Bay 12 Games Forum

Not legal advice. No one here is a client. If you take legal advice off the internet, then you are stupid. One size does not fit all. Contact a lawyer licensed in your state/country if you have legal issues. Please No quoting. Thank you. This is based entirely off the information that has been supplied here by others and should not be relied upon by anyone for anything.

1.) I recommend you delete that section of medical record you posted. While it does not appear to contain any sensitive information, you never know.

2.) ADA is complicated. You can be referred to a licensed attorney who practices in your location: Be disabled, describe disability, impact of disability on job, proposed reasonable accommodation. Cannot be an "undue hardship," on the company ($ or operational changes). Those are basics but it is not all cut and dry like that at all.

3.) Having done several med mal cases, and worked for several healthcare concerns, here are some of the abbreviations that might be giving you issues:
Pt: Patient
PT: Physical Therapy (Not to be confused with Pt, lowercase).
R: Right side (but you probably knew that).
Supine (laying down on your back)
A/P: Assessment and Plan (What the physician thinks and what they might consider doing about it.
Neurectomy: A surgical removal or destruction of a nerve.
RLE: Right Lower Extremity (Right Leg).
RLQ: Right Lower Quadrant (The lower right side of the abdomen)

4.) Records Problems: "even if the original hospital system is being stupid and not wanting to give me records or saying it's been too long for them to retain them."

While I have the utmost respect for physicians, nurses, technicians, CNAs (Certified Nursing Aides), and most everyone else in the healthcare field, unfortunately there exist stupid, overpaid (making easily 6 or 7 figures) healthcare administrators who do not understand HIPAA, and refuse to listen to reason. These are overwhelmingly NOT physicians, but rather have an MBA/MPA for what should have been a law degree, but is no longer commonly the case.... Many of these people exist for no other reason than to boss around actual doctors and maximize profits at your expense. Several fail to understand that HIPAA stands for Health Insurance Portability and Accountability Act (of 1996), and the accountability is theirs to demonstrate not to demand.... I've seen them try to hide medical records in cases where surgical instruments have been left inside people. Patients have certain (although not absolute) rights to their medical records in many circumstances. https://www.law.cornell.edu/cfr/text/45/164.524 While I cannot represent you, let me tell you, hospital administrators hate it when a judge rules they have to pay the attorneys' fees for being stupid and explaining this to their board of directors is simply not fun for them.

This is another reason you can be referred to an attorney for, and thankfully now that the government shutdown has been averted, the good people at US HHS OCR (United States Department of Health and Human Services Office of Civil Rights) may factor in....

https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

If the original hospital refuses to see reason,

https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html?language=es

Bottom line, there are ways to get your medical records and an appropriate referral to the right attorney can result in this. Said referral can be through PM as your location information even at the state level should always remain private for your benefit. Suffice it to say I once had a hospital deny me a copy of my medical records (and they would not even give me them if I paid them a fee of any amount). In the event the hospital stupidly destroyed your records too soon and or improperly against the required records retention policy, then that would explain to future decision makers why you could not get records was not your fault.

5.) I always recommend taking the polite, professional route. Never lead with the links above, or impolite force of any kind. Rather these are nuclear options of last resort. As you may know, everyone has a boss somehow or another, and you don't know if the person telling you "no," is only following orders ... and might even prefer to assist you. It seems your immediate supervisor ("boss") is on your side. This is good and tactically advantageous to know someone higher up is the problem. Your boss also told you what to ask the physician to write in a note (about car rides being a problem). Hopefully the physician can be asked to accommodate this to appease the higher up. The physician's duty is to the accuracy of the medical truth to assist the patient. However, many doctors are intelligent and respond well to a polite request if appropriate. I am glad your physician has told you they will write whatever is needed.

If you have a good professional relationship with your boss you might consider asking him or her for advice (assuming they can give it to you, possibly without notifying the higher up person/getting in trouble).

The question is how does this end, and how does it end well? What is the person in HQ looking for? What is that person's reservation to granting what you are asking (costing money? changing business practice? fear of someone abusing the system (possibly after some jerk did so in the past and ruined it for the rest of us)?, fear other employees would also demand the same and they couldn't provide it? avoiding the wrath of an owner/investor in the business?, triggering some sort of regulation? tax issues (where you and other employees work physically may have tax implications, especially at the city/county level, and state level if more than one is involved)? It may or may not be a legit issue, and someone may or may not be handling it correctly/well. I bet there's more information that you aren't being told as to why they are holding this up if your injury is "open and obvious" as you use an assistive device to ambulate.

