Cracking the code—why labels don’t matter so don’t drive yourself crazy

post reply Forum Index » Kids With Special Needs and Disabilities

1 2 3 4 5 ► Go

Go to page...

10/01/2015 12:54

Subject: Cracking the code—why labels don’t matter so don’t drive yourself crazy

quote

Anonymous

Parents, to be your kid’s best advocate, remember it’s an extremely imprecise numbers game. Don’t get hung up in the IEP meeting, “But my kid’s not autistic!” It may be true, but focus on the end game—what help does your kid need to function and succeed at school.

There are 3 categories of 504:
http://www.kidslegal.org/section-504-what-does-it-mean
The purpose of Section 504 is not about getting special education services for your kid rather about preventing discrimination.

There are 13 categories of disability listed under IDEA:
http://www.parentcenterhub.org/wp-content/uploads/repo_items/gr3.pdf

Lawmakers defined and wrote these in the 1970s: http://dredf.org/advocacy/comparison.html

(It’s not a secret that Congress is slow to respond and fraught with partisan politics that it doesn’t get much done. Our current 113th Congress and the 112th enacted fewer laws than any other Congress in modern history, so at least we have something: http://www.nbcnews.com/politics/first-read/113th-congress-not-least-productive-modern-history-n276216)

There are over 300 codes in the DSM and it is published by the American Psychiatric Association so there is standard langue in classifying mental disorders. It’s on it’s 5th edition since 1952. Not perfect, but again what we have.

Doctors use ICD codes (International Classification of Diseases) to specify diagnoses. Insurance companies use these codes to determine coverage of services and reimbursement. In the ICD 9 which established in the 1970s, the are about 4,000 codes. In the proposed ICD 10, there will be 72,000 codes: http://www.npr.org/sections/health-shots/2014/04/10/300976034/doctors-billing-system-stays-stuck-in-the-1970s-for-now

(Just for fun, here is a list of where ICD and DSM codes cross-over: http://www.dr-bob.org/tips/dsm5a.html)

To make it more fun, ICD codes don’t need to match insurance billing codes for neuropsychological testing (NPT or CPT). Many insurance companies don’t consider neuropsych testing medically necessary for educational purposes b/c ha, ha, ha it’s “usually provided by school systems under applicable state and federal rules.” Schools aren't required to test, they can't legally suggest that you test your child, and do not have to accept independent testing you do.

CPT codes used in neuropsych evals are “time based codes for billing.” http://www.codapedia.com/topicOpen.cfm?id=B19F9E03-8CA3-48DE-85F96AA3F38CC8D5 As an FYI, here’s a list of CPT codes: https://www.theaacn.org/userdocuments/neuropsychology_model_lcd-1.pdf

Have I lost you? Is your head spinning yet? The point is that, a medical diagnosis is not the same thing as an educational designation at all. It may not have any bearing on what insurance coverage for services you receive, if your child is eligible for an IEP or 504, or what will be offered on an IEP/504.

In a nutshell, out of a potential 72,000 possible diagnoses and treatments and the 300 of them could possibly apply to your child, and the dozens of codes the insurance company will use to deem it medically or non-medically necessary, the public school needs to put your kid in 1 of 16 categories. That's it. Ta Da!

So, don’t get hung up on the public school “label” on your kid’s 504 or IEP—designations created nearly half a century ago. Ask yourself what accommodations and modifications does my kid need? e.g.,: http://www.wrightslaw.com/info/fape.accoms.mods.pdf

Now focus, focus, focus—what help does my kid need and how do I get it? Labels don’t matter. Substance does.

Good luck and Godspeed.