Completing my list of billing code errors

This post will complete (I hope!) the list of errors that I discovered in the billing data that forms part of my medical records. The original post is here.

As I said in the the previous post, “Let me make clear, I personally have only one agenda: to empower, equip and enable engaged patients to get control of, and be responsible for, their medical records. To me this is a fundamental step toward participatory medicine, in which patients play an active role in their own care, in partnership with their providers.”

Thanks to Dr. John Halamka, CIO of my hospital (Beth Israel Deaconess Medical Center), and to my primary physician Danny Sands for his generosity in spending hours digging through records to confirm what I’ve written here.

Again, my point here in opening up my medical records is to give e-patients an example of what can go wrong. Please do not punish Beth Israel Deaconess for their cooperation and transparency.

From everything I’ve heard, what you will read here is not unusual. Those of us who work in data know, this is a natural consequence of not having effective process controls on how data gets into systems. And that’s how our healthcare universe is today.

This is why you need to get your butt in gear and see what’s in your data.

(For those who want more details, the ICD-9 billing codes are listed here and the Wikipedia page about ICD codes is here. Our post on other medical data formats is here.)

Two abbreviations to explain:
NOS = Not Otherwise Specified, i.e. “Other”
NEC = Not Elsewhere Classified, i.e. “Other,” again :–)

Here are the additional oddities and errors we found in my billing data.

255.9 Adrenal Disorder N0S was entered 1/5/07, the day of my very first exploratory CT scan. At this point all we knew was that I had something in my lung – nothing about anything adrenal.

705.83 Hidradenitis, armpit or groin cysts, was entered 1/11/07, when I got the abdominal ultrasound where we first saw the tumors in my kidney. Hidradenitis can’t be diagnosed with any form of radiology, not to mention that the ultrasound only touched the belly.

424.2 Nonrheumatoid Tricuspid Valve Disease was entered 3/19/07, on a visit to get an infusion of Zometa, a drug to fight the bone metastasis in my femur. I don’t have valve disease; never did. (Besides, why would this be coded by orthopedics?)

529.0 Glossitis (inflamed/red/swollen tongue) was coded on 3/21/07, when I came in with a lump growing out of my tongue. I never had an inflamed/swollen tongue. However, there’s probably no separate code for “lump growing out of the tongue,” so the way they entered it into the record had to be wrong. For billing that’s fine; but if you read it as clinical reality, you get a false reading.

733.90 Bone & Cartilage Disease, NOS also appeared that day. No idea why this would appear during a clinic visit for a lump on my tongue.

V15.82 History Of Tobacco Use was coded while I was in the hospital having my leg repaired, after it broke from the cancer. (I’d quit smoking ten years earlier; strange time to enter that as a billing code.)

129 Intestinal Parasitism NOS (ringworm etc): I never had this, but it was coded on a visit where I was getting another infusion of Zometa. (3/26/07)

733.13 Pathological Fracture of Vertebrae, 8/6/07: Never had this either. This was coded during a follow-up visit to orthopedics, but it’s not a diagnosis they made. The code was repeated just a few weeks ago, on 3/30/09.

995.0, Anaphylactic Shock (severe allergic reaction), 7/16/07. This was the final week of the Interleukin treatment that saved my life. It did indeed cause my blood pressure to drop precipitously (a common side effect), but I did not have anaphylactic shock. Having this in my record could give a future physician important wrong information about allergies.

V10.83 History of skin cancer, NEC: Yes, in 1980 I had skin cancer. Not sure why it entered my record during my final week of Interleukin.

441.2 Thoracic Aortic Aneurysm (9/10/07) – I mentioned this in my original post, and now we have details: the radiology report for this CT scan does say the aorta measured 43x43mm, which is <1/8” larger than the normal limit of 40×40. Billing data cannot convey those details, so when “aneurysm” showed up in Google Health, it looked like something very different.

Three months later the radiologist’s report said “The heart, great vessels and pericardium are unremarkable,” but there was still a (different) billing code for aneurysm.

