Vent, homeschool ICD-10-cm (diagnosis code) code, Z55.9, Update

[Kimberly in IN]

Talk me down, please tell me this is no big deal. Came home from a doctor visit with my youngest dd and found this code, Z55.9, listed as a secondary diagnosis. Didn't seem familiar, looked it up, and discovered - problems related to education and literacy, unspecified. There is a bit more detail to the code, all related to problems with school. Called the office, as the doctor had not discussed anything like this with us, and was told that is the homeschool code. I asked what the public school code was & was told no need for a public school code.

 

This is a relatively new doctor for dd and none of the other doctors any of my 4 dc have had have used this code. Is this the norm & our other doctors were just lax?

 

We moved to this location & needed new doctors. Other kids are older and are going to an internist. Thought I would stay with a ped for youngest dd. Neither I nor my dd really liked this doctor, have seen her twice now. We were planning on finding a new doctor even before discovering the homeschool diagnosis.

 

(I know most of you don't know us in real life, but the definition of the code really doesn't fit my dd.)

 

Thank you for any input, insight, whatever...

 

UPDATE.  I talked to a nurse at the office this afternoon. She said the doctor says the ICD-10-cm code Z55.9 means homeschooled. End of story from them. I am not sure how to proceed. I would like the code removed as it does not mean homeschooled & its correct meaning does not apply. Any suggestions?  I did ask to speak with the doctor and was told she did not want to speak with me. I am open to suggestions. (yes, we will another doctor, but I would like this diagnosis removed.)

[Jean in Newcastle]

I've never heard of such a thing.  

[amo_mea_filiis.]

That sounds crazy. Are there education problems? What kind of dr is this?

[Kimberly in IN]

Thank you for making me not feel crazy for my surprise at seeing this code. This is a regular pediatrician, no other specialty. The doctor did not discuss any school issues, other than asking her where she went to school. So, I was surprised to see the code listed as a secondary diagnosis.

[Anne]

I would want to know why it was necessary for the pediatrician to put that in your child's records!! Call me suspicious, but I would NOT be happy about that!!

 

Anne

[amo_mea_filiis.]

That really doesn't make sense. I'd insist on him explaining why your educational choices need to be diagnosed.

[maize]

Did the dr. encounter have anything to do with education?

 

If not the code seems inappropriate.

 

http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z55-Z65/Z55-/Z55.9

[Lara in Colo]

sounds like he might be trying to bill for counseling he did not do (After reading the link above)

 

[Aiden]

I would ask her about it. If her answer didn't satisfy me--and I doubt that it would, based on her office's response that all homeschooled kids get a DIAGNOSIS of educational PROBLEMS--I'd ask her to remove the FALSE DIAGNOSIS (it isn't simply erroneous if there are no academic problems at all). If she refused, I'd contact the state medical board and find out from them if it's appropriate for doctors to give medical diagnoses based on nothing more than the parents' educational choices. I'd raise a big stink.

 

And I'd find a different doctor, no matter what explanation she offered.

[Mergath]

I would complain and find a new doctor immediately. I'm not all that familiar with medical coding, but a doctor diagnosing my child with education problems because of homeschooling would send up a huge red flag for me. 

[Kimberly in IN]

Reason for visit is a rash on dd's arms & face that comes and goes.. Thought I should check it out. Doctor gave us a referral to a dermatologist. From that encounter, came school & literacy problems. There were no trick questions for dd to answer, no reading of any kind, just a real quick visit.

[umsami]

I would call.

 

The codes are new for everybody and perhaps the doctor was told to use it by a consultant or whatever.  Regardless, I would emphasize that the visit had nothing to do with literacy or school issues....etc.  

[Lara in Colo]

I would complain, make a stink, let the local homeschool programs aware of this doctor and possibly, notify (even though I really hate them and am NOT a member) the HSLDA

 

[zoobie]

Oh hell no. I'd also call my insurance and make sure they're not being billed for some nonsense.

[TechWife]

That is wrong. Homeschooling is not a diagnosis. I'd raise a stink with anyone and everyone. 

[CupOCoffee]

Holy Whoah!!! That was enough to bring me out of lurkdome!!!  Um, since when is Homeschooling a disease worthy of a DX code???????

