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Wednesday, July 25, 2012

He's In! (I think...)

The good news here is that Bob was approved for financial assistance for Outpatient Rehab. That means the hospital (God love them!) is picking up the $80.00 co-pay per visit and so it will cost us nothing!!!!

The bad news is the CODES that the doctor's office submitted for the insurance are still screwed up.... I talked with a woman in the office at Rehab and she said the doctor put down a code for CVA and Rehab doesn't "treat CVA" but treats "the symptoms" and she needed the codes for the exact symptoms to be treated, i.e. "gait" or "balance" etc. So I called the doctor's office and talked to a nurse who looked up Bob's chart but she said the doctor failed to put anything in the chart except for "CVA with right hemiplegia" but she said she would fax the paperwork again with a code for "right hemiplegia". Which she did. Which still, according to Rehab, is the wrong code....

So back and forth we went. With the nurse telling me that Rehab needs to do an evaluation first to decide the proper treatment needed and then, and only then, will she know the exact code to fax. And Rehab telling me that the doctor's office has to fax the right code before they can do an evaluation!

Last week, a woman in the Rehab office had told me that PT was approved, but not OT. This week, I'm told neither were approved yet.

All I can say is AAAAAARGH!

But back to the good news, the woman at Rehab scheduling decided to just "go ahead and get him scheduled and worry about the codes later". So Bob's first appointment is next Tuesday.

So we're off! I think.

Let's hope this all works out.


Willowangel said...

Hi D, I used to do ICD9 Coding for the hospital for many years. You can look up the ICD 9 codes that the doctor's office needs to write for Bob's rehab on the internet. Google "icd 9 code lookup" and put in his symptoms. They will provide you with the code. For Example:

781.2 Abnormality of gait
NOS (781.3)
difficulty in walking (719.7)
locomotor (progressive) (094.0)

719.7 Difficulty in walking
abnormality of gait (781.2)

V57.81 Orthotic training
Gait training in the use of artificial limbs

729.89 Other
abnormality of gait (781.2)
tetany (781.7)
transient paralysis of limb (781.4)

781.3 Lack of coordination
Ataxia NOS
Muscular incoordination
ataxic gait (781.2)
cerebellar ataxia (334.0-334.9)
difficulty in walking (719.7)
vertigo NOS (780.4)

Doctor's do not understand the codes. Billing personnal does that. The doctor just needs to give the billing people some symptoms to work with!

Jenn said...

Wow. Excellent bit of info!!! Can't go wrong there! Go for it!!!

Anonymous said...

Been in that "AAAAAAAAARGH" position so many times.....totally feel for you and all the hoops you have to jump through. Hugs, Dan

barbpolan said...

OMG, you encounter more bureaucratic nonsense than anyone I've ever heard of. But your persistence will beat it!

Rebecca Dutton said...

I'm so glad both you and Bob are getting help. When you finally get to therapy ask the therapist to recommnend a physiatrist who specializes in rehab medicine. Physiatrists know all about rehab codes.

Anonymous said...

Moving forward is great...So happy for you two...The codes will get figured out....

Anonymous said...

Wonderful website you have here but I was curious about if you knew
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I'd really love to be a part of community where I can get feed-back from other knowledgeable people that share the same interest. If you have any suggestions, please let me know. Kudos!
My page : phsycial therapy 10305

Diane said...

There is a great user discussion forum for caregivers of stroke survivors at

Helen M said...

Gaack! I disliked the ICD9 codes and E codes (for equipment parts)when I worked rehab. So much room for error and interpretation. It will get figured out though. Good luck.