decoding-coding/ Thoughts of a moderately strange (yet not harmful) primary care physician. Thu, 11 Mar 2010 23:22:34 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: How doctors are at the mercy of ICD coding | Telecom News http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3425 How doctors are at the mercy of ICD coding | Telecom News Mon, 12 Jan 2009 20:15:22 +0000 http://distractible.org/?p=2017#comment-3425 [...] as Dr. Rob points out. It can mean the difference of whether the physician is paid for the visit or not. He points out more inane examples, such as a positive rapid strep test that gets paid when [...] [...] as Dr. Rob points out. It can mean the difference of whether the physician is paid for the visit or not. He points out more inane examples, such as a positive rapid strep test that gets paid when [...]

]]> By: Ken O http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3422 Ken O Mon, 12 Jan 2009 15:56:49 +0000 http://distractible.org/?p=2017#comment-3422 Not me; I don't have that sort of interface with the system, and don't know anyone that does well enough to ask them to come and join us. Not me; I don’t have that sort of interface with the system, and don’t know anyone that does well enough to ask them to come and join us.

]]> By: Robert http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3417 Robert Mon, 12 Jan 2009 03:50:09 +0000 http://distractible.org/?p=2017#comment-3417 Who invented such a silly system! It probably started up trying to facilitate the already cumbersome paperwork and for statistical purpose too. How on Earth has it evolved to today's sorry shape?.... Frustrating. Does anyone know how European docs "code"/designate diagnosis and treatment? Who invented such a silly system!

It probably started up trying to facilitate the already cumbersome paperwork and for statistical purpose too. How on Earth has it evolved to today’s sorry shape?…. Frustrating.

Does anyone know how European docs “code”/designate diagnosis and treatment?

]]> By: Coding Complexity « The ACUTE CARE Blog: Non-Urban Emergency Medicine http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3414 Coding Complexity « The ACUTE CARE Blog: Non-Urban Emergency Medicine Mon, 12 Jan 2009 00:20:09 +0000 http://distractible.org/?p=2017#comment-3414 [...] as Dr. Rob points out. It can mean the difference of whether the physician is paid for the visit or not. He points out more inane examples, such as a positive rapid strep test that gets paid when [...] [...] as Dr. Rob points out. It can mean the difference of whether the physician is paid for the visit or not. He points out more inane examples, such as a positive rapid strep test that gets paid when [...]

]]> By: medrecgal http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3413 medrecgal Sun, 11 Jan 2009 18:25:02 +0000 http://distractible.org/?p=2017#comment-3413 Well, they're either providing the wrong CPT code for the test itself (a glitch in the system, perhaps) or the wrong associated diagnosis code (which should be something like hyperlipidemia or hypercholesterolemia). It sounds to me like you (as the pt required to pay) are getting the screws put to you by someone in the system (don't know if it might be the computer people, the business people or whoever) who doesn't care what happens. It's not really the doc's fault, and it's not the insurance company's fault, either; but they need to find a reasonable solution to this problem so it doesn't keep recurring and giving patients like you a big old headache and/or resulting in unnecessary out of pocket expense. Does your doc's office have any coders? If they do, perhaps they'd be the people to help fix this problem in conjunction with the docs and the insurance company. Just a thought. Well, they’re either providing the wrong CPT code for the test itself (a glitch in the system, perhaps) or the wrong associated diagnosis code (which should be something like hyperlipidemia or hypercholesterolemia). It sounds to me like you (as the pt required to pay) are getting the screws put to you by someone in the system (don’t know if it might be the computer people, the business people or whoever) who doesn’t care what happens. It’s not really the doc’s fault, and it’s not the insurance company’s fault, either; but they need to find a reasonable solution to this problem so it doesn’t keep recurring and giving patients like you a big old headache and/or resulting in unnecessary out of pocket expense. Does your doc’s office have any coders? If they do, perhaps they’d be the people to help fix this problem in conjunction with the docs and the insurance company. Just a thought.

]]> By: geekette http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3412 geekette Sat, 10 Jan 2009 20:16:58 +0000 http://distractible.org/?p=2017#comment-3412 Annoying and expensive for the patient as well. There's a cholesterol test my doc routinely orders, and my insurance company routinely says it's not covered because it's "not coded right." They won't tell me how it's coded, or what code would work. My doctor says it should be paid (and uses the results to fine tune my meds), but...how to get the two together? The insurance company wants my doctor to call. I can't seem to get the attention of the office manager to get anything done about it. So the lab charges $150 because they know the insurance company will only pay a small portion of that. Since it's denied, I end up on the hook for the full $150. What a waste of time and money. Annoying and expensive for the patient as well. There’s a cholesterol test my doc routinely orders, and my insurance company routinely says it’s not covered because it’s “not coded right.” They won’t tell me how it’s coded, or what code would work. My doctor says it should be paid (and uses the results to fine tune my meds), but…how to get the two together? The insurance company wants my doctor to call. I can’t seem to get the attention of the office manager to get anything done about it.