 

Uh, yeah, I'd be complaining, calling, threatening, whatever it takes to get that removed, for sure!!  Especially if there is no code for merely going to public school!! (I could say something really snarky at this point, but won't).  ;)

 

~coffee~

[Dmmetler]

My DD's pediatrician does ask me/DD how school is going, etc as part of a yearly physical, along with a list of other things (social, physical activity, etc).

[73349]

Is homeschooling unusual enough there that only kids with serious medical issues or learning problems would be homeschooled??

 

I would call and ask to speak with the doctor directly to clear that right up.

[Kimberly in IN]

I would ask her about it. If her answer didn't satisfy me--and I doubt that it would, based on her office's response that all homeschooled kids get a DIAGNOSIS of educational PROBLEMS--I'd ask her to remove the FALSE DIAGNOSIS (it isn't simply erroneous if there are no academic problems at all). If she refused, I'd contact the state medical board and find out from them if it's appropriate for doctors to give medical diagnoses based on nothing more than the parents' educational choices. I'd raise a big stink.

 

And I'd find a different doctor, no matter what explanation she offered.

When I talked to the nurse at the office, she said all homeschooled patients have this code assigned to them. I did request that the code be removed & not billed to insurance and to call me when the code was removed. Nurse said she would talk to the doctor. (in a patronizing tone)

 

We will find another doctor. It never occurred to me that homeschooling would be considered odd in this day & age.

 

(on a good note, dermatologist had a cancellation for this afternoon. I think the rash is related to a skin condition she had when she came home from China. Doctors at the time said it may reoccur throughout her life.)

 

Have calmed down & will look at this as a good to find out now, before any major health issues arise kind of thing. Will insist code is removed & then transfer to a new doctor, associated with a different health organization.

[gardenmom5]

I would not return to that dr.

 

kids do have problems in public school too and there should be codes for that as well.  they may be more general of "literacy, reading, etc."

 

  to single out homeschooling would concern me for the future.

[gardenmom5]

I would ask her about it. If her answer didn't satisfy me--and I doubt that it would, based on her office's response that all homeschooled kids get a DIAGNOSIS of educational PROBLEMS--I'd ask her to remove the FALSE DIAGNOSIS (it isn't simply erroneous if there are no academic problems at all). If she refused, I'd contact the state medical board and find out from them if it's appropriate for doctors to give medical diagnoses based on nothing more than the parents' educational choices. I'd raise a big stink.

 

And I'd find a different doctor, no matter what explanation she offered.

 

 

You can also look into making a complaint to the state medical board.

[Garga]

I would make a complaint to the medical board. I would.

 

Best case scenario:

 

For whatever reason, this office likes to categorize their patients. Perhaps they use a number of obscure codes and use them to mean things only for themselves. Z55.9 is for homeschoolers, another code is for smokers, etc. Perhaps they have lots and lots of these codes that they use for all their patients. Perhaps it's harmless. Just a way for them to sort through the different patients and lives they have so that at their visits, they know what's what with each patient.

 

Worst case scenario:

 

These people are heavily biased against homeschooling. Whenever you're in their office, they'll be looking to find abuse in your home. They'll assume you are doing a disservice to your kids and they may feel obligated to intervene.

 

No matter which scenario it is, I would 100% contact the medical board. No matter their motives, the action is wrong and possibly illegal, since it goes into people's medical records.

 

I would talk with the doctor, not his/her staff, directly and tell them you're leaving the practice and why. I'd tell him/her that it's amazingly improper to diagnose people with an issue based on where the child goes to school.

 

And then I'd contact the medical board for them to tell the doctor to stop for all the other homeschoolers they're out there categorizing.

[umsami]

I would call your insurance company.  Much more effective I would think.  I would also email the AAP (American Academy of Pediatrics).  

 

Info on the code...nothing about it says anything regarding homeschooling.  I would let them know that this office informed you that they are diagnosing all homeschool students with this.  

 

http://www.hipaaspace.com/Medical_Billing/Coding/ICD-10/Diagnosis/Z559

 

Nothing anywhere comes up as recommending this for homeschooling, BTW.

