6 ms·

So initial vs subsequent encounter are completely different codes? Wouldn't this approach double the number of codes? Why wouldn't this be some other field of d

So initial vs subsequent encounter are completely different codes? Wouldn't this approach double the number of codes? Why wouldn't this be some other field of data associated with the form instead of mixing it up in the diagnostic 'topic'. I know nothing about medical diagnosis codes.

cpfohl 10y ago
Pretty sure its just a suffix That indicates a second encounter with the patient
- emodendroket 10y ago
  Looking at the examples, they end with A for initial and D for subsequent visits.
criley2 10y ago
Medical diagnosis codes are all about reimbursement. Doctors do not rely on coding so much as finance dept relies on coding. Proper coding means more $$, so talented dx coders are valuable. Separating the code this way may not make sense medically, but it makes a lot more sense when you realize CMS or Blue Cross wants more coded granularity for automatic transmission of accurate financial information.
- matt4077 10y ago
  What does this have to do with anything? Is it just to inject a bit of cynicism? Because while there's certainly a lot to be gained by a bit of creativity with the coding, the first/subsequent encounter distinction is ill-suited, considering these are binary categories, and any mistakes/attempts to defraud can detected with an sQL query shorter than this paragraph. Concerning the original question: it's basically denormalized, with the usual tradeoffs. I'd guess it's easier to double the number of codes than to add a new attribute to legacy systems.
  - manigandham 10y ago
    Medical codes date back before modern computer systems - this is what legacy process looks like.
  - criley2 10y ago
    Dx codes are a big part of my programming world, I work on medical software. Not trying to be cynical, just offering an insider perspective from someone who just helped hundreds of hospitals and thousands of agencies complete the ICD-10 switch seamlessly with no rejected 485s, no rejected 837I(5010)s or other payer rejections. Not trying to be cynical, just trying to offer a view into the requirements set before me.
jbeckham 10y ago
There is a format to the code that allows any code to indicate initial vs. subsequent. It is important for looking for first visit cure vs. multiple visits to cure a condition.
oldmanjay 10y ago
The codes are used to make the reimbursement system complicated enough that it can be gamed. That's the general purpose of impenetrable bureaucracy.
- gbog 10y ago
  Actually it's worth reminding that it's the opposite that is true. Bureaucracy, paperwork, are the only known ways to reduce gaming and enforce equal access to justice. O boy I hate paperwork, but it's there for a reason, a good reason.
  - nostrebored 10y ago
    That is the initial purpose. Unfortunately bureaucrats tend to value other bureaucrats highly. It's a self perpetuating bureaucracy machine.
    - ctchocula 10y ago
      "The bureaucracy is expanding to meet the needs of the expanding bureaucracy."
  - waffle_ss 10y ago
    Maybe that's the intention, but like code, the more complex you make e.g. tax laws, the greater chance there are loopholes (bugs). And there certainly are loopholes, if corporations' low/zero tax rates are any evidence. It's not really equality when you raise the barriers to entry by giving larger companies an advantage when they can hire people who know how to game the rules, or who can hire lobbyists to write the rules in their favor, or get their own people into said bureaucracy (regulatory capture) and the little guys just don't have the money for any of that. You prevent people from entering the market, resulting in reduced competition.
    - bigboris 10y ago
      I've been a HN lurker for a long, long time. Just wanted to say I created an account specifically to upvote this. Thank you.
btown 10y ago
My understanding is that codes are simply a lookup into the structured version of the above document; they aren't "parseable" any more than an MD5 hash is parseable, but they uniquely identify a combination of conditions. As other posters have noted, the complexity required to implement that lookup table is an intentional barrier to entry.
vacri 10y ago
An initial consultation is more in-depth, as the doctor is gathering information and diagnosing, whereas subsequent consultations are more about monitoring and fine-tuning the issue. Usually they're also shorter.

cpfohl 10y ago

Pretty sure its just a suffix That indicates a second encounter with the patient

emodendroket 10y ago
Looking at the examples, they end with A for initial and D for subsequent visits.

criley2 10y ago

Medical diagnosis codes are all about reimbursement. Doctors do not rely on coding so much as finance dept relies on coding. Proper coding means more $$, so talented dx coders are valuable. Separating the code this way may not make sense medically, but it makes a lot more sense when you realize CMS or Blue Cross wants more coded granularity for automatic transmission of accurate financial information.

matt4077 10y ago
What does this have to do with anything? Is it just to inject a bit of cynicism? Because while there's certainly a lot to be gained by a bit of creativity with the coding, the first/subsequent encounter distinction is ill-suited, considering these are binary categories, and any mistakes/attempts to defraud can detected with an sQL query shorter than this paragraph. Concerning the original question: it's basically denormalized, with the usual tradeoffs. I'd guess it's easier to double the number of codes than to add a new attribute to legacy systems.
- manigandham 10y ago
  Medical codes date back before modern computer systems - this is what legacy process looks like.
- criley2 10y ago
  Dx codes are a big part of my programming world, I work on medical software. Not trying to be cynical, just offering an insider perspective from someone who just helped hundreds of hospitals and thousands of agencies complete the ICD-10 switch seamlessly with no rejected 485s, no rejected 837I(5010)s or other payer rejections. Not trying to be cynical, just trying to offer a view into the requirements set before me.

jbeckham 10y ago

There is a format to the code that allows any code to indicate initial vs. subsequent. It is important for looking for first visit cure vs. multiple visits to cure a condition.

oldmanjay 10y ago

The codes are used to make the reimbursement system complicated enough that it can be gamed. That's the general purpose of impenetrable bureaucracy.

gbog 10y ago
Actually it's worth reminding that it's the opposite that is true. Bureaucracy, paperwork, are the only known ways to reduce gaming and enforce equal access to justice. O boy I hate paperwork, but it's there for a reason, a good reason.
- nostrebored 10y ago
  That is the initial purpose. Unfortunately bureaucrats tend to value other bureaucrats highly. It's a self perpetuating bureaucracy machine.
  - ctchocula 10y ago
    "The bureaucracy is expanding to meet the needs of the expanding bureaucracy."
- waffle_ss 10y ago
  Maybe that's the intention, but like code, the more complex you make e.g. tax laws, the greater chance there are loopholes (bugs). And there certainly are loopholes, if corporations' low/zero tax rates are any evidence. It's not really equality when you raise the barriers to entry by giving larger companies an advantage when they can hire people who know how to game the rules, or who can hire lobbyists to write the rules in their favor, or get their own people into said bureaucracy (regulatory capture) and the little guys just don't have the money for any of that. You prevent people from entering the market, resulting in reduced competition.
  - bigboris 10y ago
    I've been a HN lurker for a long, long time. Just wanted to say I created an account specifically to upvote this. Thank you.

btown 10y ago

My understanding is that codes are simply a lookup into the structured version of the above document; they aren't "parseable" any more than an MD5 hash is parseable, but they uniquely identify a combination of conditions. As other posters have noted, the complexity required to implement that lookup table is an intentional barrier to entry.

vacri 10y ago

An initial consultation is more in-depth, as the doctor is gathering information and diagnosing, whereas subsequent consultations are more about monitoring and fine-tuning the issue. Usually they're also shorter.