560.2 Volvulus Of Intestine appeared on that same scan. It’s a life-threatening kink in the colon, which I never had.

438.85 S/P CVA (Status=Post CVA, i.e, “patient had a stroke sometime in the past”) With Vertigo. This was entered when I went in to check out a dizziness episode. Vertigo yes, but stroke?? Never. Note: this is an example of how a similar-sounding code might be sufficient for billing but completely misleading if used as clinical history.



Again, don’t punish the transparent! Please don’t read this list as an indictment of the one hospital that has helped us understand this. From everything I’ve heard, this kind of folly or error is common just about everywhere.

So: what’s in your wallet?  To find out, ask your providers – all of them – for copies of your records. Ask for  your clinical data as well as your billing records. It’s the first step toward taking responsibility for your own medical information, and taking control of your health.

You can do it.

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Posted in: e-pts resources | hc's problem list | medical records | pt/doc co-care | reforming hc | trends & principles

 

 

Comments

10 Responses to “Completing my list of billing code errors”

  1. ePatientDave says:

    New on e-patients.net: Completing my list of billing code errors http://bit.ly/wGQVN

  2. […] patients play an active role in their own care, in partnership with their providers”.” Article e-Patient Dave, e-Patients.net, 19 April […]

  3. ePatientDave says:

    New on e-patients.net: Completing my list of billing code errors http://bit.ly/wGQVN

  4. ePatientDave says:

    New on e-patients.net: The rest of my billing code errors http://bit.ly/wGQVN (repeat of overnight tweet)

  5. James says:

    The question is WHY? Why care about this now? For 100 years the docs have done all this crazy stuff and just kept the papers to themselves. Now we all have to make this our business! I think that is part of the reason why everyone is so “busy” and “tired” all the time! Let the docs do the medical records, let the taxmen do the taxes, etc. I am a video engineer. I don’t expect my doctor to understand super 8 tape or how to do a smooth cut transition. Why should s/he expect me to know an 802.11 b code for my pancreasee is broken!? YEAH! HELL YAY!

  6. LaFleur says:

    James, you are a doofus maximus!

    Dude, if you don’t watch this stuff and some RN puts down: “James has allergy to PENACILLEINS!” then you might be up in that and dieing and stuff and NEED a abibiotics!! That would = PENACILLEINS! It *should* save your life but since you didn’t bother to check taht medical error just killed you since you get some crap like Amox or something (which is NO WHERE NEARLY AS STRONG AND POTENT AS THE PENACILLEINS!! I LEARNED ALL THIS B/C I’m A “DOCROT OF PHARMACY” which is like a doctor but BETTER_-we TEACH the studpid doctors about drugs nad medications and salves and unguiments and stuff–you have konw i dea how little those dudes know!!!!1) so that would be the end of you, right Darwin! (ha ha! j/k to all my creationist bros! I’m down with that, 4 realz).

    So in sum, check it. you NEED to.

    Yours,

    LaFleur (not my real name of course!)

  7. Eddie Dean says:

    It’s nice to know that you guys are helping educate the world about cancer. Thanks for the post.

  8. Alison says:

    Dave, I noticed you didn’t address any privacy concerns. Let’s say a patient uploads their health data to google–which includes an admission for chemical dependency/detox. Their insurance company or workplace discovers this, and fires them. They couldn’t turn around and sue for a HIPAA violation if they’ve released the data themselves. Just something to think about.

    • Actually, Alison, privacy concerns were tops on my list (and published) long before this post was written. I’m sorry I don’t have time to dig it out but if you’ll trace back through the links, you’ll see that way back in January 2008 I wrote something that said “Fat chance” to the idea of giving my private information to any service like this.

      AND you’ll see that in early 2009 I decided I wanted to step beyond that, to help encourage innovation by exploring what these tools could do. This was a personal choice, and I never urged any other individual to overrule their own privacy preferences.

      Of course I have VERY strong opinions about the morality of an insurer or employer taking the action you describe…

  9. […] which I’d asked for). They’d submitted billing codes for conditions I never had (blog post), […]

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