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


Kimberly in IN
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I realize that MD's don't have the same ethics I do - but I am guessing they have an equivalent principle to what I am about to say.

 

I am bound by ethics to suggest the least aggressive, least restrictive treatment plan. Similarly, I am bound to use the least severe - least profound diagnosis that meets the symptoms presented.

 

This use of s code to categorize imposes content onto the patient that is aggressive and restrictive taking them at face value and assuming no fraud intent, they are using a code to categorize. This can be done more responsibly in other ways. The coding system is for pathology. As such, they are automatically pathologizong am educational choice - that is against ethics.

 

The office, doctor and practice is out of line. Please take this to the next level.

 

Homeschool is not pathology and power without accountability is dangerous.

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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.

 

And at no charge to the OP.

 

There are no damages here so going for an attorney here at this point is over kill.

 

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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.)

Talk to the state medical board. The doctor is wrong and cannot leave the code on the chart. File a formal complaint. Also, make sure you state that the doctor did not counsel on the matter, at any rate. Also make sure you mention the doctor refused to talk to you about a code you dispute.

 

This is a ridiculous misuse of the new codes.

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Another voice urging you to contact HSLDA and/or a statewide group that has the resources to pursue this issue legally. There are no financial damages at this point, but there are damages--a potential but as-yet-unknown harm to your daughter's future options if that fraudulent code remains on her medical record. It must be removed, and this doctor must be stopped from adding fraudulent codes to the records of other patients.

 

Contact HSLDA, another well-funded homeschool legal group, or an independent lawyer who understands medical coding (HSLDA is probably your least expensive, most expert option in that list ...). Contact your state medical board. Contact your insurance company. I would contact all those people/groups, and then--depending on what they told me--I'd make this thing go very, very public. Even before talking with them, I'd start publicizing among other homeschoolers, so that those who don't currently go to this doctor don't start and so that those who do go to this doctor can check their own records and potentially join with you to fight these fraudulent diagnoses. For now I wouldn't go full-court press ... but I'd start making plans in case I decided that was the way to go in the future.

 

I know this is a hassle, and you don't want to deal with it; you just want to fix your daughter's record and move on. But the truth is that your daughter is not the only one affected by this doctor's fraud. You do have a responsibility, at the very least, to make it known among other homeschoolers so that others who may be affected are notified and can choose their own course of action. I personally would feel responsible to take what action I could to make this doctor stop doing this to ANY homeschoolers, not just to my own daughter, but if you don't feel that responsibility, that's fine. You DO, however, have a responsibility to notify others who may be affected.

 

Please take action on this, not just for your daughter's sake, but for the sake of others who may not know yet that they're being affected by this too.

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There are no damages here so going for an attorney here at this point is over kill.

 

 

 

She needs to get help before damage is done. An attorney can help her do that. Erroneous medical records can be a pain to deal with later in life. At worst, they can cause problems where other doctors assume there are problems where none exist. Using an attorney isn't always about recouping damages. It can help you prevent damage from occurring in the first place. 

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Maybe a coding consultant did tell the office to use this code for any homeschoolers & the doctor doesn't know what code really means.

 

The doctor has a graduate degree. The doctor should know better than to just listen to some consultant and use codes without *knowing* what they mean. It's not even hard to look these things up. So, even if some consultant told the doc to use it for all homeschoolers, I think it's still malpractice. Not the worst kind of malpractice (not the "oops, I killed my patient" kind), but still. Either that, or insurance fraud if they're trying to bill for it. Not a minor issue regardless.

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And at no charge to the OP.

 

There are no damages here so going for an attorney here at this point is over kill.

 

I think having a wrongful medical diagnosis of emotional problems that can follow this child for the rest of her (or his? I forget...) life IS damaging in and of itself. I'm really not a quick to sue person and if they would just remove it, in her place, I'd drop the matter (and change doctors, obviously). But I think getting a lawyer involved is totally appropriate at this point.

