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A petabyte of health insurance prices per month

blog.turquoise.health

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Re: A petabyte of health insurance prices per month

#61

Post by natosaichek »

valleyer wrote: post #52
maweaver wrote: post #39

Earlier quoted context omitted.

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?

Because, like it or not, a doctor's discretion can sometimes be self-serving. The more treatments a doctor gives, the more they get paid, and there is an enormous information imbalance between doctor and patient. (As in, they went to medical school, and you didn't.) Unfortunately, some doctors are willing to take advantage of this.

It's kinda ridiculous that because it costs x billion in doctors overcharging, we'll spend 100x on administration to control costs. Cutting off one's nose to spite one's face and all that.

Re: A petabyte of health insurance prices per month

#62

Post by arcticfox »

mensetmanusman wrote: post #53
bradgessler wrote: post #20

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…

"I'd like to file a complaint. This is my fourth time being bitten by a duck not my second time. You have overcharged me!" This is possible in America today. Great job post ww2 employer coverage side effects!

As others have explained, the subsequent encounter is for a follow-up visit, not a repeated duck attack.

Re: A petabyte of health insurance prices per month

#63

Post by none_to_remain »

chimeracoder wrote: post #37
pc86 wrote: post #25

Earlier quoted context omitted.

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.)

There's at least one guy who got partially sucked into an engine but caught up on something before his head reached the blades.

Re: A petabyte of health insurance prices per month

#64

Post by FireBeyond »

thomascgalvin wrote: post #15

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…

> 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."

All this means is "first visit", as in "I need immediate attention for this", and "subsequent encounter" doesn't mean "another duck" it means "follow up for X, but it's already been 'counted' (and presumably the care is less acute)" (i.e. for statistical purposes, "X,000/year people bit by ducks".

Re: A petabyte of health insurance prices per month

#65

Post by thomascgalvin »

vsareto wrote: post #30
thomascgalvin wrote: post #15

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…

IIRC the "initial encounter" refers to the first visit between the patient and doctor about the duck bite, and "subsequent encounter" means a follow-up visit about the issue, not a second maiming by the duck. It makes for a fun first impression though

That does make more sense, but I refuse to let go of the image of a duck with a vendetta tracking some poor bastard down, and the stalwart medical coding technician who is dutifully documenting it all.

Re: A petabyte of health insurance prices per month

#66

Post by [deleted] »

bradgessler wrote: post #20
thomascgalvin wrote: post #15

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…

[deleted]

Re: A petabyte of health insurance prices per month

#67

Post by NoMoreNicksLeft »

pc86 wrote: post #25
thomascgalvin wrote: post #15

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."

I'm having trouble being sympathetic with this one. Maybe he does deserve to have this claim rejected.

Re: A petabyte of health insurance prices per month

#68

Post by chimeracoder »

marcus0x62 wrote: post #48
chimeracoder wrote: post #31

Earlier quoted context omitted.

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 enco…

That's really interesting, because I had a customer that did nothing but provide medical billing services, and about 15 years ago when the industry was moving from ICD-9 to ICD-10, that customer seemed really focused on their billing coders learning ICD-10.

> That's really interesting, because I had a customer that did nothing but provide medical billing services, and about 15 years ago when the industry was moving from ICD-9 to ICD-10, that customer seemed really focused on their billing coders learning ICD-10.

I mean, sure? You can't bill for a service without a diagnosis code that justifies the service. Anyone who does medical billing is going to need to be able to format that data. But ICD codes are not the codes that insurers are billed for - billing codes are completely separate and not even determined by the same party.

Re: A petabyte of health insurance prices per month

#69

Post by yardie »

Medical billing coder is one of the most bullshitiest of bullshit jobs. Even when I was chatting with a coder a while back and she was explaining to me, a programmer, her job. And in the back of my mind I'm thinking, "I'm sorry, but why does this job exist?" I guess in the government's battle against medical fraud they have created a convoluted system that is even easier to defraud.

Re: A petabyte of health insurance prices per month

#70

Post by arcticfox »

marcus0x62 wrote: post #42
chimeracoder wrote: post #37

Earlier quoted context omitted.

> 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.)

If a person were sucked into a jet engine, they'd be turned into soup. Maybe they could be poured into a container and the doctor could subsequently encounter them in that state.

https://twitter.com/NavalInstitute/status/123054297912482202...

Here's a video of a guy getting sucked into a jet engine and surviving. Most, of course, do die.

I don't quite understand why everyone is so bothered by the extensive ICD taxonomy; it clearly needs to be extremely extensive to cover even fairly common scenarios, and once you're past the point that things can be easily managed why not cover everything?

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