Not legal advice. No one here is a client. If you take legal advice off the internet, then you are stupid. One size does not fit all. Contact a lawyer licensed in your state/country if you have legal issues. Please No quoting. Thank you. This is based entirely off the information that has been supplied here by others and should not be relied upon by anyone for anything.

Not legal advice. No one here is a client. If you take legal advice off the internet, then you are stupid. One size does not fit all. Contact a lawyer licensed in your state/country if you have legal issues.
Please No quoting. Thank you. This is based entirely off the information that has been supplied here by others and should not be relied upon by anyone for anything.

Before anything else. True then; true now. Glad to see you growing still.

[reads all that.....] O wow.... You know this is all suspect as hell, right?

1.) "Standard," does not exist. Period. No exceptions, and least of all in probate court. I have seen fortunes spent correcting "simple will" mistakes on "cheaper" preprinted forms. I think my old boss liked charging way more to fix other people's mistakes in that garbage than he would have just doing a will/trust. This quote is music to my ears, "someone here once told me there's no such thing as standard with this stuff, and I can read." That was me telling you that. Hi. I can't tell you how many morons have tried to go in front of a judge and say, "Uh, I thought it was standard." Moron #1 says this, and is followed by Moron #2 saying the exact opposite is also "standard." Reading matters. I am glad to see you doing that.

This is not standard. I do not do that, and I have not seen anyone I work with do that. Let me ask you something, if it is "standard," then what happens if/when your mom cannot be healthcare POA? Who takes over for her if she is "unwilling or unable?" Is it you? If not, who? How is this determined? Is it the "same" as that section you quoted? If not, why not, and how is that "standard?" I have no idea why anyone would list the successor executor/POA/whatever with such a blatant conflict. I am assuming you have a copy of this, seeing as you are sort of quoting/paraphrasing it. Do not post the will/documents in public, but just think about that to yourself when you hear that nonsense. Having no ability (or I'm sorry, desire) to read the whole thing, there may be other issues which cannot be determined if there are "mistakes" like that....

2.) Untruth. I'm sorry but I call B.S. on uncle. If that was a drafting mistake in his original will right after it was made, he would have called up his lawyer and had it fixed. Especially if it was a drafting mistake he was completely unaware of. This has happened before, and it just got fixed as long as it was an honest drafting mistake (as opposed to somebody changed their mind for the umpteenth time, again, this week, and that revision costs $ so somebody finally makes up their mind). It can be a pain to get new witnesses/attestation and a certification where applicable, but on the rare occasion somebody legitimately messed up something in any office I was in, right after it was issued, we just fixed it/redid it. Whoever botched something may have gotten a stern talking to but.... If he does not want her 2nd in line.... This is fixable; if he does not fix it, then why not? Same reason he does not remove her entirely....

Additionally, I am wondering why any of this other nonsense is happening. Let me get this straight, she ... talked him into disinheriting a special needs relative so she.... could be put in the will.... That's messed up. I'm sorry but wow. I just can't imagine how that conversation must have went. Something smells rotten in Denmark here. You are not being told the whole story.

3.) Bypass for SNT Implementation Possibility (Special Needs Trust). Ask yourself and answer yourself quietly, if you are a substantial beneficiary/heir in his will? If not, why not (this is a lot of work and responsibility you will end up doing). If so, if/when you inherit things, you may consider establishing a special needs trust for the special needs relative. This is dependent upon several things. 1.) How big a pie slice mommy dearest managed to secure for herself in the will (thereby diverting funds from the special needs relative), 2.) If you can even possibly get anything sufficient to establish a special needs trust for the special needs relative, and 3.) Medicaid, etc.... Special needs trusts largely, legally shelter funds from Medicaid recovery for those with disabilities/special needs. This brings us to....

4.) Medicaid spend down/recovery. You are correct on the 5 year lookback period (generally) and that the idea is to plan ahead. No idea why he is not. This could endanger a lot and end up with the state paid long before you/anyone else. I am a little shocked his lawyer did not bring this up with him. Makes me wonder if he is being stubborn/in denial it might happen to him. I've seen it before.

"Medicare [but mostly Medicaid) could wipe out just about all his assets if he ends up in a home without a trust." Other programs might too. However, you also need to know if he is on traditional Medicare (Parts A, B, and D), or a "Medicare Advantage" (Part C) (usually worse) plan. If you stay in this role, you are going to have to get to know him and how he does stuff.