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I hope the neighbors can advise you how to best get this taken care of quickly. I recall that in applying for life insurance, I was asked if I'd ever been diagnosed or treated for any psychological or neurological condition, so I would be calling the doctor back again to speak in person as well as calling the insurance company. This ought not to be left standing, even if you change doctors.

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I think having a wrongful medical diagnosis of emotional problems that can follow this child for the rest of her (or his? I forget...) life IS damaging in and of itself. I'm really not a quick to sue person and if they would just remove it, in her place, I'd drop the matter (and change doctors, obviously). But I think getting a lawyer involved is totally appropriate at this point.

 

 

As it has just happened there are no monetary damages, and it can be removed fairly easily still.  By going to the insurance company and medical board if needed she can achieve the same result without spending any money.

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Is it possible that the ped used that code as an educational "other." Medically, it would make sense to have an overall picture of the patient's life. The doctor knows she needn't worry about the lice epidemic at XYZ school, but maybe should add routine school screenings (sight, hearing, scoliosis) to your child's annual check-up routine. I wouldn't assume my pediatrician is more invested in school choice than my child's overall health.

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Is it possible that the ped used that code as an educational "other." Medically, it would make sense to have an overall picture of the patient's life. The doctor knows she needn't worry about the lice epidemic at XYZ school, but maybe should add routine school screenings (sight, hearing, scoliosis) to your child's annual check-up routine. I wouldn't assume my pediatrician is more invested in school choice than my child's overall health.

 

But that's not what it means. It means something else entirely - something that is standardized. As has been pointed out, they could have used another method for making an in house note if they wanted to have it on the chart that the child is homeschooled.

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As it has just happened there are no monetary damages, and it can be removed fairly easily still.  By going to the insurance company and medical board if needed she can achieve the same result without spending any money.

 

The insurance company has no control over the medical records. The most they can do is dispute a claim that is filed in error. For example, if the physician billed for counseling that did not occur, then they can refuse to pay the claim on the grounds that the parent stated the service did not occur. The insurance company cannot change any records that the physician has sent. This means that if the insurance company has entered the code into their system, then every insurance company this child has from this point forward will be able to see it. 

 

With access to medical records being made available to other physicians treating the same patient, once a diagnosis is on a medical record, then all physicians who access that record will be able to see it.  Diagnosis codes mean something to those who use them. There will be assumptions made by any medical personnel who see the record. If a diagnosis is correct, this is a good thing. They will better know how to approach the patient and to treat the patient. If the diagnosis is incorrect, it can have serious repercussions. 

 

Additionally, any medical boards have limited influence on patient medical records. They can inquire about it, they can note if on the physicians record and they can take action if there is malpractice,  but they cannot force the doctor to agree with them.   

 

Getting a lawyer involved at an early stage, even though it costs money, can save a lot of time and anguish, and  yes, even money, down the road.  Spending money is not a bad thing. 

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But that's not what it means. It means something else entirely - something that is standardized. As has been pointed out, they could have used another method for making an in house note if they wanted to have it on the chart that the child is homeschooled.

True, but I'd still consult another pediatrician in the same area and see if there is a logical, locally acceptable reason for this code to be used. If there is and the OP goes in guns a-blazin' with lawyers and everything, then she starts to look paranoid and that adds another note to the chart. Either the doctor is up to something, or she isn't and needs to adjust her record-keeping, or what she's doing is normal for that area. Escalating too quickly in any of those situations doesn't seem to be in the OPs best interest.

 

I'm not saying the OP is wrong. I'm just saying that from the other end of the line she might come off as someone difficult who needs to be 'managed.' It might not be in her best interest to push the doctor and staff into a defensive posture right away.

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True, but I'd still consult another pediatrician in the same area and see if there is a logical, locally acceptable reason for this code to be used. If there is and the OP goes in guns a-blazin' with lawyers and everything, then she starts to look paranoid and that adds another note to the chart. Either the doctor is up to something, or she isn't and needs to adjust her record-keeping, or what she's doing is normal for that area. Escalating too quickly in any of those situations doesn't seem to be in the OPs best interest.

