4 ms·

non-automated review and provide the necessary resolution in coding that they can be identified and distinguished without that review and the associated cost.

non-automated review and provide the necessary resolution in coding that they can be identified and distinguished without that review and the associated cost. What type of review - automated or manual - requires the categorical specificity of distinguishing between 359+ different types of marginally varying finger trauma from bites? This is just madness. That anyone would even suggest that that level of specificity was even useful, never mind required, is bureaucratic madness. Step back from the tree and you can see the forest burning.

jjm 11y ago
Believe it or not, these codes are used to define contracts and aid in payment all the way from patient to broker.
- hga 11y ago
  So, pretend I'm a doctor and tell me, will I get paid more for S61.354D Open bite of right ring finger with damage to nail, subsequent encounter Or S61.355D Open bite of left ring finger with damage to nail, subsequent encounter ??? And with such specificity, why include this code: S61.359D: Open bite of unspecified finger with damage to nail, subsequent encounter I'm assuming "other finger" is the one between your little and middle ones, and we'll all sleep easier knowing that, while not found with jhulla's search, your left and right thumbs have not been neglected.
  - Mz 11y ago
    I actually used to pay insurance claims. Sometimes, the question being answeed is how many fingers we are paying for. To know that, we sometimes need specifics. There were enough fraud claims where someone was wanting to be paid for a third leg amputation that we joked we needed LL (left) R (right) and M (middle) as our designations instead of just L and R.
  - dragonwriter 11y ago
    Generally, you don't get paid an amount for a diagnosis, you get paid for the services you bill. Whether a payer accepts that the specific services you billed for are medically appropriate and thus pays them depends, often, on the diagnosis they are treating. (And, often, there are three possibilities: the payer pays the claim directly, or the payer requires additional supporting documentation which is manually reviewed before making a decision, or the payer denies payment outright.) The more detail diagnostic coding provides (and, for that matter, the more detail procedure coding provides), the more an automated system can move cases that would otherwise be in the manual review category (which adds costs for all parties, and delays) to an automated decision (which is quicker and cheaper for all parties.)
dragonwriter 11y ago
> What type of review - automated or manual - requires the categorical specificity of distinguishing between 359+ different types of marginally varying finger trauma from bites? Quite likely, review for medical necessity of the particular treatments billed for those bites. Which probably have wildly varying costs, and different indication; precision of diagnostic coding reduces the degree of circumstances in which it is necessary to require additional supporting documentation to be sent and have a human review it; manual review adds time and cost to claim processing, and is something everyone -- payers, providers, and patients -- benefits from reducing. > That anyone would even suggest that that level of specificity was even useful, never mind required, is bureaucratic madness. Only to the extent that medical insurance is inherently "bureaucratic madness".

jjm 11y ago

Believe it or not, these codes are used to define contracts and aid in payment all the way from patient to broker.

hga 11y ago
So, pretend I'm a doctor and tell me, will I get paid more for S61.354D Open bite of right ring finger with damage to nail, subsequent encounter Or S61.355D Open bite of left ring finger with damage to nail, subsequent encounter ??? And with such specificity, why include this code: S61.359D: Open bite of unspecified finger with damage to nail, subsequent encounter I'm assuming "other finger" is the one between your little and middle ones, and we'll all sleep easier knowing that, while not found with jhulla's search, your left and right thumbs have not been neglected.
- Mz 11y ago
  I actually used to pay insurance claims. Sometimes, the question being answeed is how many fingers we are paying for. To know that, we sometimes need specifics. There were enough fraud claims where someone was wanting to be paid for a third leg amputation that we joked we needed LL (left) R (right) and M (middle) as our designations instead of just L and R.
- dragonwriter 11y ago
  Generally, you don't get paid an amount for a diagnosis, you get paid for the services you bill. Whether a payer accepts that the specific services you billed for are medically appropriate and thus pays them depends, often, on the diagnosis they are treating. (And, often, there are three possibilities: the payer pays the claim directly, or the payer requires additional supporting documentation which is manually reviewed before making a decision, or the payer denies payment outright.) The more detail diagnostic coding provides (and, for that matter, the more detail procedure coding provides), the more an automated system can move cases that would otherwise be in the manual review category (which adds costs for all parties, and delays) to an automated decision (which is quicker and cheaper for all parties.)

dragonwriter 11y ago

> What type of review - automated or manual - requires the categorical specificity of distinguishing between 359+ different types of marginally varying finger trauma from bites? Quite likely, review for medical necessity of the particular treatments billed for those bites. Which probably have wildly varying costs, and different indication; precision of diagnostic coding reduces the degree of circumstances in which it is necessary to require additional supporting documentation to be sent and have a human review it; manual review adds time and cost to claim processing, and is something everyone -- payers, providers, and patients -- benefits from reducing. > That anyone would even suggest that that level of specificity was even useful, never mind required, is bureaucratic madness. Only to the extent that medical insurance is inherently "bureaucratic madness".