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

[Reefgazer]

No brainer - find a new doctor.

[mathnerd]

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.

This is more like it - I was billed for an eye operation when I had an eye infection and got antibiotics from the doctor. The funny thing is that they billed me for both anesthesia and the procedure when I had never seen an eye surgeon in my life. It took me 2 months to sort that out. And I contacted the billing department and the management of the hospital and reported a "fraud" - they had a fraud investigator who called me back. Their final answer was that it was a data entry mistake - their exact words were "when someone was typing in the social security number for a patient, they punched in a wrong digit by mistake". So, I suggest that you call the billing department and the Hospital Management and report a "billing fraud" for services never received.

[Garga]

It would be interesting to know what CPT code the insurance was billed for. Those are 5 digit codes that describe what action was taken in the doctor's office. If they billed for a consultation rather than an office visit, they would get paid more money. And if they want to bill for a consult, perhaps they wanted a dx that would sound like it supports the higher paying consult code. (I worked for a health insurance company for 10 years, though it was 13 years ago, so I hope I'm not completely out of date. I would *think* it still works the same way.)

 

Insurance probably won't get the bill for a bit of time, though, so you might have to wait for it to come through, depending on how they bill. (Electronic, paper, every day/weekly, etc.)

 

ETA: If you call the insurance company, they might not be allowed to tell you the dx code and cpt code on the phone due to HIPAA. I don't know. But you can tell them that the dx code Z55.9 was incorrect and that if anything other than an office visit was billed, it's possibly fraud. Insurance companies have departments set up to deal with that. It was pretty rampant back when I worked for health insurance.

[Butter]

A diagnosis code doesn't necessarily mean the doctor is trying to bill for services not rendered.  That would involve CPT codes.  It is, however, a completely incorrect to give her that diagnosis code.  She is not having educational difficulties just because she is homeschooled.  By assigning that code to all homeschoolers, they are using it incorrectly.  Even if they want to keep an eye on homeschoolers, this can be done without using a diagnosis code indicating problems with education.  They can just note that the kid is homeschooled in their records.  Definitely don't let this drop.  What they are doing is wrong.  (I checked and none of my four kids have ever been assigned that diagnosis code and their doctors know they are homeschooled.  Two of them see a pediatrician and two see a regular family doctor.)

[myfunnybunch]

I would be livid.

 

Assignment of a diagnostic code for any condition that the doctor did not assess is unethical, regardless of whether they are billing the insurance for it or not.

 

If they want to track the schooling of their patients, they can assign an in-house non-diagnostic code to those charts.

[HSmomof2]

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.

I would guess it's #2 or 3 from the options above. The doctor's billed procedure code determines payment. That diagnosis code won't give him a bigger payment. But, there is absolutely no reason to list this diagnosis code, and I would also be furious. I've stopped telling medical people that we homeschool unless specifically asked where they go to school.

 

As a pp mentioned, while I'm also not a fan, I really think HSLDA should be notified on this one. As well as your state homeschool organization.

[TX Native]

As someone said above, please get this word out to local homeschoolers! Ask on any local or state homeschool media site if they attend this practice and make them fully aware what the staff told you about the problem code on every homeschooler's record. Write a review of this practice on social media stating this MD office catorigorizes all homeschoolers with an educational problem code. I am not an HSLDA fan, but please report it to them. They thrive on fighting these things, and will likely contact their members in the area to see if they have fallen victim to the same thing. Please tell your insurance company and the medical board that the staff told you they give this code to every homeschooler. If you have a connection to the local news or a friend with a connection, see if their investigation department is interested in publicizing this fraud, after an investigation, of course, and seeing if other homeschoolers want to come forward and voice their children received false coding on their medical record.

 

ETA, better advice below is wait and see. Use above advice for extreme measures. I would at minimum contact local homeschoolers who may use this practice to check for this code filed on their records. With the staff saying they know the code is there and it is applied to all homeschoolers makes me think ill intentions instead of innocent mistake.

[Jean in Newcastle]

Wouldn't it be worth it to talk to the doctor first before going all Rambo on this office?  The RN might have said something in error.  It happens.  