 

I'm not saying the OP is wrong. I'm just saying that from the other end of the line she might come off as someone difficult who needs to be 'managed.' It might not be in her best interest to push the doctor and staff into a defensive posture right away.

 

But the OP already tried to go in without guns a-blazin'.  She shouldn't have to go to consult another ped.  Her own ped should be willing to talk to her about it.  The fact that this doctor won't talk to her doesn't put the onus on the OP to consult some other doctor to find out what is acceptable practice (and just because other docs might be doing it as well doesn't make it acceptable either).  Refusing to discuss the issue is unacceptable enough, especially after using an incorrect diagnostic code.  The OP did her due diligence in asking about the code, then asking about the code again and asking to speak to the doc and being told that the doctor wouldn't discuss it.  All of that right there is enough to inform a decision to go to the medical board, or insurance company or a lawyer.  She can't even get the doc to talk to her to consider removing the code from the son's file.  They are already in a defensive posture and what put them there was, apparently, her just asking about this.

 

 

When you read the code, there is no "locally acceptable" reason to use it (like it would only apply to their city that homeschoolers are necessarily have literacy issues?).  I mean, how could a code like that apply only to the OP's geographic location?  It's a specific diagnosis for a specific child.

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The insurance company has no control over the medical records. The most they can do is dispute a claim that is filed in error. For example, if the physician billed for counseling that did not occur, then they can refuse to pay the claim on the grounds that the parent stated the service did not occur. The insurance company cannot change any records that the physician has sent. This means that if the insurance company has entered the code into their system, then every insurance company this child has from this point forward will be able to see it.

 

With access to medical records being made available to other physicians treating the same patient, once a diagnosis is on a medical record, then all physicians who access that record will be able to see it. Diagnosis codes mean something to those who use them. There will be assumptions made by any medical personnel who see the record. If a diagnosis is correct, this is a good thing. They will better know how to approach the patient and to treat the patient. If the diagnosis is incorrect, it can have serious repercussions.

 

Additionally, any medical boards have limited influence on patient medical records. They can inquire about it, they can note if on the physicians record and they can take action if there is malpractice, but they cannot force the doctor to agree with them.

 

Getting a lawyer involved at an early stage, even though it costs money, can save a lot of time and anguish, and yes, even money, down the road. Spending money is not a bad thing.

You use the insurance company and medical board to start inquiries and it is fairly simple to get the physician to remove it from the records. If he doesn't then you get an attorney.

And honestly this is unlikely to cause anguish down the road.

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She needs to get help before damage is done. An attorney can help her do that. Erroneous medical records can be a pain to deal with later in life. At worst, they can cause problems where other doctors assume there are problems where none exist. Using an attorney isn't always about recouping damages. It can help you prevent damage from occurring in the first place. 

 

 

:iagree: And they can be used against the OP if the doctor decides to report her to social services.

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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.

 

Oh, o.k.  I had never seen it before.  I thought ICD codes were mostly for the "back office" type of thing for billing.  It seemed like the doctor's office was out of control or something and maybe handed her papers that were for their billing office.

Hot Lava Mama

 

Hmmm.  Just checked some of our billing and didn't see any codes.  Anyone have ideas on how I can see what they are WITHOUT calling our doc?  Just wondering if our doctor did the same thing but we never saw it because they don't include the codes.  I am wondering if my insurance company would give up that information?  Very disturbing that a doctor would do that!

 

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Not only that, but security investigations for the military or other government jobs want to know if you've *ever* been diagnosed with these types of issues.  If you say no and something else turns up on your record, you risk losing the possibility of getting that job.  If you say yes, then you have some 'xplainin' to do and probably have a ding against you going in anyway.  OP, take care of it now so it doesn't come back and bite your child in the butt later.

I hope the neighbors can advise you how to best get this taken care of quickly. I recall that in applying for life insurance, I was asked if I'd ever been diagnosed or treated for any psychological or neurological condition, so I would be calling the doctor back again to speak in person as well as calling the insurance company. This ought not to be left standing, even if you change doctors.