5.) Dealing with her. For whatever reason, uncle is unwilling to find somebody else to be healthcare POA. This makes no sense based upon what you have said. We called this, "setting up an avoidable conflict," as you previously indicated. Possibly unknowingly, uncle has put you in a hell of a position, by directly incentivizing her to get you to quit so she can rule. Frankly, is there a mechanism in writing for you to overrule her in this messed up situation (or are you just relying on state law, etc)? For that matter are there provisions requiring someone else to sign off on her healthcare decisions (e.g. a doctor or 3). Are you just supposed to rely on whatever legal mechanism (probate court, lawsuit etc), and if so will uncle's lawyer be handling that, presumably with the estate paying it?  If not, are you supposed to just somehow manage this yourself?

Recap: This is a mess.

"Standard," is a lie. This is not standard. You are not being told the whole truth. Depending on several variables, it might be possible to do something for special needs relative. Medicaid spend down is important. Dealing with your mom is going to be a challenge. That said, is all of this worth it to do? If not, withdrawing will have costs, familial, social, and probably being written out of whatever will, etc. If so, then prepare to deal with her as best you can knowing it will be a mess. Also, if you leave, she takes over, from what you are saying.... If you stay, then you will have to out think, outfox and outmaneuver her. This will involve matters including but most definitely not limited to paper trails. If he wakes up and actually (unlikely) sees the need to replace her and do something about Medicaid spenddown, then who would take her place? If she stays in that role, what is the check and balance on her? Several, reasons to be concerned. It is regrettable you got put in this situation and there is no easy way out.


Not legal advice. No one here is a client. If you take legal advice off the internet, then you are stupid. One size does not fit all. Contact a lawyer licensed in your state/country if you have legal issues.
Please No quoting. Thank you. This is based entirely off the information that has been supplied here by others and should not be relied upon by anyone for anything.

Now if you'll excuse me, I have to be grumpy and work some more on Labor Day, due to a colleague's critical mass of stupid, but at least I'm getting credit for it this time.

[Please do not quote:]

RPL, you magnificent bastard, you know exactly how to bait me with someone getting screwed over who doesn't deserve it, don't you? Hi there. How're you doing?

[Looks around, reads, slight grumble, other noise {very possibly a grumble, but unconfirmed}, reads more, sips coffee. Screw it. Operator inbound.... ]

Hello Weird. Good to see you. I do not know if a technical material piece like this would be in a public library, but good thought. Constructive. Informative, as always friend.

\....

Hi again Fem. Long time no see. You were always nice to me.... As this is clearly a theoretical exercise only....

What are you coding for/what insurance in your example? {Answered via other means Medicare, o joy} Consult your MAC, and ask them. Document that you asked them and their response.
What are the dates of service in your example?

Context is key in coding, as I imagine you know. I may request more details, especially before thinking of providing anything like a code ... in this example.

______________________________________________________

I imagine you want this thing I probably don't have a copy of: (See page 40 out of 54)

https://commerce.ama-assn.org/catalog/media/cpt-assistant-index-2019.pdf

Spine and Spinal Cord Code Changes, 7, 2012, Jul, 3,
01996, 0274T, 0275T, 0276T, 0277T, 62267, 62287, 62290,
62310, 62311, 62318, 62319, 62367, 62368, 62369, 62370,
63001, 63003, 63005, 63020, 63030, 63035, 63056, 64484,
64633, 64634, 64635, 64636, 72275, 72295, 77003, 77012,
95990, 95991

?


______________________________________________________

Back when I most certainly did not help run hospitals if popular belief is to be trusted (O, it is, it is), CPT manuals and the CPT assistant were nice sources on this. I do not know if I have a paper copy or where I might have stored that paper copy, which I most certainly know nothing about. That's my story and I'm sticking to it.

If there is anyone who could locate one? I also would be interested in this. The above documentation may assist anyone helping in this search. Please assist in this assistance
__________________________________________________________



Correct coding is an entirely different matter, fraught with difficult (unappreciated) technical matters. Make sure (what I assume to be the physician you are coding for gives you) the operative report copy to double check. I certainly hope no one is pressuring you to code 63056, which is an very invasive procedure code, for something done with an endoscope....

The three things that you need to worry about with this particular fiasco you inadvertently walked into were likely thrown into through no fault of your own and I'm going to get you out of are as follows.