[Ottakee]

Wouldn't it be worth it to talk to the doctor first before going all Rambo on this office? The RN might have said something in error. It happens.

I agree. I would ask first and then take action if it is needed. This new system is a TOTAL nightmare for practitioners. My friend is a DNP and said it is horrible. There could easily be an error. My friend said where there used to be 1 or 2 codes for a condition there are now 10-20 and just one tiny typo would be a problem.

 

I would ask them first, then follow up if needed.

[dirty ethel rackham]

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.

I have homeschooled in IL for 17 years and have never heard of anyone doing this.  It sounds like this practice.  So, I wouldn't look at this as something the state is trying to do.  Yes, there are some in the government who try to fix something that isn't broken and figure out any backdoor way to get homeschoolers to register.  Since there hasn't been any move on the legislature's part nor the ISBE that I have heard of, I doubt it is statewide. 

 

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

I don't know of anyone who has actually filed.  Every site in IL that is not associated with a local BOE or the ISBE says NOT to send one of these in.  I guess if you ask the schools how to homeschool, I supposed you could be hoodwinked.  But, most people ask homeschoolers how to homeschool. 

 

I agree. I would ask first and then take action if it is needed. This new system is a TOTAL nightmare for practitioners. My friend is a DNP and said it is horrible. There could easily be an error. My friend said where there used to be 1 or 2 codes for a condition there are now 10-20 and just one tiny typo would be a problem.

 

I would ask them first, then follow up if needed.

Well, it sounds like she has followed up and they said that they use that code for all homeschoolers.  While it may be ignorance that led them to do this, it is not innocuous.  I don't know where they would get the idea to use a medical diagnosis for all homeschoolers in their practice.  That is just nonsense.  Maybe they don't understand the ramifications, but if a layperson can see huge reg flags with this, I can't believe that someone who deals with this every day would not know that it could be problematic. 

[TX Native]

Wouldn't it be worth it to talk to the doctor first before going all Rambo on this office? The RN might have said something in error. It happens.

Yes, you are right. My instinct is Rambo, but waiting to hear back and see if there is a correction is the best approach. If it is indeed a fraud, then maybe one step at a time seeing if baby steps resolves the issue. Media is the extreme.

[Annie G]

I have homeschooled in IL for 17 years and have never heard of anyone doing this.  It sounds like this practice.  So, I wouldn't look at this as something the state is trying to do.  Yes, there are some in the government who try to fix something that isn't broken and figure out any backdoor way to get homeschoolers to register.  Since there hasn't been any move on the legislature's part nor the ISBE that I have heard of, I doubt it is statewide. 

 

I don't know of anyone who has actually filed.  Every site in IL that is not associated with a local BOE or the ISBE says NOT to send one of these in.  I guess if you ask the schools how to homeschool, I supposed you could be hoodwinked.  But, most people ask homeschoolers how to homeschool. 

 

Well, it sounds like she has followed up and they said that they use that code for all homeschoolers.  While it may be ignorance that led them to do this, it is not innocuous.  I don't know where they would get the idea to use a medical diagnosis for all homeschoolers in their practice.  That is just nonsense.  Maybe they don't understand the ramifications, but if a layperson can see huge reg flags with this, I can't believe that someone who deals with this every day would not know that it could be problematic. 

 

Our area used to have a very aggressive regional superintendent who would send letter and forms to people who either just pulled their kids from school or who the district recently learned were homeschoolers.  She's gone now but her replacement is only a little less forceful when it comes to trying to 'identify' homeschoolers.  Some people are fine filling those forms out. Other people feel pressured by the school district to fill it out. I'm surprised nobody you know has ever filled one out. 

 

Way back when we were actively fighting any downstate attempts to require us to register, the regional superintendents were showing a large stack of these forms saying that all these people had no problem registering so what are the rest of us hiding in our home schools that make us afraid to register?  Legislators were swayed- why didn't we want to register? Kids register for public school, they register for little league, etc.  Thankfully the legislation didn't pass. 

 

I don't think there's a statewide effort to track homeschoolers using this code...but better safe than sorry. 