 

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Hmmm.  Just checked some of our billing and didn't see any codes.  Anyone have ideas on how I can see what they are WITHOUT calling our doc?  Just wondering if our doctor did the same thing but we never saw it because they don't include the codes.  I am wondering if my insurance company would give up that information?  Very disturbing that a doctor would do that!

 

When we go to our family doctor, the sheet he hands us to give to the gal at the check-out desk has codes on it. The doctor puts a check mark next to the appropriate service(s) and/or diagnoses, and the gal puts those in the computer and tells us the total cost. The sheet they have been using for years has a bunch of the most often-used services and codes pre-printed. I'd guess it's at least a hundred or so. They are arranged in categories: the office visit itself; injections; lab work; x-rays; frequent ailments; frequent injuries, etc. 

 

I haven't seen a sheet since the newer, much more complex code listing was revealed. 

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OP, I would insist that the nurse who told you this was a "homeschool code," put that in writing, and to include the statement that all homeschoolers are given this code even if they have no learning issues whatsoever. Then you can send copies of this to the medical board, insurance company, HSLDA, etc., with a note explaining the issue and that the doctor has not only refused to remove the code, but has refused to discuss it with you.

 

I think having this clearly stated in writing will make it much easier to get other entities involved, because it makes it clear that this problem is a practice-wide POLICY of misdiagnosis, rather than just a personal disagreement about your own child's diagnosis. And without that in writing, the doctor can always backpedal and say she never claimed it was a homeschool code, she used it because she felt there was something "off" about your child.

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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.

 

I must have worded my comment awkwardly as I didn't mean to imply that the OP had done anything wrong.  It was more of me talking aloud to myself as in, "That's weird that I have never seen that...I wonder what I have missed or what has been hidden from me regarding billing." 

 

OP, if you thought I as implying something, please accept my apology.  I wasn't trying to point any fingers at you.  I was just so startled by the revelation of what your doctor was doing that I wanted to figure out if the same thing was happening to us by our doctor.

Hot Lava Mama

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You use the insurance company and medical board to start inquiries and it is fairly simple to get the physician to remove it from the records. If he doesn't then you get an attorney.

And honestly this is unlikely to cause anguish down the road.

 

In my "professional life" I worked in healthcare administration. I am very familiar with how coding, reimbursement and medical records are handled. I am also familiar with medical boards and insurance companies. I have worked with many physicians and many billing office personnel, as well as a variety  health care administrators (including risk managers), clinicians and support staff.  I am speaking from experience. 

 

It is not "fairly simple" to get a diagnosis code change when the physician states that it is the correct code. It is not "fairly simple," as a non-clinician, to communicate clearly, making sure all of your bases are covered, with a licensing board. The physician's response to an inquiry from the licensing board will most likely result in the doctor stating it is the right code. 

 

I can only surmise that you don't have a child with any learning differences, or you would not think that a diagnosis code that states there are "problems related to education and literacy" is unlikely to cause anguish.

 

OP, make sure you ask the physician's office to write down how they determined that your child met this diagnostic criteria. If the response is "homeschool," then you have that to take to the attorney as well. It's difficult to say if you are dealing with some type of misconception of homeschoolers or with a doctor that is unclear about the meaning of the code, or both. Having the rationale for the diagnosis code in writing will help your case, either way. 

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Thank you for everyone!!! I do have it in writing that Z55.9 is used for homeschooled. It is on the sheets I received from the visit. That a code was associated with homeschooling surprised me & I looked it up. (Prior to kids, I was in medical practice adm. I was thinking wow, they even have a code for homeschool now, let me look it up b/c no other doctor has ever used it for any of my dc. The true definition of the code is what got me concerned.)

 

Monday I will request a copy of dd's medical records before doing anything else. I do not want it to be changed retroactively, or if it is I will have a copy of pre-change record.

