4 ms·

But why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspe

But why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion?

88913527 3y ago
Well, it employs a lot of people to have this complex billing. And whoever argued the need for it got to do some major empire building, maybe scored a promotion.
- brendanyounger 3y ago
  Medical billing is a dreary business. Check out https://www.reddit.com/r/CodingAndBilling/ https://www.reddit.com/r/CodingAndBilling/. It's not clear that anyone is _trying_ to build an empire out of this. More likely, they're trying to build a bigger trash heap to climb on top of.
- nradov 3y ago
  No one got a promotion out of it. The USA adopted the WHO ICD code system for diagnoses on billing claims because it was good enough, and much easier than defining a whole new code system. Some of the codes are never used, but so what.
Ylpertnodi 3y ago
[flagged]
- mensetmanusman 3y ago
  Bitten by a communist just yesterday. I wonder how it is coded.
  - squeaky-clean 3y ago
    Looks like it's W50.3XXA if it was accidental. Or Y04.8XXA if it was intentional. If you were the communist and bit yourself on the upper right arm it would be S40.871A or S41.151A depending on how deep the bite went.
valleyer 3y ago
Because, like it or not, a doctor's discretion can sometimes be self-serving. The more treatments a doctor gives, the more they get paid, and there is an enormous information imbalance between doctor and patient. (As in, they went to medical school, and you didn't.) Unfortunately, some doctors are willing to take advantage of this.
- natosaichek 3y ago
  It's kinda ridiculous that because it costs x billion in doctors overcharging, we'll spend 100x on administration to control costs. Cutting off one's nose to spite one's face and all that.
  - tristor 3y ago
    I always preferred "The cure is worse than the disease." for a metaphor describing US healthcare billing.
  - willcipriano 3y ago
    Nobody actually wants to control costs. From doctors to hospitals to insurance companies, everyone but consumers benefit from high prices.
    - nradov 3y ago
      Employers and other group buyers want to control costs.
      - willcipriano 3y ago
        They are consumers
        nradov 3y ago
        Employers are customers, not consumers. That word has a specific meaning in the industry and you are using it incorrectly.
shubb 3y ago
Because these are world health organisation 'international disease classification' codes that are designed for population health study and happen to be used for insurance billing in the US. There are requirements for some data to be reported to federal and international organisations. For instance, these codes are also used on death certificates I think, so they can track whether a lot of people are dieing of flu (primary cause) after contact with duck (qualifier) and there is a bird flu outbreak. There are many coding systems - semi-standard extensions of ICD used to identify very specific types of cancer or the ontology based SNOMED which is rarely used as intended but none the less is becoming the standard. These codes are used for billing in the US to some extent but also for lots of other things, they are just a standardized set of codes that hospital IT systems use to talk about what is wrong with patients so they can somewhat interoperate - and they are forced to use them by government because the vendors prefer walled gardens over interoperability.
- gowld 3y ago
  But if an app developer in a different industry doesn't know the history behind it then a must be worthless.
  - shubb 3y ago
    They are funny though, I just thought people might like to know the context
  - ElFitz 3y ago
    That’s how it usually goes. I’ve lost count of all these times a freshly onboarded dev, replacing the old one, decided the système was needlessly complex, nothing made sense, and it’d be easier to just rebuild everything from the ground up. Only to end up with a similarly complicated nonsense, because the complexity actually was in the domain, and he knew nothing of it.
- CogitoCogito 3y ago
  > Because these are world health organisation 'international disease classification' codes that are designed for population health study and happen to be used for insurance billing in the US. This is the root of the problem. These codes should not be used for billing. That should be much more coarse. They bill you for visiting the GP. They bill you for a surgery. Adding the codes to the records is fine and good, but really should just be an internal detail that isn't that relevant to the patient.
tsbischof 3y ago
It partly arises as a mechanism to pay per case, not just per visit. For example, if we put all payment for a breast cancer treatment into the first visit, there is now an incentive to either complete the treatment (ideal) or keep the patient from coming back (less ideal). You can use these follow-up codes to measure rates of return visits, which can be related to quality of care metrics.
paulmd 3y ago
because CDC wanted to collect epidemiological data on how those bites were happening, instead of having single generic "animal bite" code. If there is a sudden rise in duck bites in a future decade, we can start asking about whether there's a reason behind that, or something we should be doing to control duck populations, or something. That's what CDC is there to do. It's extraordinarily difficult to capture this information after the encounter... the patient is gone, the provider is working from notes/memory, and now it's this additional specific burden. How are you supposed to run an epidemiological study on the prevalence of duck bites if everyone involved has vanished into the ether? If you're going to capture it, it has to be rolled into the diagnosis codes and captured during the encounter. Also, you really want to capture the contemporaneous narrative including any misdiagnoses/etc - the CDC wants to know how much that is happening too! really those low-level codes are kinda just there, they're not really used in practice, and most billing systems would care about the higher levels of the hierarchy anyway. The part insurance cares about is "cleaning and stitches after small wild animal bite", not the levels of the coding scheme that indicate that it's a duck bite. (but you can see how it is potentially useful to shake some of these details out - is it a large animal, or a small one? a pet or a wild animal? a wild bear bite and a pet duck bite are two very different scenarios for the provider+insurer!) It's also really more about things like "gunshot wound from stranger" vs "gunshot wound from partner" vs "gunshot wound from LEO" where there is obvious value in capturing what is going on. Jokes aside, nobody is super concerned about duck bites, it's just a funny example of how detailed the coding system can be (not must be... at least yet). The real travesty is the idea that the same action using the same materials in the same facility can be billed 2 different ways based on two different ICD codes, not that ICD codes include the diagnosis data. It shouldn't matter if it's a duck or a cat, it's a superficial clean-and-bandage, that's what procedure coding (CPT) is supposed to capture. If there's major variations in how you perform a procedure based on how the patient presents, such that cost is substantially impacted... that is a deficiency in CPT and needs to be fixed independently, not forcing everyone to track CPT+ICD for eternity. ~~CPT itself incorporates a huge amount of nuance and sub-coding for this exact reason.~~ Simple example but we'd spit out CPT codes like "MRI with contrast-enhancer" vs "without", "MRI 3-tesla" vs "1.5T" vs "Open", "CT 64-slice" vs "40-slice", etc. If you're not capturing some aspect of the procedure you need to take it up with the CPT people, not make it everyone else's problem. edit: superfun memory this just triggered, in fact this imprecision in CPT coding actually does lead to different things having the same CPT code and operators have to select from a picker of these possibilities that are specific to their organization's coding/billing systems. Forgot about that, awesome! Medical data systems are the absolute worst
sandworm101 3y ago
>> I could understand from a treatment perspective the type of animal mattering Rabies, which is not just animals but also predators (snakes) that eat animals with rabies. There is even a disease called "seal finger" that is linked to seal bites. And bats, all sorts of nasty stuff can come from bats.
paulddraper 3y ago
> From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion? That is FFS (fee-for-service) billing. And indeed that does not use the diagnosis code, except for reporting purposes and documentation that the treatments were appropriate/necessary. The diagnosis code would be used if billing in a DRG (diagnostic-related groups) model, which is an overall fee for overall treatment related to the condition -- exam, stitches, etc.