 

 

[JoJosMom]

Talk me down, please tell me this is no big deal. Came home from a doctor visit with my youngest dd and found this code, Z55.9, listed as a secondary diagnosis. Didn't seem familiar, looked it up, and discovered - problems related to education and literacy, unspecified. There is a bit more detail to the code, all related to problems with school. Called the office, as the doctor had not discussed anything like this with us, and was told that is the homeschool code. I asked what the public school code was & was told no need for a public school code.

 

This is a relatively new doctor for dd and none of the other doctors any of my 4 dc have had have used this code. Is this the norm & our other doctors were just lax?

 

We moved to this location & needed new doctors. Other kids are older and are going to an internist. Thought I would stay with a ped for youngest dd. Neither I nor my dd really liked this doctor, have seen her twice now. We were planning on finding a new doctor even before discovering the homeschool diagnosis.

 

(I know most of you don't know us in real life, but the definition of the code really doesn't fit my dd.)

 

Thank you for any input, insight, whatever...

 

:eek:

 

 

[Lang Syne Boardie]

Kimberly, are you still in Indiana?

[JoJosMom]

Having finally picked myself up off of the floor, I agree with the posters above who advised notifying your insurance company, the state medical board, and the HSLDA and who suggested a new doctor.

 

I'm pretty cynical and hard to shock, but that one completely gobsmacked me.  I'm so sorry that you're having to deal with this, OP.

[Lang Syne Boardie]

Having finally picked myself up off of the floor, I agree with the posters above who advised notifying your insurance company, the state medical board, and the HSLDA and who suggested a new doctor.

 

I'm pretty cynical and hard to shock, but that one completely gobsmacked me.  I'm so sorry that you're having to deal with this, OP.

 

I'm equally shocked. This is a big deal.

 

There's no such thing as an isolated doctor's office. The information was being reported out...

 

Just a few weeks ago, my son's allergist showed me what he has to go through now, coding diagnoses for every patient, every visit. He doesn't even let the front office personnel do it anymore because of potential liability and complications -- and he specifically mentioned not wanting the wrong diagnostic codes being passed along as part of patients' medical profile. He said he didn't know what they wanted with all this data, nor even whom "they" were, but he believed it was all about data collection.

 

This is not a right wing nor tinfoil hat type person, if that makes a difference to anyone reading along. He's a respected and credentialed specialist who is concerned about the implications of mistakes in the new, onerous coding system.

 

What might it mean to a child's (or family's) treatment if the first thing every HCP sees in the record is a history of education and literacy problems, under the category of "Persons with potential health hazards related to socioeconomic and psychosocial circumstances?" That's a heck of a label. I don't think my first thought would be that this is a totally normal and healthy homeschooler!

[Kimberly in IN]

Kimberly, are you still in Indiana?

No, we are in central IL. This doctor is in a practice that is part of the large Catholic health organization headquartered in Peoria. (if you live here, you know which hospital group I am talking about, religion only included to identify the group. I know this is NOT a Catholic thing   :001_smile: )

 

I was truly surprised by the code & the response from the nurse (RN) at the office. I don't know if this code is assigned to all homeschoolers in this health network or just this particular practice. Maybe a coding consultant did tell the office to use this code for any homeschoolers & the doctor doesn't know what code really means. But, I don't care the reason.

 

This is dc number 4 & have never run into anything like this before.

[Lang Syne Boardie]

No, we are in central IL. This doctor is in a practice that is part of the large Catholic health organization headquartered in Peoria. (if you live here, you know which hospital group I am talking about, religion only included to identify the group. I know this is NOT a Catholic thing   :001_smile: )

 

I was truly surprised by the code & the response from the nurse (RN) at the office. I don't know if this code is assigned to all homeschoolers in this health network or just this particular practice. Maybe a coding consultant did tell the office to use this code for any homeschoolers & the doctor doesn't know what code really means. But, I don't care the reason.

 

This is dc number 4 & have never run into anything like this before.

 

Thanks for letting me know! I'm so sorry this happened. I don't like it, not one little bit.

[Annie G]

I don't like that it's a billable code- is the office attempting to receive payment for this code? 

 

I don't like that it indicates 'problem'.  It makes me think homeschooling is seen as a problem or a risk to the child's health and development. 