 

There is no way the doctor can justify our socioeconomic circumstances can lead to a health hazard. (we are not well off, but sitting in middle class, living in a middle class neighborhood, in a middle class part of town. I don't work outside of house, but dh is employed.) I will need her to explain what psychosocial circumstances she thinks are contributing to problems related to education and literacy & then what those problems are. Out of curiosity, does anyone know what things fall under psychosocial circumstances?

 

Needless to say, I am stressed out. I either need to get the coding issue solved or there is the potential for a serious issue with my dd, the doctor didn't share it with me, what could it be????

 

(here's the thing, dd does have some educational issues. we didn't talk about them in either visit & they are not apparent in that kind of setting. dd is literate. dd participates in a group for speech therapy with other fifth graders at the local school. her speech disfluency is practically nonexistent & not noticeable to an untrained ear anymore. this is her last semester of speech therapy. there are much more appropriate codes for speech issues. Z55.9 doesn't seem to address this issue at all.)

 

I loved our last pediatrician in Saratoga Springs, NY. I erred in selecting this particular pediatric practice here in our new location in IL. :(

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I loved our last pediatrician in Saratoga Springs, NY. I erred in selecting this particular pediatric practice here in our new location in IL. :(

 

Don't beat yourself up about it. I don't think you (or any of us) could have anticipated something like this could happen.  :grouphug:

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OP, I would insist that the nurse who told you this was a "homeschool code," put that in writing, and to include the statement that all homeschoolers are given this code even if they have no learning issues whatsoever. Then you can send copies of this to the medical board, insurance company, HSLDA, etc., with a note explaining the issue and that the doctor has not only refused to remove the code, but has refused to discuss it with you.

 

I think having this clearly stated in writing will make it much easier to get other entities involved, because it makes it clear that this problem is a practice-wide POLICY of misdiagnosis, rather than just a personal disagreement about your own child's diagnosis. And without that in writing, the doctor can always backpedal and say she never claimed it was a homeschool code, she used it because she felt there was something "off" about your child.

 

Kimberly, I also think it is probably a good idea for all of your further inquiries to the doctor to be in writing. You will then have a paper trail. I would write a formal letter restating what the office has already told you about this code. Include the reasons that you think it is incorrect, and ask for it to be removed. If you are notifying the insurance company, state that also. Then either send it to the office through certified mail, so that you will have proof that they received it, or hand deliver it. If you hand deliver it, I would also take a second copy of the letter to keep for yourself and ask the person at the desk to sign it at the bottom to show that they received it. If they refuse, I would make a note of their name, the date, and the fact that you hand delivered the letter on your copy.

 

If you have phone conversations with anyone (at the doctor's office or anyone else you might contact), ask for their email address and send a follow up email restating the information discussed in the phone call. Print out copies of your emails and start a file. If you don't have an email address for someone you speak to on the phone, write about the conversation in a phone log that you keep. Include the dates and times of the calls and the person's complete name and title.

 

Write down everything. Hopefully doing so will prompt the doctor's office to realize you are serious and won't be dissuaded from pursuing this, and they will decide to remove the code from the file. If not, you will have documentation for whatever the next steps might be.

 

I'm sorry you are dealing with this. I hope it is cleared up quickly.

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I hope the neighbors can advise you how to best get this taken care of quickly. I recall that in applying for life insurance, I was asked if I'd ever been diagnosed or treated for any psychological or neurological condition, so I would be calling the doctor back again to speak in person as well as calling the insurance company. This ought not to be left standing, even if you change doctors.

 

I could be mistaken, but I wouldn't see this as a psychological or neurological condition, but rather an educational one. So, I'm not sure this would haunt her as far as psychological/neurological stuff is concerned in the future. And I don't think it would affect life insurance anyway (do problems with literacy as a kid really impact life expectancy)? That said, the doctor is obviously coding wrong which is a major issue regardless of what the code is.

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Please fight to have this changed. I had to do this once for a different reason. My hubby had an asthma attack and used his inhaler. But due to the attack he passed out and was unresponsive. He was taken to ER. By the time he got here his wheezing was better but his chest and throat were still constricted. He was semi conscious. He was panicking because he could not make the staff understand about his asthma because they didn't hear him wheezing. They diagnosed him with panic attacks and a mental disorder. Our insurance denied all claims because they didn't cover mental disorders or something crazy. It took months but I had his diagnosis changed and the claims were paid. I did not want an error like that to stay in his records.

