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» LymeNet Flash » Questions and Discussion » Medical Questions » question about diagnosis codes

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Author Topic: question about diagnosis codes
yankees237
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i just got back from my second LLMD visit and on my receipt form it says diagnosis code 719.49 (which is pain in multiple joints) and 780.71 (chronic fatigue syndrome) ....

the only thing is i never mentioned to him i had any joint pain or that i was always tired. weird thing is i actually do have some random pain in my hip (no clue if its lyme related - its only been a month since my tick bite) and i mentioned that im tired once and a while but made no mention of the hip pain. im just confused as to why he wrote these diagnosis codes down [confused]

Posts: 132 | From jersey | Registered: May 2010  |  IP: Logged | Report this post to a Moderator
trigal2
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You should definatly call him and ask.

Could have something to do with your insurance and what diagnoses they will and will not reinburse for.

Is this a different diagnoses then your first visit?

Posts: 376 | From New Jersey | Registered: Jun 2009  |  IP: Logged | Report this post to a Moderator
Keebler
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confused as to why he wrote these diagnosis codes down?

Lyme is not recognized as a illness by insurance or by governing medical bodies. In this case, symptoms are the only diagnoses that matter.

If your insurance company finds out that you have lyme, you could loose your coverage. So, while they say it's no big deal, they sure won't treat it and even (new) life insurance policies can be canceled (mine was). It can be impossible to obtain life insurance after a diagnosis.

If you also have babesia, another tick-borne infection, you would be prevented from donating blood for life - and it would not be possible to be an organ donor. Of course, since you clearly have lyme in your body (and there is no cure as of yet), you should never donate blood or be an organ donor. But the Red Cross is not about to open Pandora's box regarding lyme.

But will insurance actually cover such tick-borne infections? Usually not. And doctors are being run out of practice every day .

Also, if he codes it as lyme, he could be made to stop treating. It's a brutal world for any doctor who treats lyme.

And, according to the CDC and the IDSA, you probably don't fit the lyme criteria. It's a very messed up system.

Yes, you had recent bites with multiple bulls eye rashes (which is lyme, of course) but the IDSA would have wanted you to have a spinal tap, and positives for tests that are not that great. And that is not needed- but if your are coded as having lyme, every single match might need to be made to make the IDSA and CDC happy.

You know. Your LLMD knows it. That's enough. For anyone else, you're working on this or that symptom. It's also a fact that, without the treatment you are getting, the symptoms checked would be far, far worse. So, yes, those are being treated.
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sutherngrl
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Just what Keebler said......codes are used mostly for insurance purposes.
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yankees237
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thanks alot guys , i was really confused but i figured there was a reason. thanks!
Posts: 132 | From jersey | Registered: May 2010  |  IP: Logged | Report this post to a Moderator
desertwind
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My LLMD puts Lyme down as my diagnosis with no hesitation.

My current insurance co. reinburses for lyme diagnosis with no questions - and have been for the past 5 months.

But to trigals point.. my previous insurance would not reinburse for lyme so my then LLMD put codes that spoke to my consellation of symptoms.

Posts: 1671 | From Tick Infested New Jersey | Registered: Apr 2010  |  IP: Logged | Report this post to a Moderator
yankees237
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what insurance do u have desertwind if u dont mind me asking?

anybody had any luck getting reimbursed with horizon bcbs?

Posts: 132 | From jersey | Registered: May 2010  |  IP: Logged | Report this post to a Moderator
desertwind
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I have Aetna. It is a PPO so I can see out of network and they cover 80% of the visit.

Like I said, my LLMD has no problem putting lyme down as my diagnosis and my insurance reimburses me fully and quickly.

I understand the politics behind lyme however my LLMD being out of network does not have a contract with my insurance company and as such my insurance company cannot dictate my treatment I receive from him. The contract is between my employer and my insurance company and my LLMD is not a part of that contract.

Can they deny payment? Of course, but the insurance company cannot stop me from seeing him or from him treating me. I would just not recieve reimbursement.

My LLMD is not hesitant at all to diagnosing lyme and has no fear of being run out of practice.

In fact, he is very vocal in the community and involved in research. He communicates with my other medical practitioner when necessary. It is not something that is "hidden" and allows for comprehensive treatment.

I do realize that this is not everyones experience, but there are some of us who do have transparent treatment with our LLMD's without backlash.

Posts: 1671 | From Tick Infested New Jersey | Registered: Apr 2010  |  IP: Logged | Report this post to a Moderator
greengirl
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Years and years ago a very nice doctor told me to pay no attention to diagnosis codes. Different doctors have different ways of using codes depending upon symptoms, length of treatment they expect, their experience with your particular insurance company, the kind of medicine they want to prescribe, the reason you were referred to them, etc, etc. In my experience, that has proven true, again and again.
Posts: 252 | From New York | Registered: Apr 2010  |  IP: Logged | Report this post to a Moderator
   

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