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

[Anonymous]

Anonymous wrote:

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.

OP here: Thank you! This is hugely helpful.

[Anonymous]

NP who has seen psychiatrists for most of her life here.

By all means ask the doctor about it.

But I would encourage you to understand that diagnoses are for insurance companies. They truly don't matter much outside of that. They are just labels from the DSM that potentially inform what meds the insurance company is willing to pay for. A good psychiatrist evaluates and treats symptoms. There is a huge amount of symptom overlap in psychiatric conditions. And your DS's symptoms are what they are whatever you (or the doctor or the psychologist or whomever) call them.

[Anonymous]

Anonymous wrote:NP who has seen psychiatrists for most of her life here.

By all means ask the doctor about it.

But I would encourage you to understand that diagnoses are for insurance companies. They truly don't matter much outside of that. They are just labels from the DSM that potentially inform what meds the insurance company is willing to pay for. A good psychiatrist evaluates and treats symptoms. There is a huge amount of symptom overlap in psychiatric conditions. And your DS's symptoms are what they are whatever you (or the doctor or the psychologist or whomever) call them.

LCSW from above. I completely disagree with the above, particularly the bolded. This kid came in with a previously established ADHD/anxiety diagnosis. DMDD is a completely new class of mental health issue her son has been labeled with that will absolutely affect the care he gets going forward.

[Anonymous]

Anonymous wrote: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.

You should definitely ask. WHen I have in the past I was told that the physician or staff picks the codes most likely to be paid by your insurance company

[Anonymous]

Anonymous wrote:

Anonymous wrote:NP who has seen psychiatrists for most of her life here.

By all means ask the doctor about it.

But I would encourage you to understand that diagnoses are for insurance companies. They truly don't matter much outside of that. They are just labels from the DSM that potentially inform what meds the insurance company is willing to pay for. A good psychiatrist evaluates and treats symptoms. There is a huge amount of symptom overlap in psychiatric conditions. And your DS's symptoms are what they are whatever you (or the doctor or the psychologist or whomever) call them.

LCSW from above. I completely disagree with the above, particularly the bolded. This kid came in with a previously established ADHD/anxiety diagnosis. DMDD is a completely new class of mental health issue her son has been labeled with that will absolutely affect the care he gets going forward.

OP here: This is what I feared. I also don’t know anything about DMDD other than what I’m now reading on the internet which seems quite severe. And doesn’t particularly describe my son. The diagnosis at 14 is also concerning as based on my brief look it seems to be diagnosed between 6-10 and is only something that applies to those under 18 and then falls under an anxiety/depression diagnosis.

I’m only spinning my wheels here because there was no conversation at all.

[Anonymous]

Meanwhile, OP, I’m over here assuming it was a coding because insurance policies changed and this got you the most coverage 🙃

[Anonymous]

My DS has a diagnosis of ADHD and DMDD. He was 10 when we received it, along with the ADHD diagnosis.

Here is my extreme laymen's opinion on it generally.

Whoever puts together the DSM wrongly eliminated the emotional dysregulation component of ADHD. To account for it separately, this DMDD diagnosis is tacked on.

For us, I don't think it helps insurance-wise but maybe it does.

[Anonymous]

Anonymous wrote:My DS has a diagnosis of ADHD and DMDD. He was 10 when we received it, along with the ADHD diagnosis.

Here is my extreme laymen's opinion on it generally.

Whoever puts together the DSM wrongly eliminated the emotional dysregulation component of ADHD. To account for it separately, this DMDD diagnosis is tacked on.

For us, I don't think it helps insurance-wise but maybe it does.

NP but fwiw, DS has SEVERE adhd. All hyperactivity symptoms, evident from infancy, diagnosed at age 3, required medication at age 4. Still very severe at age 12. Just a physically very intense, unable to slow down or stop his body moving kind of kid. I've had many teachers over the years make comments like "we see a lot of kids with ADHD diagnoses and 504s and special accommodations, and a lot of them seem like a stretch, but then you see a kid like Larlo and realize that ADHD does actually exist."