A.) Correct Coding
B.) Experimental and Investigational 
C.) CYA / whoever threw you into this has (wrong) expectations you will have to manage.

A.) Correct Coding
Naturally, you will wish to know the operation and methodology performing it, including surgical approach.

The surgical approach is important, as is the area operated on (thoracic or lumbar, etc?). https://coder.aapc.com/cpt-codes/63056
 Exploration/Decompression Procedures on the Spine and Spinal Cord

63055: Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg herniated inter vertebral disc) single segment thoracic
* See CPT Assistant Nov 99:36; CPT changes an insider's view 2000

63056 LUMBAR (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc

63057 each additional segment, thoracic or lumbar (list separately in addition to code for primary procedure
(Use 63057 in conjuction with 63055 and 63056)

AMA CPT 2012 professional edition, p. 323


63056 is an open procedure. Traditionally, I have always understood open procedures to be "cutting someone open" verify for correct coding.
The RVU (relative value units) for 63056 are about 3x more than the next possibly permissible code (3x the cost). Use it if it's the right procedure, but not if it isn't.

The dates of service are paramount, especially in this situation, which I am not commenting upon.

IN 2017, CMS issued a separate code for endoscope procedures like this under CPT code 62380

https://www.health.ny.gov/health_care/medicaid/ebbrac/docs/2017-12-08_endoscopic_decompression.pdf

B.) Experimental and Investigational 
There are certain dangers you must be aware of when coding this particular matter. First and foremost, you must be absolutely sure this procedure is not a PILD/MILD (percutaneous or minimally invasive), as several insurances do not pay for them (double check with your Compliance Officer). Medicare does not cover PILD/MILD except in a clinical trial with specific registration requirements. Some physicians have tried passing PILDs off as 63055-63056. Don't. The auditors know to look for this and they do not care. Again, review with your Compliance Officer.

IF THIS IS A PILD, which my jaded self can't help but think.... Then this will likely be denied by most insurance as an experimental and investigational procedure (and your doctor will hate this answer but for insurance purposes, meh). And, CMS has already answered this ....

https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=269

In a move it certainly does not get any credit for, the government considered covering this back in 2013 or so. Wanting to be a responsive and responsible decision making body, they solicited comments from experts in the feild and reviewed every piece of scientific literature they could get their hands on, while asking for more.Summarily the literary evidence was not fantastic, standards were not sufficiently consistent and their methodology was .... we're going to say not great. Basically, it was found not to be covered except in clinical trials to gather more evidence.

CMS also addressed subjective comments from physicians in the feild who favored the procedure and said it should be covered, like so:

"General Issues

Comments: There were numerous comments from physicians who perform the procedure who reported anecdotal good outcomes and few to no complications or adverse events for their patients. A number of commenters pointed out that patients who do not improve still have the option of continuing with non-surgical care or opting for open decompression.

Response: CMS appreciates the input of the many physicians sincerely conveying their personal experience with PILD. However, evidence from well-designed methodologically robust clinical studies is more persuasive to draw confident conclusions about the impact of medical technologies. As we state in the General Methodologic Principles in the Appendix to this decision memorandum, anecdotal reports are subject to biases and do not carry the evidentiary weight of methodologically appropriate clinical studies."

In other words, CMS has heard all of this and steadfastly refused to care in writing.

In the Event that it is percutaenous via an endoscope prior to 2017, but after 2011, then it may be in danger of falling into 0275T (note the category III CPT code for emerging tech and procedures, hence experimental and investigational. If it is prior to 2011, then I fear you may fall into 84.99, which is other procedure on relevant anatomy..... If that's the case, then you need to be very careful, because it will be likely be denied recouped if put under 63056. More info needed.

C.) CYA / whoever threw you into this has (wrong) expectations you will have to manage.

You need to review this with your compliance officer, and experienced coding staff, preferably CPC (Certified Professional Coder). Again, ask your MAC for guidance, preferably in writing to CYA. The physician you are coding for may have a strong opinion on this matter. He or she may very well be an excellent doctor, and I assume he or she is. This isn't about medicine, this is about insurance and having someone pay for it. At the end of the day, this isn't about restricting what your physician does, but if the insurance company won't pay for it, or won't pay for it at a higher level billing, then that's an admin issue. Nobody wants an auditor saying things weren't coded. If the physician you are coding for wants this code for an endoscope procedure, then be the following is advised:

I.) Always be respectful, as this physician is very experienced and probably means well, but the insurance (is always blamed on the coder if it goes south)....
II.) CYA, and make sure you have multiple opinions verifying this procedure is the exact code. It isn't about disputing the operation (that's the Dr.'s call), it's what to bill it under.
III.) Respectful diplomacy, while CYAing and documenting to show you did your job.