So the lab charges $150 because they know the insurance company will only pay a small portion of that. Since it’s denied, I end up on the hook for the full $150.

What a waste of time and money.

]]> By: Ken O http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3410 Ken O Fri, 09 Jan 2009 11:08:20 +0000 http://distractible.org/?p=2017#comment-3410 I think everyone (well except maybe people who have shares in insurance companies ;) ) is singing off the same sheet here! I think everyone (well except maybe people who have shares in insurance companies ;) ) is singing off the same sheet here!

]]> By: Toni Brayer, MD http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3409 Toni Brayer, MD Fri, 09 Jan 2009 05:15:37 +0000 http://distractible.org/?p=2017#comment-3409 You have addressed one of my biggest hassles and the sadness is that I get to face it over and over each day. I do not have an EHR that makes it easy so I am constantly stopping my work flow to look up codes in the HUGE book and flip through trying to find the code for Vitamin D deficiency or blood in stool or thousands of symptoms that patients present with. Yes, I have a cheat sheet but finding what I need is time consuming and frustrating beyond belief. It is Byzantine and wasteful and is one of the factors that is driving primary care into concierge practices (where there is no coding) and driving medical students away from primary care. You are also correct that patients suffer in their pocketbook as denials for coverage of legitimate claims increase. Patients can't begin to understand the complexity and we do try and change the codes when we find out about it, but most of the time it is just another free ride for the insurer. You have addressed one of my biggest hassles and the sadness is that I get to face it over and over each day. I do not have an EHR that makes it easy so I am constantly stopping my work flow to look up codes in the HUGE book and flip through trying to find the code for Vitamin D deficiency or blood in stool or thousands of symptoms that patients present with. Yes, I have a cheat sheet but finding what I need is time consuming and frustrating beyond belief. It is Byzantine and wasteful and is one of the factors that is driving primary care into concierge practices (where there is no coding) and driving medical students away from primary care.

You are also correct that patients suffer in their pocketbook as denials for coverage of legitimate claims increase. Patients can’t begin to understand the complexity and we do try and change the codes when we find out about it, but most of the time it is just another free ride for the insurer.

]]> By: Frank Drackman http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3408 Frank Drackman Fri, 09 Jan 2009 00:25:03 +0000 http://distractible.org/?p=2017#comment-3408 Jeez, even an Anesthesiologist like me knows a case of Hidadrenitis Supporativa when he sees it....Then you take out the Code Bookie Thingie, and look it up, just like it was a naughty word, which I usually end up yelling, cause I always pick up the PROCEDURE Coding book by mistake....shouldn't I pick the right one %50 of the time? Jeez, even an Anesthesiologist like me knows a case of Hidadrenitis Supporativa when he sees it….Then you take out the Code Bookie Thingie, and look it up, just like it was a naughty word, which I usually end up yelling, cause I always pick up the PROCEDURE Coding book by mistake….shouldn’t I pick the right one %50 of the time?

]]> By: medrecgal http://distractible.org/2009/01/07/decoding-coding/comment-page-1/#comment-3407 medrecgal Thu, 08 Jan 2009 22:28:27 +0000 http://distractible.org/?p=2017#comment-3407 Hey...even though I'm an outpatient coder, I absolutely agree with your last statement about "the mysterious language of idiots". We (the coders) aren't the idiots in question, of course; hopefully you're referring to the insurance companies who won't pay anyone unless the codes are exactly right. It's a total nuisance of a system, and there are actually some occasions when I feel a bit badly about having to ask the provider sometimes several questions to make sure the documentation is consistent enough to pull the "proper" codes from. I've even had situations like you describe with the "rule out" concept; often providers don't understand the convoluted, crazy rules (most devised by Medicare and its relatives) and they ask us why certain codes can't be used or why they always need a definitive diagnosis. It's nuts, for sure! (But at least you talk about it with a much nicer tone than some other doc bloggers I've seen!) It's all just a symptom of a broken system, IMHO. Hey…even though I’m an outpatient coder, I absolutely agree with your last statement about “the mysterious language of idiots”. We (the coders) aren’t the idiots in question, of course; hopefully you’re referring to the insurance companies who won’t pay anyone unless the codes are exactly right. It’s a total nuisance of a system, and there are actually some occasions when I feel a bit badly about having to ask the provider sometimes several questions to make sure the documentation is consistent enough to pull the “proper” codes from.

I’ve even had situations like you describe with the “rule out” concept; often providers don’t understand the convoluted, crazy rules (most devised by Medicare and its relatives) and they ask us why certain codes can’t be used or why they always need a definitive diagnosis. It’s nuts, for sure! (But at least you talk about it with a much nicer tone than some other doc bloggers I’ve seen!) It’s all just a symptom of a broken system, IMHO.

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