Jump to content
CrazyBoards.org

ICD-10 code provided to insurance not matching dx one was told


Recommended Posts

Out of curiosity, I called my insurance company today and asked for the ICD-10 code my pdoc had provided them. It was f31.81, i.e. bipolar II. The thing is that my pdoc had always told me I was bipolar I, and I found this easier to believe than bipolar II since I have had psychosis in high moods, which according to the DSM5 is by definition mania, and indeed at one point my pdoc had told me I was manic (even though I didn't quite believe her). So why would my pdoc bill my insurance with something different than what she told me I was dxed as?

Link to comment
Share on other sites

According to this F31.81 is unambiguously bipolar II. My only thought is that she believes that psychotic hypomania is the thing (she has diagnosed me as having it in the past), and she's reconsidered when she's said I was manic (as at the time she thought I was manic because I was psychotic without being depressed or mixed, which made no sense to me and which I contested).

My thought on why she has not diagnosed me as SZA bipolar-type is that she does not really think I have ever really been normal mood while psychotic, but rather either at least mildly depresed or mildly hypomanic, that I don't really have characteristically SZ-like delusions or hallucinations (I do not hear voices at all, my delusions are only mildly bizarre at most*), and that I just have longstanding mild depression rather than negative symptoms.

* She did say that my delusion of thought broadcasting was SZ-like, though, when I told her about it.

Edited by Closure
Link to comment
Share on other sites

Were you diagnosed with Bipolar II originally? I know sometimes therapists and doctors keep won't update the code they bill under even when they've changed their working diagnosis. Basically, as long as it's not going to change insurance coverage, they'll often keep submitting the same information on claims rather than updating them every time. 

Link to comment
Share on other sites

24 minutes ago, thunder said:

Were you diagnosed with Bipolar II originally? I know sometimes therapists and doctors keep won't update the code they bill under even when they've changed their working diagnosis. Basically, as long as it's not going to change insurance coverage, they'll often keep submitting the same information on claims rather than updating them every time. 

This could very well be why.

Link to comment
Share on other sites

Also bipolar 2 and 1 are treated very differently for obtaining other forms of insurance, like life insurance. A bipolar 1 diagnosis on paper might bring practical difficulties. Maybe the bp2 diagnosis is just pragmatism, even if it doesn't match your symptoms.

Link to comment
Share on other sites

10 hours ago, Closure said:

According to this F31.81 is unambiguously bipolar II.

Oh my bad I was reading just the first page. Yeah they are all BPII aren't they. Hmm.. my only thought is for insurance purposes. Not sure why that would matter though. But I do know if it is an 'umbrella' code, usually insurances will accept it as a 'NOS'. 

Link to comment
Share on other sites

I wouldn't read too much into this until you speak with your pdoc. It's possible she made a mistake, or believes that BPII is easier to deal with insurance-wise. When I had to go on short-term disability, my pdoc listed my dx as Bipolar instead of Sz as it's easier for insurance companies to deal with.

  • Like 1
Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...