88913527 3y ago

Well, it employs a lot of people to have this complex billing. And whoever argued the need for it got to do some major empire building, maybe scored a promotion.

brendanyounger 3y ago
Medical billing is a dreary business. Check out https://www.reddit.com/r/CodingAndBilling/ https://www.reddit.com/r/CodingAndBilling/. It's not clear that anyone is _trying_ to build an empire out of this. More likely, they're trying to build a bigger trash heap to climb on top of.
nradov 3y ago
No one got a promotion out of it. The USA adopted the WHO ICD code system for diagnoses on billing claims because it was good enough, and much easier than defining a whole new code system. Some of the codes are never used, but so what.

Ylpertnodi 3y ago

[flagged]

mensetmanusman 3y ago
Bitten by a communist just yesterday. I wonder how it is coded.
- squeaky-clean 3y ago
  Looks like it's W50.3XXA if it was accidental. Or Y04.8XXA if it was intentional. If you were the communist and bit yourself on the upper right arm it would be S40.871A or S41.151A depending on how deep the bite went.

valleyer 3y ago

Because, like it or not, a doctor's discretion can sometimes be self-serving. The more treatments a doctor gives, the more they get paid, and there is an enormous information imbalance between doctor and patient. (As in, they went to medical school, and you didn't.) Unfortunately, some doctors are willing to take advantage of this.

natosaichek 3y ago
It's kinda ridiculous that because it costs x billion in doctors overcharging, we'll spend 100x on administration to control costs. Cutting off one's nose to spite one's face and all that.
- tristor 3y ago
  I always preferred "The cure is worse than the disease." for a metaphor describing US healthcare billing.
- willcipriano 3y ago
  Nobody actually wants to control costs. From doctors to hospitals to insurance companies, everyone but consumers benefit from high prices.
  - nradov 3y ago
    Employers and other group buyers want to control costs.
    - willcipriano 3y ago
      They are consumers
      - nradov 3y ago
        Employers are customers, not consumers. That word has a specific meaning in the industry and you are using it incorrectly.