DS has zero emotional dysregulation. Never has. Is the opposite, in fact. Extremely emotionally even keel. So emotional liability is not a part of DS's ADHD.

Ultimately, what this mostly points to is the fact that the DSM and insurance codes are NOT science and not gospel. Just a roomful of people trying to categorize stuff that probably shouldn't be categorized.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My DS has a diagnosis of ADHD and DMDD. He was 10 when we received it, along with the ADHD diagnosis.

Here is my extreme laymen's opinion on it generally.

Whoever puts together the DSM wrongly eliminated the emotional dysregulation component of ADHD. To account for it separately, this DMDD diagnosis is tacked on.

For us, I don't think it helps insurance-wise but maybe it does.

NP but fwiw, DS has SEVERE adhd. All hyperactivity symptoms, evident from infancy, diagnosed at age 3, required medication at age 4. Still very severe at age 12. Just a physically very intense, unable to slow down or stop his body moving kind of kid. I've had many teachers over the years make comments like "we see a lot of kids with ADHD diagnoses and 504s and special accommodations, and a lot of them seem like a stretch, but then you see a kid like Larlo and realize that ADHD does actually exist."

DS has zero emotional dysregulation. Never has. Is the opposite, in fact. Extremely emotionally even keel. So emotional liability is not a part of DS's ADHD.

Ultimately, what this mostly points to is the fact that the DSM and insurance codes are NOT science and not gospel. Just a roomful of people trying to categorize stuff that probably shouldn't be categorized.

I'm not saying that everyone with ADHD has emotional dysregulation. It is a frequent feature, though. My other kid has dyslexia and he can do several things very well that people with dyslexia aren't supposed to be good at...yet he still has dyslexia.

I agree that the DSM is not gospel. Some people do like to take it as such, including some posters on this forum. DMDD can be a very serious diagnosis. For us, it's inappropriate and should be included under the ADHD umbrella.

[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.

Yes this, ask what this new dx is based on.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My DS has a diagnosis of ADHD and DMDD. He was 10 when we received it, along with the ADHD diagnosis.

Here is my extreme laymen's opinion on it generally.

Whoever puts together the DSM wrongly eliminated the emotional dysregulation component of ADHD. To account for it separately, this DMDD diagnosis is tacked on.

For us, I don't think it helps insurance-wise but maybe it does.

NP but fwiw, DS has SEVERE adhd. All hyperactivity symptoms, evident from infancy, diagnosed at age 3, required medication at age 4. Still very severe at age 12. Just a physically very intense, unable to slow down or stop his body moving kind of kid. I've had many teachers over the years make comments like "we see a lot of kids with ADHD diagnoses and 504s and special accommodations, and a lot of them seem like a stretch, but then you see a kid like Larlo and realize that ADHD does actually exist."

DS has zero emotional dysregulation. Never has. Is the opposite, in fact. Extremely emotionally even keel. So emotional liability is not a part of DS's ADHD.

Ultimately, what this mostly points to is the fact that the DSM and insurance codes are NOT science and not gospel. Just a roomful of people trying to categorize stuff that probably shouldn't be categorized.

I'm not saying that everyone with ADHD has emotional dysregulation. It is a frequent feature, though. My other kid has dyslexia and he can do several things very well that people with dyslexia aren't supposed to be good at...yet he still has dyslexia.

I agree that the DSM is not gospel. Some people do like to take it as such, including some posters on this forum. DMDD can be a very serious diagnosis. For us, it's inappropriate and should be included under the ADHD umbrella.

What's the difference between DMDD and what you see as classic ADHD emotional liability?

[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.

.

I don’t know what people are telling you to expect to be charged for asking about the code or to not expect it to be removed. That’s not my experience at all. Psychiatric diagnosis codes are incredibly subjective. When a new one pops up, if I disagree with it, I always ask, and they have always removed it if I had a problem with it.