Summary:
MAKE SURE 63056 is the right code. MAKE SURE this is not a PILD. MAKE sure you document to CYA.
Consult your Compliance Officer, and ASK YOUR MAC, before you bill and document that you did so, their response, etc. (See also CYA).

This is not coding advice, but rather an assistance attempt to point you in the right direction, your compliance officer/MAC, and to gather additional information.

Again, I apologize that I do not have the document you requested, but hopefully this helps both generally, and specifically with more information for anyone who can find it. If found, please make available, as I would also enjoy access. Thank you.

[Please do not quote, come on, I'm just dropping in to help a bit and then operator outbound].

Really?

Max, you keep right on following me, and quoting me after being asked not to when I've already convinced one person not to report you this week when you derailed his thread. I am attempting harmony as opposed to disharmony. It's only monday and here you are on thread derail 2?

http://www.bay12forums.com/smf/index.php?topic=157225.msg7889001#msg7889001

I could quote his remark about phlegm and forks, but it's better to do this:

Hey Lord Shonus, may I ask if you agree forks go in mouths? Based on your prior post do you also not like putting forks in your mouth after somebody else put one in theirs?

It does seem to pop up more or less every single time Truean shows up.

I rarely show you anymore, because when I do, usually to help people, he shows up.....

Will you please stop following me and expressly doing this stuff.... the last post just.... wow.

I have actively helped you avoid trouble. Please stop.

Yes. Very yes.

Finally, somebody gets it: both generally and specifically.
You are too good to be true, merely for saying this.
At the certainty of sounding but not being stoned, are you real?

Quote from: Robot Parade Leader on November 18, 2018, 05:07:05 pm

What am I supposed to do with this? Like, how is this supposed to help me? At all?

It helps if you let it.
Look at it this way. In a few decades you'll be dead and nothing will have changed. What happens between then and now is up to you. There's no point suffering during that time. Sit, breathe, remember everything is going to be fine.

The alternative is some batshit ascientific nonsense about dimensions with no mathematical rigour or meaning, which is basically the same as pyramids and crystals and Chopra, ie, a way to rationalise your suffering instead of stopping it.

O wow..... Here I was typing up a peacemaker post, about misunderstandings, and that I'm sure he wouldn't have said that to one of the people they're talking about replacing with machines..... I mean especially when they're asking for help.... We just got him out of a bad job.... But wow, "Look at it this way. In a few decades you'll be dead and nothing will have changed."..... Wow, that ... has to be the least hopeful thing I've heard in a while, and I... I'm saying that .... looking over my jade colored glasses rims.... Jesus. I've been cold as hell before but ... wow. I'm trying to be better.

Dude, are you ok man?

What ... are ... you doing?

Different people are in different positions, and a lot of them can't just "let it." Life isn't that easy, especially not for a lot of people.... There's nothing the retail clerk can do when the customer goes ballistic on them for no good reason, because that job pays the rent and food. People in that spot have no choice. If you read through this thread, OP has given examples like that....

This guy has some issues, is trying to avoid drinking, drugs, an unethical boss who got fired for being unethical, and stuff.... We worked through unethical boss, got him another job, stopped the drinking, and we're getting him stable. Have been, for a couple years now....

Say whatever you want. Two words, "It worked." Results. They happened, and keep happening.

This isn't the first time I'm helping someone here.... You're not trying to help him, not with statements like that.

So ask yourself within your own mind again what you are doing...? How do you expect anyone to respond to statements like you made?

You are ad homming the OP, when they've done nothing to you. He has never done anything but ask for help we could give. Please, tell me this is clicking? Jesus, a little empathy, and compassion?

Furnaces:

Spent $1000 last year on repairs. (Issue persists).
Spent $200 so far this year for a guy to install a vent (to give it more air. Done this morning; issue persists).

Issue: It won't run with the door off. Green light flashes 3 times (I understand that to be an inducer issue).



Odd, considering just had vent installed. I need to leave without coming back to frozen pipes....
Guy is coming back. Not sure if this will be another charge, or if this will fix it. Here's hoping to resolve it soon.