Should I be concerned? Psychiatrist added new diagnosis code on insurance billing.

Anonymous
We had our first meeting with a new psychiatrist a few weeks ago. As I was going over paperwork for filing an out-of-network claim, I noticed that a new diagnosis code for DMDD was added. We just had a brief get-to-know-you conversation, and they only met DS virtually for 5 minutes. He was diagnosed with ADHD and anxiety on his neuropsych testing, so I'm wondering where this new diagnosis came from and if it should have been discussed with me prior to adding it to the insurance bill. Reading up on DMDD he doesn't seem to meet the criteria. Am I overreacting, or should I contact the new provider and ask for clarification?
Anonymous
Of course ask for clarification!
Anonymous
Yes, this is a serious diagnosis that should have been discussed with you, particularly since it’s not really aligned with the preexisting diagnoses.

FWIW ask for clarification but expect that they will probably try to charge you for that conversation.
Anonymous
OP here. Hopefully, it was entered in error. I assumed any new diagnosis would be discussed, especially something that doesn't seem to fit. DS is also 14, so it would be a very late diagnosis for this, and he doesn't have pervasive irritability or tantrums on a regular basis. We had a 30-minute conversation, and she met DS for 5 minutes, all virtually; he was pleasant and answered all of her questions. I would think that more would be needed to support that diagnosis. Hopefully, it will be removed until more conversation can be had or it was an error.
Anonymous
Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.
Anonymous
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


OP Here: It is so strange, though, that there would be no conversation about it! Should I continue with this provider or switch to someone else? I'm uncomfortable that it was added without any explanation or conversation. I really liked them initially as well! Is this something that will now follow my child to another psychiatrist?
Anonymous
Anonymous wrote:
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


OP Here: It is so strange, though, that there would be no conversation about it! Should I continue with this provider or switch to someone else? I'm uncomfortable that it was added without any explanation or conversation. I really liked them initially as well! Is this something that will now follow my child to another psychiatrist?


Dude take a breath and send a note to the doctor. Perfectly normal to ask. No need to spiral.
Anonymous
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


OP Here: It is so strange, though, that there would be no conversation about it! Should I continue with this provider or switch to someone else? I'm uncomfortable that it was added without any explanation or conversation. I really liked them initially as well! Is this something that will now follow my child to another psychiatrist?


Dude take a breath and send a note to the doctor. Perfectly normal to ask. No need to spiral.


Op Here. Thanks for that. I need to step off my ledge. Clearly, anxiety runs in the family. I sent an email and I'll wait to hear back from her.
Anonymous
Anonymous wrote:
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


OP Here: It is so strange, though, that there would be no conversation about it! Should I continue with this provider or switch to someone else? I'm uncomfortable that it was added without any explanation or conversation. I really liked them initially as well! Is this something that will now follow my child to another psychiatrist?


If you aren’t comfortable with the provider definitely change. When your kid needs psychiatric care, it’s always hard and not trusting your provider would make it unmanageable for me.

As to the diagnosis following, if a new provider asks for records then yes. As to not discussing with you, I’ve had it both ways - full discussions and discovering new things from reading records, getting a new prescription that wouldn’t be indicated for the diagnoses I new of, discussions with my kid, etc. there is no singular way it’s done.

One last thing from my experience. Each time we got a new psychiatrist there was some difference in the way the doctor viewed things. And over time, diagnoses evolve given that the same symptoms can be part of many diagnoses. Some of the diagnoses we’ve gotten were hard to hear and weren’t always apparent to us at the time. And sometimes one would give one diagnosis and the follow up one wouldn’t agree - such as inpatient versus outpatient long term provider.
Anonymous
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


OP Here: It is so strange, though, that there would be no conversation about it! Should I continue with this provider or switch to someone else? I'm uncomfortable that it was added without any explanation or conversation. I really liked them initially as well! Is this something that will now follow my child to another psychiatrist?


If you aren’t comfortable with the provider definitely change. When your kid needs psychiatric care, it’s always hard and not trusting your provider would make it unmanageable for me.

As to the diagnosis following, if a new provider asks for records then yes. As to not discussing with you, I’ve had it both ways - full discussions and discovering new things from reading records, getting a new prescription that wouldn’t be indicated for the diagnoses I new of, discussions with my kid, etc. there is no singular way it’s done.

One last thing from my experience. Each time we got a new psychiatrist there was some difference in the way the doctor viewed things. And over time, diagnoses evolve given that the same symptoms can be part of many diagnoses. Some of the diagnoses we’ve gotten were hard to hear and weren’t always apparent to us at the time. And sometimes one would give one diagnosis and the follow up one wouldn’t agree - such as inpatient versus outpatient long term provider.


OP Here. Thanks. Both our psychologist and new psychiatrist are with the Chesapeake Center and now have different diagnoses. Is this normal? I changed to a psychiatrist with the same practice for ease, but I might make a different decision depending on the new doctor's response. I would assume there would be some questions asked of my son prior to diagnosing something like this. Maybe a survey? He has had some behavioral issues at school lately but is generally well-liked. The behaviors just started in December when the social scene became more difficult for him to navigate. He's also 14, so I wonder how much of the irritability is a normal teen attitude, as he is helpful at home. On our call, we talked about social anxiety and RSD; DMDD wasn't mentioned.

We're getting our neuropsych testing updated, and I was going to use the Chesapeake Center again, but now I'm nervous.
Anonymous
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


OP Here: It is so strange, though, that there would be no conversation about it! Should I continue with this provider or switch to someone else? I'm uncomfortable that it was added without any explanation or conversation. I really liked them initially as well! Is this something that will now follow my child to another psychiatrist?


If you aren’t comfortable with the provider definitely change. When your kid needs psychiatric care, it’s always hard and not trusting your provider would make it unmanageable for me.

