Last week’s column discussed the fact that knowing what diagnostic codes doctors have reported to your insurance company can help you get the right care, understand exactly what doctors see when they look at your records, and avoid insurance denials.
Even if the codes recorded are accurate, it still pays to know what they mean. You may uncover surprises that can improve your understanding of your own condition, and help you explain it better to other doctors you see.
For example, some time after I’d had a bicycle accident that took much of the skin off my forearm, a doctor asked, “Did you ever have cellulitis in that arm?” Mistakenly assuming that “cellulitis” meant something closely related to “cellulite,” I said no.
It was only years later, when reviewing my medical records, that I discovered a diagnostic code a doctor recorded when the arm had become redder and even more painful. The code translated into cellulitis.
I turned to the Mayo Clinic online to get definitions of the two words. Cellulite is “lumpy, dimpled flesh on the thighs, hips, buttocks and abdomen. . .[and] isn’t a serious medical condition.” Cellulitis, on the other hand, “is a common, potentially serious bacterial skin infection. . . [that] can rapidly turn life-threatening.”
While, as far as I know, I didn’t suffer any harm by giving the next doctor the wrong information, I easily could have. And whose fault would that have been? Mine, for not knowing my own medical history in the language that doctors use.
Doctors could help if they translated their questions into plain language. If I had been asked, “Did that arm get infected?” I would instantly have known to say “yes.” But doctors may forget that patients don’t necessarily know the medical language that is second nature to them.
In a second example, a doctor recently asked me about an injury that occurred more than two decades ago: “Which metatarsal broke?”
Unfamiliar with the terminology, I couldn’t say. Later, I looked up a picture of feet with the bones labeled, and checked the diagnostic codes on the bills from the orthopedic specialist who had treated the injury. I was surprised to discover that I hadn’t broken my little toe, as I had always thought, but had broken the long bone that connects the toe to the midfoot.
In this case, little harm was done as a result of my failing to understand the diagnostic code, but it is easy to imagine how such misunderstandings could lead to problems – including the unsettling sense that other people have a better grasp of what’s happened with your body than you do.
To find the meaning of specific diagnostic codes, search online for CMS ICD Code Lookup.