[ChocolateReignRemix]

Our area used to have a very aggressive regional superintendent who would send letter and forms to people who either just pulled their kids from school or who the district recently learned were homeschoolers.  She's gone now but her replacement is only a little less forceful when it comes to trying to 'identify' homeschoolers.  Some people are fine filling those forms out. Other people feel pressured by the school district to fill it out. I'm surprised nobody you know has ever filled one out. 

 

Way back when we were actively fighting any downstate attempts to require us to register, the regional superintendents were showing a large stack of these forms saying that all these people had no problem registering so what are the rest of us hiding in our home schools that make us afraid to register?  Legislators were swayed- why didn't we want to register? Kids register for public school, they register for little league, etc.  Thankfully the legislation didn't pass. 

 

I don't think there's a statewide effort to track homeschoolers using this code...but better safe than sorry. 

 

It would be a major HIPAA violation so I think it is fairly safe to say no one is being tracked via that code.

[Annie G]

It would be a major HIPAA violation so I think it is fairly safe to say no one is being tracked via that code.

No, I didn't mean identifying individuals, I was merely thinking they could see how many homeschoolers their practice has for patients if they search how many have that code on their file.  Much like how our doc's office knows how many cases of the flu they've seen, I guess. 

[ChocolateReignRemix]

No, I didn't mean identifying individuals, I was merely thinking they could see how many homeschoolers their practice has for patients if they search how many have that code on their file.  Much like how our doc's office knows how many cases of the flu they've seen, I guess. 

 

I don't see what benefit that provides, and as it doesn't sound as if all doctors are doing it, my guess is this is something this practice is doing for their own purposes (or could be a mistake of some sort).

[goldberry]

I would be livid.

 

Assignment of a diagnostic code for any condition that the doctor did not assess is unethical, regardless of whether they are billing the insurance for it or not.

 

If they want to track the schooling of their patients, they can assign an in-house non-diagnostic code to those charts.

 

This, 100 times.  A medical record is a permanent record associated with the patient.  Your child now has a medical record with an inaccurate diagnoses.

 

What if someone purposely started checked "mental disorder" to identify patients who are afraid of needles?  Ten years down the road someone wants to know what mental disorder you had back in 2005.  Good luck trying to explain they just "used it for a different reason."

 

I would file reports with various agencies first to make sure the mistake is documented, and second to ensure they stop doing it.

 

[SparklyUnicorn]

My guess is this sort of "crap" is fairly common . Years ago when I worked for a health insurance company I encountered a lot of doctor's offices using a code which oddly was assumed to mean "other not specified".  Except that really the code states the person died.  We'd have to deny the claim because it was an inappropriate use for the code and led to problems if there were future bills.  Because ya know, you can't really continue to seek medical services when you are dead. 

 

I don't know if it is incompetence on the part of the billers or that the whole thing can get pretty convoluted.  Probably both.

 

 

[SparklyUnicorn]

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

 

Actually, probably not.  Doctors can't bill for services they aren't qualified to provide because they are generally contracted for certain services (and that is it).  For example, a podiatrist can't bill for a pelvic exam. 

[TrixieB]

ETA: If you call the insurance company, they might not be allowed to tell you the dx code and cpt code on the phone due to HIPAA. I don't know. But you can tell them that the dx code Z55.9 was incorrect and that if anything other than an office visit was billed, it's possibly fraud. Insurance companies have departments set up to deal with that. It was pretty rampant back when I worked for health insurance.

 

The insurance company should be able to tell you the ICD-10 codes, or mail the information to you, as your child is only 10yo. 

 

If your child went to the doctor because of a rash, something pertaining to the rash or its cause should be the coded diagnosis, unless the doctor found something else (for example, high blood pressure - not so likely in a child, but it was the only example I could think of quickly) and in that case he or she should have talked to your child and to you about the additional finding(s).

 

The Z code sounds totally bogus.  I suppose it could be a typo though. 