shubb 3y ago

Because these are world health organisation 'international disease classification' codes that are designed for population health study and happen to be used for insurance billing in the US. There are requirements for some data to be reported to federal and international organisations. For instance, these codes are also used on death certificates I think, so they can track whether a lot of people are dieing of flu (primary cause) after contact with duck (qualifier) and there is a bird flu outbreak. There are many coding systems - semi-standard extensions of ICD used to identify very specific types of cancer or the ontology based SNOMED which is rarely used as intended but none the less is becoming the standard. These codes are used for billing in the US to some extent but also for lots of other things, they are just a standardized set of codes that hospital IT systems use to talk about what is wrong with patients so they can somewhat interoperate - and they are forced to use them by government because the vendors prefer walled gardens over interoperability.

gowld 3y ago
But if an app developer in a different industry doesn't know the history behind it then a must be worthless.
- shubb 3y ago
  They are funny though, I just thought people might like to know the context
- ElFitz 3y ago
  That’s how it usually goes. I’ve lost count of all these times a freshly onboarded dev, replacing the old one, decided the système was needlessly complex, nothing made sense, and it’d be easier to just rebuild everything from the ground up. Only to end up with a similarly complicated nonsense, because the complexity actually was in the domain, and he knew nothing of it.
CogitoCogito 3y ago
> Because these are world health organisation 'international disease classification' codes that are designed for population health study and happen to be used for insurance billing in the US. This is the root of the problem. These codes should not be used for billing. That should be much more coarse. They bill you for visiting the GP. They bill you for a surgery. Adding the codes to the records is fine and good, but really should just be an internal detail that isn't that relevant to the patient.

tsbischof 3y ago

It partly arises as a mechanism to pay per case, not just per visit. For example, if we put all payment for a breast cancer treatment into the first visit, there is now an incentive to either complete the treatment (ideal) or keep the patient from coming back (less ideal). You can use these follow-up codes to measure rates of return visits, which can be related to quality of care metrics.

paulmd 3y ago

because CDC wanted to collect epidemiological data on how those bites were happening, instead of having single generic "animal bite" code. If there is a sudden rise in duck bites in a future decade, we can start asking about whether there's a reason behind that, or something we should be doing to control duck populations, or something. That's what CDC is there to do. It's extraordinarily difficult to capture this information after the encounter... the patient is gone, the provider is working from notes/memory, and now it's this additional specific burden. How are you supposed to run an epidemiological study on the prevalence of duck bites if everyone involved has vanished into the ether? If you're going to capture it, it has to be rolled into the diagnosis codes and captured during the encounter. Also, you really want to capture the contemporaneous narrative including any misdiagnoses/etc - the CDC wants to know how much that is happening too! really those low-level codes are kinda just there, they're not really used in practice, and most billing systems would care about the higher levels of the hierarchy anyway. The part insurance cares about is "cleaning and stitches after small wild animal bite", not the levels of the coding scheme that indicate that it's a duck bite. (but you can see how it is potentially useful to shake some of these details out - is it a large animal, or a small one? a pet or a wild animal? a wild bear bite and a pet duck bite are two very different scenarios for the provider+insurer!) It's also really more about things like "gunshot wound from stranger" vs "gunshot wound from partner" vs "gunshot wound from LEO" where there is obvious value in capturing what is going on. Jokes aside, nobody is super concerned about duck bites, it's just a funny example of how detailed the coding system can be (not must be... at least yet). The real travesty is the idea that the same action using the same materials in the same facility can be billed 2 different ways based on two different ICD codes, not that ICD codes include the diagnosis data. It shouldn't matter if it's a duck or a cat, it's a superficial clean-and-bandage, that's what procedure coding (CPT) is supposed to capture. If there's major variations in how you perform a procedure based on how the patient presents, such that cost is substantially impacted... that is a deficiency in CPT and needs to be fixed independently, not forcing everyone to track CPT+ICD for eternity. ~~CPT itself incorporates a huge amount of nuance and sub-coding for this exact reason.~~ Simple example but we'd spit out CPT codes like "MRI with contrast-enhancer" vs "without", "MRI 3-tesla" vs "1.5T" vs "Open", "CT 64-slice" vs "40-slice", etc. If you're not capturing some aspect of the procedure you need to take it up with the CPT people, not make it everyone else's problem. edit: superfun memory this just triggered, in fact this imprecision in CPT coding actually does lead to different things having the same CPT code and operators have to select from a picker of these possibilities that are specific to their organization's coding/billing systems. Forgot about that, awesome! Medical data systems are the absolute worst

sandworm101 3y ago

>> I could understand from a treatment perspective the type of animal mattering Rabies, which is not just animals but also predators (snakes) that eat animals with rabies. There is even a disease called "seal finger" that is linked to seal bites. And bats, all sorts of nasty stuff can come from bats.

paulddraper 3y ago

> From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion? That is FFS (fee-for-service) billing. And indeed that does not use the diagnosis code, except for reporting purposes and documentation that the treatments were appropriate/necessary. The diagnosis code would be used if billing in a DRG (diagnostic-related groups) model, which is an overall fee for overall treatment related to the condition -- exam, stitches, etc.