I recently had one of those odd health insurance moments. You may be able to relate to this. I received a document from my health insurance provider questioning a claim for a diagnosis they contended was "a pre-existing condition." I had no idea what they were talking about; the paper I was holding in my hand had very little in the way of an explanation, but it did list a "diagnosis code." When I called the insurer's "customer service" number, a claims representative told me she could not provide any information about the "diagnosis code" due to "health privacy regulations."
Um...OK. Never mind that this was me calling about my own "diagnosis." Apparently, I had to make a written request to find out what the insurance company assumed was wrong with me.
Feh.
There had to be a better way of obtaining this information. Now I have no background whatsoever in the health care/health insurance industry. But I do have a certain amount of common sense. And research skills. It occurred to me that an insurance-related diagnosis code was probably a pretty standard piece of data -- e.g., a certain diagnosis number was equivalent to the same diagnosis regardless of the insurance company.
And so I started searching. Almost immediately, I hit the motherlode -- at the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, which apparently releases a new tables of these codes at the start of each federal fiscal year, in October. I downloaded a zipped file of "Version 26," which took effect last October, unzipped the file, and scanned the list until I spotted the "diagnosis code" in question.
It turned out to be a "condition" I did not recognize at all, which prompted another call to the insurance company "customer service" department. The woman on the phone conceded that yes, it could have been an error, and that she'd check into it and get back to me. And I was thinking...of course it could have been an error. Think of all the opportunities for something to go wrong here. The doctor's handwriting could be illegible. (Yeah, this never happens.) A medical office worker could get the code completely wrong. A data entry person could transpose a number.
Somehow, a mistake enters the system and gets perpetuated, and the patient/consumer is left to deal with the fallout.
Feh.
But I repeat myself.
Now, at least, you have some way to check and make sure that your diagnosis code matches your diagnosis. And while this may not be a revelation to some of you out there who work with this information -- or who have had a similar experience and had to resolve it via your own research -- I'm sure I'm not the only one who never realized this data was out there.
ICD, by the way, is an acronym for International Classification of Diseases. It is, according to the NCHS, "designed to promote international comparability in the collection, processing, classification, and presentation of mortality statistics." When CM (Clinical Modification) is appended -- as in ICD-9-CM -- what we have is "the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States."
Now you know.
If you are familiar with this data and can provide additional enlightenment (or a better explanation), please contact us. I'll be more than happy to update or expand this post, since I think this is extremely important information for those of us in the U.S. who must deal with such a convoluted health care system.
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