[TechWife]

 

ETA: If you call the insurance company, they might not be allowed to tell you the dx code and cpt code on the phone due to HIPAA. I don't know. But you can tell them that the dx code Z55.9 was incorrect and that if anything other than an office visit was billed, it's possibly fraud. Insurance companies have departments set up to deal with that. It was pretty rampant back when I worked for health insurance.

 

It's her information (her child's actually) - HIPPA allows for this conversation. The insurance company has to verify identity, but by the time you get to talk to a real person at an insurance company, you've already done that by providing your policy number, DOB, etc.. 

[TechWife]

 

 

The Z code sounds totally bogus.  I suppose it could be a typo though. 

 

It's not a bogus code - it's real.

[zoobie]

It's not a bogus code - it's real.

I read it that she means the usage of the code by the doctor in this instance is bogus.

[TrixieB]

I read it that she means the usage of the code by the doctor in this instance is bogus.

 

Yes, that is what I meant.  I know it's a real code.

[MyThreeSons]

This is more like it - I was billed for an eye operation when I had an eye infection and got antibiotics from the doctor. The funny thing is that they billed me for both anesthesia and the procedure when I had never seen an eye surgeon in my life. It took me 2 months to sort that out. And I contacted the billing department and the management of the hospital and reported a "fraud" - they had a fraud investigator who called me back. Their final answer was that it was a data entry mistake - their exact words were "when someone was typing in the social security number for a patient, they punched in a wrong digit by mistake". So, I suggest that you call the billing department and the Hospital Management and report a "billing fraud" for services never received.

 

Several years ago, my dh had to have his scalp stapled after a tubing accident on a river. Several weeks later, we got the ER bill, which was outrageously high. It turned out that we were being billed for a surgical procedure to drain an abscess on a certain part of male anatomy. We didn't find out about it until after the insurance company had already paid their part, so I called them and told them they had overpaid. I also told the hospital we wouldn't pay our part until it was corrected. I never heard back from either of them. 

[Kim in Appalachia]

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).

 

 

There are a bunch of new codes, and the code COULD have been used to confirm that he asked about school.  The codes are used for billing AND for compliance, for stuff like "meaningful use".  It may just be there so the correct boxes are checked.  

 

You should still call and ask, and make sure that he isn't billing incorrectly or falsely.  

[Annie G]

There are a bunch of new codes, and the code COULD have been used to confirm that he asked about school.  The codes are used for billing AND for compliance, for stuff like "meaningful use".  It may just be there so the correct boxes are checked.  

 

You should still call and ask, and make sure that he isn't billing incorrectly or falsely.  

 

 

That definitely could be true, but does that mean when my doctor asks me if I feel safe at home he might slap a code down for domestic abuse?  They have a bajillion codes- if they want to use them to note they asked something, it seems like they should have codes that don't imply there's a problem.   

[Kimberly in IN]

There are a bunch of new codes, and the code COULD have been used to confirm that he asked about school.  The codes are used for billing AND for compliance, for stuff like "meaningful use".  It may just be there so the correct boxes are checked.  

 

You should still call and ask, and make sure that he isn't billing incorrectly or falsely.  

The doctor's office may want some kind of confirmation that a patient is asked about school at every visit. But, the code Z55.9 falls under the category, Persons with potential health hazards related to socioeconomic and psychosocial circumstances, and in particular, problems related to education and literacy, unspecified.

 

If the office wants confirmation that the doctor asked about school, this is not the code to use. This Z code does not mean, doctor asked where patient goes to school.

 

The fact that the office is telling me they equate Persons with potential health hazards related to socioeconomic and psychosocial circumstances, and in particular, problems related to education and literacy, unspecified, with homeschooling is alarming to me. (and/or if the doctor does feel this applies to my dd, I feel we are owed an explanation as to why this applies) To me, this code implies some serious issues & if the doctor truly sees them, we need to get dd the help she needs. But, we can't do this if the doctor/office doesn't share info.

 

I do understand that icd-10-cm brought about a great deal of coding changes. But, that doesn't change the fact that Z55.9 does not correspond to homeschooled.

[TX Native]

Also, in response the above comment, if the code mistakingly is used to confirm the MD asked about school, why doesn't the code get applied to public schooled kids? The staff specifically said public schooled kids don't get a code.