 

Because it's Illinois ( I live here, too), it does make me curious as to whether it's a back door way to identify homeschoolers. Since we don't have to register, there is often a push to find out who is really homeschooling. Back in the day (we started homeschooling in 1992) every year or two there was legislation introduced in Springfield to try to get us to register.  I don't know if there is still an effort being made on that front but we fought it hard for years. So it wouldn't surprise me if this is a way to track who is homeschooling.  Well, not really who since this info should be kept private, but perhaps how many. It might be that statisticians have access to how many times a code has been used...makes sense since they might want to track things like how many kids get strep throat or something. 

[Joanne]

I can't talk you down OR tell you it is not a big deal.

It it a HUGE deal. I diagnose and use codes. I report to insurance companies and licensing boards.

 

Your Doctor's use of this code in this context is out of line - at best.

I'd be making phone calls: his licensing board for one.

 

Here is a pertinent synompsis:

 

Applicable To

    Academic problems NOS

Description Synonyms

    Counseling for educational problems done
    Counseling for educational problems done (situation)
    Educational problems counseling
    Encounter for school problem
    Encounter for school problem done
    Encounter for school problem done (situation)

ICD-10-CM Z55.9 is grouped within Diagnostic Related Group (MS-DRG v30.0):

    951 Other factors influencing health status

 

 

[TechWife]

 

 

kids do have problems in public school too and there should be codes for that as well.  they may be more general of "literacy, reading, etc."

 

  

 

This is a general code used for educational difficulties. The diagnosis was misused by this particular physician. 

[Shellydon]

I'm gobsmacked as well.  I use ICD9 codes all the time. Sometimes that particular ICD9 would be used for a kid having serious trouble in school and the parents talked to the doctor about it.  It should NEVER be used in the context that you are describing.  Report to the medical board today.

[AmandaVT]

I do mental health billing for my job and I cannot see how that is an appropriate code for a dr's visit for a rash. And giving that code automatically because a child is homeschooled is ridiculous! I agree with PP's - definitely worth a complaint and a new Dr.

[Kimberly in IN]

I can't talk you down OR tell you it is not a big deal.

It it a HUGE deal. I diagnose and use codes. I report to insurance companies and licensing boards.

 

Your Doctor's use of this code in this context is out of line - at best.

I'd be making phone calls: his licensing board for one.

 

Here is a pertinent synompsis:

 

Applicable To

    Academic problems NOS

Description Synonyms

    Counseling for educational problems done

    Counseling for educational problems done (situation)

    Educational problems counseling

    Encounter for school problem

    Encounter for school problem done

    Encounter for school problem done (situation)

ICD-10-CM Z55.9 is grouped within Diagnostic Related Group (MS-DRG v30.0):

    951 Other factors influencing health status

Thank you Joanne. Thank you to everyone for your comments and advice.

 

At first, I was livid that dd's doctor equated homeschool with serious educational issues. Then, I calmed down, began process to have code removed & decided we will find a new doctor. Now, I am beginning to understand what this code really means & I am furious. How dare she use this code & not even mention anything to me about it.

 

 

[JoJosMom]

Thank you Joanne. Thank you to everyone for your comments and advice.

 

At first, I was livid that dd's doctor equated homeschool with serious educational issues. Then, I calmed down, began process to have code removed & decided we will find a new doctor. Now, I am beginning to understand what this code really means & I am furious. How dare she use this code & not even mention anything to me about it.

 

:grouphug:  What a rotten situation.  And I'm really sorry that you now have to face a bureaucratic battle to address a problem that never should have been created. Thank you for sharing, though; I suspect that many of us will be paying much closer attention to diagnosis codes in the future.

[mamiof5]

What??? I'd seriously throw a fit. Well, I wouldn't, but would ask politely to remove such code. Sorry, can't stand to be labeled "differently" just because of our schooling choices.

[Mimm]

Yikes, I was irritated reading the OP, but after reading the replies, I'm angry that they'd do that. Definitely spread the word among homeschoolers in the area.

[JFSinIL]

I think the poster who suspects Illinois is trying to keep tabs on all the homeschoolers is on to something. We do not have to report to anyone or file anything to homeschool here, and that gives some folks in government the willies.

[idnib]

Wow, I am genuinely shocked!

 

Please update after the nurse talks to the doctor, if you feel comfortable.

 

I would definitely be notifying my insurance company, the state medical board, and the highest of the higher ups at the medical org.