As to the diagnosis following, if a new provider asks for records then yes. As to not discussing with you, I’ve had it both ways - full discussions and discovering new things from reading records, getting a new prescription that wouldn’t be indicated for the diagnoses I new of, discussions with my kid, etc. there is no singular way it’s done.

One last thing from my experience. Each time we got a new psychiatrist there was some difference in the way the doctor viewed things. And over time, diagnoses evolve given that the same symptoms can be part of many diagnoses. Some of the diagnoses we’ve gotten were hard to hear and weren’t always apparent to us at the time. And sometimes one would give one diagnosis and the follow up one wouldn’t agree - such as inpatient versus outpatient long term provider.


OP Here. Thanks. Both our psychologist and new psychiatrist are with the Chesapeake Center and now have different diagnoses. Is this normal? I changed to a psychiatrist with the same practice for ease, but I might make a different decision depending on the new doctor's response. I would assume there would be some questions asked of my son prior to diagnosing something like this. Maybe a survey? He has had some behavioral issues at school lately but is generally well-liked. The behaviors just started in December when the social scene became more difficult for him to navigate. He's also 14, so I wonder how much of the irritability is a normal teen attitude, as he is helpful at home. On our call, we talked about social anxiety and RSD; DMDD wasn't mentioned.

We're getting our neuropsych testing updated, and I was going to use the Chesapeake Center again, but now I'm nervous.


I do think it’s somewhat normal to get a different or additional diagnosis when you get a new provider. They are looking at things from a new light. Personally I don’t think that’s a bad thing unless there is a contraindicationed treatment that is provided.

Another thing that changes is treatment protocol when you switch providers. Everyone has their own favorites when it comes to protocols. I think that can be helpful if you’re going through a rough patch. Of course it can also be disastrous.

DMDD is not a diagnosis we had so I don’t know what is considered. But I would expect that the interaction between the doctor and your son along with other information would have led to the diagnosis. Having behavioral issues at school sounds problematic even with teen hormones. Don’t know if that would lead to DMDD diagnosis though.

I wouldn’t be worried about the neuropsych testing. Chesapeake has a good reputation.
Anonymous
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


Don’t approach expecting it to be removed but to better understand what the clinicians is observing and how you can help support your child.
Anonymous
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


OP Here: It is so strange, though, that there would be no conversation about it! Should I continue with this provider or switch to someone else? I'm uncomfortable that it was added without any explanation or conversation. I really liked them initially as well! Is this something that will now follow my child to another psychiatrist?


If you aren’t comfortable with the provider definitely change. When your kid needs psychiatric care, it’s always hard and not trusting your provider would make it unmanageable for me.

As to the diagnosis following, if a new provider asks for records then yes. As to not discussing with you, I’ve had it both ways - full discussions and discovering new things from reading records, getting a new prescription that wouldn’t be indicated for the diagnoses I new of, discussions with my kid, etc. there is no singular way it’s done.

One last thing from my experience. Each time we got a new psychiatrist there was some difference in the way the doctor viewed things. And over time, diagnoses evolve given that the same symptoms can be part of many diagnoses. Some of the diagnoses we’ve gotten were hard to hear and weren’t always apparent to us at the time. And sometimes one would give one diagnosis and the follow up one wouldn’t agree - such as inpatient versus outpatient long term provider.


OP Here. Thanks. Both our psychologist and new psychiatrist are with the Chesapeake Center and now have different diagnoses. Is this normal? I changed to a psychiatrist with the same practice for ease, but I might make a different decision depending on the new doctor's response. I would assume there would be some questions asked of my son prior to diagnosing something like this. Maybe a survey? He has had some behavioral issues at school lately but is generally well-liked. The behaviors just started in December when the social scene became more difficult for him to navigate. He's also 14, so I wonder how much of the irritability is a normal teen attitude, as he is helpful at home. On our call, we talked about social anxiety and RSD; DMDD wasn't mentioned.

We're getting our neuropsych testing updated, and I was going to use the Chesapeake Center again, but now I'm nervous.


OP, I'm a therapist (LCSW), and I agree with much of what has been said. There is almost always a slight difference in the way the same patient is viewed diagnostically by different providers. Some of that comes from what kind of provider they are - as a social worker, my training skews toward folks' environments being major contributing factors to their psychological health while a psychiatrist will probably have a more medical perspective and a counselor might have a more relational perspective than me. We all consider all the things, but the door you come from can make a difference in perspective.

That said, you are correct about your son's age making him a bit old for this diagnosis. If you have not noticed irritability beyond the recent stuff, it is worth asking this provider for clarification about why this diagnosis is more appropriate than other things within the differential diagnosis, which it sounds like includes (at the very least) anxiety disorders and ADHD. It's just a conversation to have with this psychiatrist, but it's understandable that you'd be spooked based on there being a new thing and then reading about what that thing is. It sounds like an error and could be someone not charting "Major Depressive Disorder" correctly. I would not let this dissuade me from getting the testing updated there.
Anonymous
OMG this could have been a typo. Just ask.
Anonymous
Anonymous wrote:
Anonymous wrote:Definitely talk with the provider. But if the provider believes the diagnosis is correct, don’t expect that it will be removed.


Don’t approach expecting it to be removed but to better understand what the clinicians is observing and how you can help support your child.


Op here. 100% will do. It’s confusing because she talked to him for 5 minutes just to say hello and he was pleasant. I think it’s important to understand how she got the diagnosis as our upcoming appointment this week is where she was going to talk to him and make any diagnosis or medication suggestions. I wouldn’t even have been aware of this if I hadn’t decided to do all my out of network billing today.

He’s been going to his psychologist for 2 years once a week in person and that diagnosis wasn’t made. Happy to hear her reasoning.
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