[ScoutTN]

I would make an appt to speak directly to the doc with no children present, call the insurance company, the state medical board, the administrative head of the practice and a lawyer if necessary to ensure the code is removed. I woul request an explanation in writing too.

 

 

 

I would certainly pass the word among homeschoolers too.

[redsquirrel]

If they need an internal code that lets them record "asked about school' then it should apply to every child. That should be an easy thing to manage internally

[Jean in Newcastle]

 

 

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.)

Call your insurance company.  Tell them that your doctor is using this code to mean homeschooled even though you did not discuss any learning difficulties with them as there are none.  Ask them how you should proceed.  

[Garga]

 

 

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.)

Wait...hang on. I missed this update.

 

Oh, no, no, no. Oh no. This is sooo infuriating. Last time I read, you'd only talked to the nurse once to find out what it was and everything was a little vague. But now you called back and it's "end of story" from them and the doctor won't talk to you???? Oh, I'm livid now.

 

Call back and say, "The doctor might not talk to me but I am calling the...." whoever it is you settle on to call. (Lots of people have suggested all sorts of organizations to call.) Let the office person know that their codes are fraudulent and you will be following up with other organizations about this issue. Let them know that at this point, you no longer wish to talk to the doctor, but that you will be having other organizations contact them to remove the fraudulent dx from your child's record. And then you'll want copies of the corrected records to take to your new doctor.

 

Oh, my. What morons. Diagnosing your child with serious issues because you homeschool? And then refusing to talk to you about it? You know, up until the part where they refused to talk to you, I was figuring we'd hear their side and go from there, but it just makes me so angry when doctors and their staff get all high-handed and refuse to open a dialog with their patients.

 

You might want to let them know that since you think it's unconscionable for doctors to deliberately mis-diagnose patients, that you'll be contacting every homeschool organization in town so they know not to go to this doctor to have their kids misdiagnosed on their permanent medical records.

 

You may want to put that in writing so that the office staff person who answers the phone doesn't forget to tell the doctor. Ugh.

 

If they'd just talk to you and be reasonable it would be one thing. But to refuse to talk to you about a very serious diagnosis that they've put in your child's records??? No. Your only course of action is to bring in other organizations. I'd call them all and ask each of them to help until someone does.

[PinkyandtheBrains.]

 

 

 

The fact that the doctor declined to speak to you about it concerns me.

 

I'd be taking necessary steps to get the code removed and to find a new doctor.

[kbutton]

My husband, who is familiar with the codes immediately stated that you should sue. He's not that type of person.

 

Based on the fact that the doctor is reported to do this all the time, my first call would be to an attorney. If this doctor is doing this all the time, it's discriminatory and/or padding the books for billing. It's not okay. The attorney would be able to tell you if you should report the doctor and to whom.

 

If you don't want to do that, you should at least talk to the insurance company and the state medical board. I would be sure to report that the nurse told you that all homeschooled kids get this diagnosis code. 

 

I would seriously consider talking to HSLDA or state homeschooling groups.

[EmseB]

I would start documenting now, in a notebook or word file, everything that's happened with dates, times, etc.  Even if it's just to c&p these posts and put dates on them, but if you pursue this you'll want records of conversations and what not.

 

Then I'd start calling insurance, medical board, etc.

[zoobie]

If your state has a homeschool-friendly government rep, I'd consider contacting him/her (usually easy to find by who starts or opposes legislation concerning homeschooling) in addition to your insurance company and the state composite medical board (licensing). And definitely get the word out to local homeschoolers!

[Twigs]

You might want to ask for a copy of your family's medical records, including the supporting documentation / evidence for that diagnosis code.

 

Best wishes.

[Lara in Colo]

I do not say this lightly, but this really sounds like a job for the Homeschool legal defense people-- this could be more than just about your child--- this could be a trend aimed at all homeschoolers in your area.  I would think that they would love to tackle something like this-- something   **inflamatory** that they can really get all blustered about. 

At the very least contact the medical board. 