I think it is crazy to categorize homeschoolers on medical records. I would have this removed.

Now I'm going to be checking my own kids' records.

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You know what I hate... I hate that our medical system can be so purposefully obfuscating and secretive as well as complex that we don't really know if this code will be nothing or a huge problem in this child's future.

This. I guard my children's medical records carefully.
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Thank you for everyone!!! I do have it in writing that Z55.9 is used for homeschooled. It is on the sheets I received from the visit. That a code was associated with homeschooling surprised me & I looked it up. (Prior to kids, I was in medical practice adm. I was thinking wow, they even have a code for homeschool now, let me look it up b/c no other doctor has ever used it for any of my dc. The true definition of the code is what got me concerned.)

 

Monday I will request a copy of dd's medical records before doing anything else. I do not want it to be changed retroactively, or if it is I will have a copy of pre-change record.

 

There is no way the doctor can justify our socioeconomic circumstances can lead to a health hazard. (we are not well off, but sitting in middle class, living in a middle class neighborhood, in a middle class part of town. I don't work outside of house, but dh is employed.) I will need her to explain what psychosocial circumstances she thinks are contributing to problems related to education and literacy & then what those problems are. Out of curiosity, does anyone know what things fall under psychosocial circumstances?

 

Needless to say, I am stressed out. I either need to get the coding issue solved or there is the potential for a serious issue with my dd, the doctor didn't share it with me, what could it be????

 

(here's the thing, dd does have some educational issues. we didn't talk about them in either visit & they are not apparent in that kind of setting. dd is literate. dd participates in a group for speech therapy with other fifth graders at the local school. her speech disfluency is practically nonexistent & not noticeable to an untrained ear anymore. this is her last semester of speech therapy. there are much more appropriate codes for speech issues. Z55.9 doesn't seem to address this issue at all.)

 

I loved our last pediatrician in Saratoga Springs, NY. I erred in selecting this particular pediatric practice here in our new location in IL. :(

 

 

Do you know any local HSers?  http://www.apachecentralillinois.org/

 

 

It's worth a call to ask for a Dr. referral from other HSers in the area.  Also, they need someone to alert them to the coding problem.  Honestly, that is something that I would miss if no one said anything.

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Thanks for asking. I am trying not to freak out/over react, so I didn't rush into anything. Will call the office tomorrow & ask to speak with the doctor, make an appointment if needed. I did post about this medical office using this code on a local homeschool fb page.

 

My problem is that I don't want to be the overreacting, irrational mother. But, I do want the code removed from her medical records. I have proof that the code is on medical records shared with other medical offices as another doctor's office asked me about it. The office nurse telling me not to worry, the code is just used for their own use is not true. (how dumb does the office think parents are?!?)

 

I will share if I do get a resolution.

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  • 2 weeks later...

 

Needless to say, I am stressed out. I either need to get the coding issue solved or there is the potential for a serious issue with my dd, the doctor didn't share it with me, what could it be????

 

(here's the thing, dd does have some educational issues. we didn't talk about them in either visit & they are not apparent in that kind of setting. dd is literate. dd participates in a group for speech therapy with other fifth graders at the local school. her speech disfluency is practically nonexistent & not noticeable to an untrained ear anymore. this is her last semester of speech therapy. there are much more appropriate codes for speech issues. Z55.9 doesn't seem to address this issue at all.)

 

. :(

 

His actions are causing you to worry, but there is no rational basis for his diagnosis. He did not do an assessment. I hope that you can put that out of your mind. However, your worry is "pain and suffering" inflicted by inappropriate diagnosis without assessment. This is his issue and has nothing to do with your dd. 

 

I agree with your plan to get the records first.

 

I also agree with other posters to after that go through the medical board and the insurance company and then to an attorney if you cannot get the code removed. 

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