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A petabyte of health insurance prices per month

blog.turquoise.health

31–40 of 275 posts

Re: A petabyte of health insurance prices per month

#31

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

Here's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W6…

Those are ICD codes, which are not the same as billing codes. ICD represent diagnoses, not services rendered.

ICD codes also are somewhat procedural in their generation - that is, there's a whole grammar to how they're formed. For example, you'll have something like "contact with", then a whole number of different animals, and then each of those will have three different varieties (initial encounter, subsequent encounter, sequela). So it does end up with very funny lists, like the one you posted, but:

(a) most of those codes are never used, and

(b) just because it's assigned just means that it's a "grammatically valid" combination, not that it has any particular clinical relevance.

The goal is to assign granular and hierarchical codes at the outset, to allow for more robust analysis later, at least in theory.

But again, all of that is irrelevant to billing, because while ICD codes are typically submitted along with the billing info (along with a whole other slew of data), ICD codes are not the actual code that's billed - there's a whole separate list of codes used for billing.

Re: A petabyte of health insurance prices per month

#32
post #6

They are making it impossible to handle the data so everyone gives up trying so they can go on screwing people over.

Hanlon's razor. Never attribute to malice what can be explained by stupidity. The US healthcare system is a mess, but I don't think it's intentionally malicious. It is just a mash of a thousand different systems, creating one big stupid system.

It's absolutely intentionally malicious, despite the individual employees not having much say... have you ever tried to bounce between calls to get information for an insurer from a hospital billing department? they can make vogons look efficient

I've spent hours trying to get an estimate for a inpatient surgery only to find out afterwards that the surgeon used a different billing code than the billing department gave me

then the insurance company won't cover it because it's not the billing code they cover, and the hospital won't change the billing code

Re: A petabyte of health insurance prices per month

#33

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

The initial/subsequent encounter coding seems to refer to the encounter with medical personnel (for the specified issue), not the number of times the same issue has been encountered by the individual. Which is maybe a good thing for recipients of T18.5XXA.

Re: A petabyte of health insurance prices per month

#34
post #8

They are making it impossible to handle the data so everyone gives up trying so they can go on screwing people over.

While the pitchfork argument may be appealing, the actual article makes a convincing case that it's just combinatorial expansion: > As a result, the Transparency in Coverage rule requires insurance companies to do the math for patients and, in most cases, publish prices as dollar amounts. That’s helpful for patients, but it requires that a price be pre-calculated for every possible service. ... So, they could publish…

[deleted]

Re: A petabyte of health insurance prices per month

#35
post #6

They are making it impossible to handle the data so everyone gives up trying so they can go on screwing people over.

Hanlon's razor. Never attribute to malice what can be explained by stupidity. The US healthcare system is a mess, but I don't think it's intentionally malicious. It is just a mash of a thousand different systems, creating one big stupid system.

If it’s stupidity, then I would assume they wouldn’t be making so much freaking money.

Re: A petabyte of health insurance prices per month

#36

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

Nuanced but important distinction: these are ICD-10 diagnosis codes. They are only loosely related to what is billed and would not show up in the pricing data referenced by the OP.

Re: A petabyte of health insurance prices per month

#37
post #25

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

My personal favorite is V97.33XD "Sucked into jet engine, subsequent encounter."

> My personal favorite is V97.33XD "Sucked into jet engine, subsequent encounter."

If you were sucked into a jet engine, you'd probably sustain serious injuries, so hopefully you'd have a followup visit with your doctor about it after the fact, rather than just one single visit.

(Yes, I get that you're joking, but that's what "subsequent encounter" actually means.)

Re: A petabyte of health insurance prices per month

#38

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

The nominal reason for the (seemingly insane) billing codes is the codes are based on ICD-10. The ICD (International Classification of Diseases) system was supposedly originally developed for epidemiological tracking.

Re: A petabyte of health insurance prices per month

#39

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

Here's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W6…

But why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion?

Re: A petabyte of health insurance prices per month

#40

Earlier quoted context omitted.

Here's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W6…

Beagle Boys health records probably have a lot of W61.6... on their files.

Ducktales?
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