[Kimberly in IN]

Thank you for all of the ideas. I really can't imagine involving a lawyer; this seems like a simple thing for the office to correct. Though, the visit was billed with this code. The neighbor across the street is a lawyer, I will ask her for a recommendation. Her dh is a cardiologist. They probably know who would be good for this. My dd is spending the night with their dds tonight. Will talk with them tomorrow.

 

Will get a lawyer name, but before I walk with him/her, will contact insurance company. Will also try to speak with the practice administrator/mgr at the doctor's office.

 

Thank you for all of responses. It is very helpful in sorting out what to do, how to approach this issue. I have run out of likes, I am sorry!!!

 

 

 

 

[Hot Lava Mama]

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.)

 

Where did you see this code?  Was it on some paperwork they handed you or did you see it in the doctor's files?  Weird that they would give you something with a billing code on it.

Hot Lava Mama

 

 

[ikslo]

Where did you see this code? Was it on some paperwork they handed you or did you see it in the doctor's files? Weird that they would give you something with a billing code on it.

Hot Lava Mama

 

 

Why is that weird? I am looking at my DS's dentist bill from the other day right now, and it has codes on it.

[Butter]

Where did you see this code?  Was it on some paperwork they handed you or did you see it in the doctor's files?  Weird that they would give you something with a billing code on it.

Hot Lava Mama

 

 

 

I think it's pretty standard, not weird.  My little guys' ped and the rest of our family doctor have patient portals on-line and all the diagnosis codes we've ever been given (separated by visit) are on there.

[idnib]

Wait...hang on. I missed this update.

 

Oh, no, no, no. Oh no. This is sooo infuriating. Last time I read, you'd only talked to the nurse once to find out what it was and everything was a little vague. But now you called back and it's "end of story" from them and the doctor won't talk to you???? Oh, I'm livid now.

 

Call back and say, "The doctor might not talk to me but I am calling the...." whoever it is you settle on to call. (Lots of people have suggested all sorts of organizations to call.) Let the office person know that their codes are fraudulent and you will be following up with other organizations about this issue. Let them know that at this point, you no longer wish to talk to the doctor, but that you will be having other organizations contact them to remove the fraudulent dx from your child's record. And then you'll want copies of the corrected records to take to your new doctor.

 

Oh, my. What morons. Diagnosing your child with serious issues because you homeschool? And then refusing to talk to you about it? You know, up until the part where they refused to talk to you, I was figuring we'd hear their side and go from there, but it just makes me so angry when doctors and their staff get all high-handed and refuse to open a dialog with their patients.

 

You might want to let them know that since you think it's unconscionable for doctors to deliberately mis-diagnose patients, that you'll be contacting every homeschool organization in town so they know not to go to this doctor to have their kids misdiagnosed on their permanent medical records.

 

You may want to put that in writing so that the office staff person who answers the phone doesn't forget to tell the doctor. Ugh.

 

If they'd just talk to you and be reasonable it would be one thing. But to refuse to talk to you about a very serious diagnosis that they've put in your child's records??? No. Your only course of action is to bring in other organizations. I'd call them all and ask each of them to help until someone does.

 

I missed the update as well. I agree with Garga.

 

I'm glad you're talking to the neighbor but one reason to involve a lawyer is to try and get them to stop doing it to the records of everyone who homeschools, not just your record.

[JoJosMom]

I do not say this lightly, but this really sounds like a job for the Homeschool legal defense people-- this could be more than just about your child--- this could be a trend aimed at all homeschoolers in your area.  I would think that they would love to tackle something like this-- something   **inflamatory** that they can really get all blustered about. 

 

At the very least contact the medical board. 

 

I totally, absolutely, 100% agree with this.  But I need to add this:  They should get all blustered about it BECAUSE IT IS TOTALLY WRONG. 

 

And I still think you need to contact your insurance company and your state's medical board.

[Alice]

Full disclosure, I'm a pediatrician. Even fuller disclosure, I'm not at all an expert on coding. 