[FO4UR]

No, we are in central IL. This doctor is in a practice that is part of the large Catholic health organization headquartered in Peoria. (if you live here, you know which hospital group I am talking about, religion only included to identify the group. I know this is NOT a Catholic thing   :001_smile: )

 

I was truly surprised by the code & the response from the nurse (RN) at the office. I don't know if this code is assigned to all homeschoolers in this health network or just this particular practice. Maybe a coding consultant did tell the office to use this code for any homeschoolers & the doctor doesn't know what code really means. But, I don't care the reason.

 

This is dc number 4 & have never run into anything like this before.

 

 

I grew up across the river.  I know exactly the organization you are speaking of.  I also know that there is a huge, thriving homeschool community in Peoria.  I'd be making some contacts to the co-ops and groups there to give a heads-up to other homeschool parents (check the diagnosis sheets, etc), but also to form a *group* of homeschoolers who will not allow this sort of thing. 

[Word Nerd]

Oh hell no. I'd also call my insurance and make sure they're not being billed for some nonsense.

 

That would be one of my biggest concerns. What exactly are they billing you for that falls under this heading? 

[Kathryn]

I would be LIVID. Please keep us updated on what their excuse is for this behavior.

[redsquirrel]

I would also put the word out among homeschoolers.

 

And the words "I have contacted my insurance company to report that your office is incorrectly coding patients" should strike fear in the heart of any medical office.

 

And are private school students 'coded' or only the homeschooled ones? I know that they said public school students don't need them, but what about private or charter? 

[SparklyUnicorn]

keep us updated, that's crazy

 

 

[Bluegoat]

I would be mostly concerned about whether this was billed for payment above what would have been given otherwise.

 

I think there are probably three possible explanations for what has happened.

 

1) THe doctor/clinic is trying to make money by extra billing, and so are putting any mention of school down as something to bill.

 

2) They have somehow misunderstood the nature of the code.

 

3) They are trying to flag homeschooled kids, probably to remind them to keep an eye on it.  If so, it is an inappropriate use, but not necessarily a conspiracy - they might just want to be aware that there isn't school oversight for those kids.  It's a misuse too but it might be meant to serve a purpose.  THough I don't know why they would not just write it on the chart.

[maize]

OP, I'm really hoping you don't just let this issue go. Someone needs to take this medical office to task for egregious mis-use of medical diagnosis codes.

[Annie G]

I would also put the word out among homeschoolers.

 

And the words "I have contacted my insurance company to report that your office is incorrectly coding patients" should strike fear in the heart of any medical office.

 

And are private school students 'coded' or only the homeschooled ones? I know that they said public school students don't need them, but what about private or charter? 

 

Yeah, the weird thing is that in Illinois, homeschooling is just considered private education, like a private school would be considered.   The other thing is that the state board of education has a nifty form they want you to fill out every September but in small print it says it's voluntary. 

 

They spent years trying to pass legislation to require registration but it never comes close, so they use this form and try to bully/scare some people into registering. Some do...I would not. Form is below:

 

http://www.isbe.net/research/pdfs/87-02_hs_reg.pdf

[Stacia]

My DD's pediatrician does ask me/DD how school is going, etc as part of a yearly physical, along with a list of other things (social, physical activity, etc).

Ours too. But it was just part of a much larger exam, both physically & through questions like you've mentioned. Even, then, I've never noticed that code used. Certainly never when visiting for an actual illness or rash, etc....

 

And, since a pp posted a link, it looks like the doctor is using it as a billable code? Um, no. No ok in this case. If you went in to discuss educational/learning problems & the doctor gave advice, referred you out to specialists (say, for something like reading tracking issues or impaired hearing impacting learning ability), then sure, it would fit the visit. Not when visiting for a rash.

 

Don't know if it's on there through error or on purpose, but I'd make sure it gets removed. In addition to talking to the doctor/nurse & insurance company, I'd also notify the business manager of the ped office so that person knows what is going on & can help educate the doctors & nurses on when it should be used or not used. I think it also needs to be reported to a higher board re: inappropriately using medical codes for billing.

[tiddles]

Sounds like that doctor just needs any excuse for an opportunity to line his pocket - I would call the insurance company and tell them you didn't receive any counseling.