 

We can use an add on code if a diagnosis impacts a visit even if the visit is not for that primary diagnosis. For example, if I was to see a kid with autism for an ear infection I could add on the code for autism IF the autism impacted the visit. It might make the exam more difficult and I am allowed to code for that IF I can document that the diagnosis actually impacted the visit. So in that example, the main diagnosis would be Otitis Media (or with the new codes some super specific diagnosis like Acute Otitis Media with Effusion of the Right Ear without Perforation) and then the secondary add on diagnosis would be Autism. Another example might be a kid in our practice who has had a double lung transplant. When we see him for an ordinary viral respiratory infection his history and diagnosis impact the visit....they change our treatment and we are allowed to code for the added complexity of care that his history brings to the visit. (If it is valid and if we document it.) 

 

However, in this case the code is incorrect and being used incorrectly. It sounds to me like they are using it as an add on code to get attempt to get reimbursed at a higher level. (I'm guessing about that and this is where I'm not an expert.) It's wrong because it's inaccurate and even if it was an accurate code, it doesn't sound like it impacted this visit in anyway. So there is really no justification. 

 

It sounds to me like this is potentially fraud. This is where I'm not an expert and I do think it would make sense to at least speak to a lawyer to get a better understanding of the situation. 

 

Oh, and not, it's not the norm. I have never heard of anyone using a "Homeschool" code and have never coded anything to do with schooling, unless the patient is there specifically for a consult about school issues. 

 

Sorry you have to deal with this. What a mess. 

[Farrar]

I just read thought this thread and I'm gobsmacked. Really, most of the time when homeschoolers cry foul and homeschool discrimination I think it's either inappropriate or making a mountain out of a molehill, but taking your word for everything, this is huge and horrible. Medical records follow you everywhere. This doctor has etched onto this child's records a false diagnosis that could now be on those records forever. And this is not a rash that's down as an allergy when it turns out it was a minor infection. This is a permanent emotional issue down on your child's charts. Just... wow.

 

I'm glad the OP is getting a lawyer. I would second looking back at Joanne's good advice and considering calling the state board as well. I'm not a fan of HSLDA, but if IL has a good statewide group, I'd definitely call them. And I'd also call the doctor's office and inform them that you're about to speak to a lawyer, inform the state board of medicine and speak with homeschool advocacy groups. If you really want to clear this up fast and aren't interested in punishing them, just in getting it taken care of, maybe they'll change their tune.

[Reefgazer]

That code is false.  It doesn't mean homeschooled; it means homeschooled with educational problems.  Normally, I just walk away from idiotic nonsense like this, but that code means false medical records for your child, a possible ding against you if you (God forbid) should ever have an encounter with CPS, potential HIPPA violations if they are collecting info for the government, and insurance fraud, as well, if the code was used to obtain insurance money for services not rendered.  I would file a complaint with your state insurance fraud bureau, call HSLDA and let them know what is going on, and report to the state medical board.  Send your doctor copies of all letters you send, and demand your medical records be corrected.

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.)

 

[idnib]

I'm glad the OP is getting a lawyer.

 

I'm not sure that is a done deal. Some if us are urging her to. Unless I missed something.

[Farrar]

Thank you for all of the ideas. I really can't imagine involving a lawyer; this seems like a simple thing for the office to correct. Though, the visit was billed with this code. The neighbor across the street is a lawyer, I will ask her for a recommendation. Her dh is a cardiologist. They probably know who would be good for this. My dd is spending the night with their dds tonight. Will talk with them tomorrow.

 

Will get a lawyer name, but before I walk with him/her, will contact insurance company. Will also try to speak with the practice administrator/mgr at the doctor's office.

 

Thank you for all of responses. It is very helpful in sorting out what to do, how to approach this issue. I have run out of likes, I am sorry!!!

 

 

I'm not sure that is a done deal. Some if us are urging her to. Unless I missed something.

 

The above update made me think she is going to. Kimberly, I think we all hope you get the name of a good lawyer.

[Jean in Newcastle]

Putting this on the right thread:  The possible fraud angle is why I suggested contacting the insurance company.  They will know if the code is being used to get more money out of them.  And they will come down on fraud with access to much better lawyers (I assume) than you have at your disposal.