What to take to new PCP?

[Clematis]

I’m taking a break from figuring out how I will spend my $1.5 billion, which I am confident I will win, to figuring out what to take to an appointment with a new PCP on Monday. This will be my first doctor visit of any kind since my DS surgery November 12. She will of course be clueless about the DS but she will also be clueless about me in general. A new patient coming in with an unknown surgery performed in Mexico could freak her out. I don’t want to come on in my usual rabid way and overwhelm her. I was thinking of bringing her the following printouts (no thumb drive as apparently she is not computer savvy and still uses a paper chart):

• Dr. K’s duodenal switch graphic
• DS surgeon’s report, including EKG and barium swallow DVD
• Tests results summary from past year, including day of surgery and former PCP physical in September
• Excel graph of prior lab work so perhaps she can compare future results
• Recommended semi-annual lab orders, first to be drawn in February

Anything else? Should I bring printouts of any DS research?

BTW, I’m feeling nervous about having “duodenal switch” added to my chart. Anything that happens to me from here on out will no doubt be viewed through DS glasses. And the entity that will always do so is my insurance company since bariatric surgery and any complications are not covered. (Fingers crossed that they’ll cover labs. Can lab orders be coded without using “surgically induced malnutrition?”)

 

[DianaCox]

http://bariatricfacts.org/threads/talking-to-your-pcp-about-the-ds.9/

 

[Clematis]

Thanks, Diana. I know you're sick of re-posting these things.

 

[Clematis]

Things went well with the new PCP. I truncated your letter @DianaCox to talking points so as to not overwhelm her. (attached)

 

[Clematis]

QUESTION:

I am trying not to alert my insurance company about my unauthorized WLS. How would my PCP phrase this? (She asked me.) Just omit the phrase "status post bariatric surgery"? Should she dx intestinal malabsorption or say suspected malnutrition without stating a cause?

Diagnosis: INTESTINAL MALABSORPTION, STATUS-POST BARIATRIC SURGERY ICD-10 Codes: K91.2, Z98.84, Z09

 

[DSRIGGS]

QUESTION:

I am trying not to alert my insurance company about my unauthorized WLS. How would my PCP phrase this? (She asked me.) Just omit the phrase "status post bariatric surgery"? Should she dx intestinal malabsorption or say suspected malnutrition without stating a cause?

Diagnosis: INTESTINAL MALABSORPTION, STATUS-POST BARIATRIC SURGERY ICD-10 Codes: K91.2, Z98.84, Z09

For labs my PCP uses nutritional deficiency

 

[Clematis]

For labs my PCP uses nutritional deficiency

Cool.

Do you know the ICD-10 codes for the semi-annual lab orders? The ones Diana mentions are strictly for bariatric surgery: K91.2 (POST-SURGICAL MALABSORPTION), Z98.84 (BARIATRIC SURGERY), Z09 (SURGERY FOLLOW-UP).

My new doc asked if I knew the codes to pin on each lab test. There is an old "annual lab" pdf from this site that uses old codes for malabsorption, weight loss, dehydration, fatigue, (I found a site to convert to ICD-10) and then on the old lab order is a list of vitamin deficiencies, but the codes were cut off the xerox. Does anyone know the codes for vitamin deficiencies or what I should tell my PCP? She's being exceptionally agreeable so I'd like to make it easy for her.

 

[BebeZed]

Cool.

Do you know the ICD-10 codes for the semi-annual lab orders? The ones Diana mentions are strictly for bariatric surgery: K91.2 (POST-SURGICAL MALABSORPTION), Z98.84 (BARIATRIC SURGERY), Z09 (SURGERY FOLLOW-UP).

My new doc asked if I knew the codes to pin on each lab test. There is an old "annual lab" pdf from this site that uses old codes for malabsorption, weight loss, dehydration, fatigue, (I found a site to convert to ICD-10) and then on the old lab order is a list of vitamin deficiencies, but the codes were cut off the xerox. Does anyone know the codes for vitamin deficiencies or what I should tell my PCP? She's being exceptionally agreeable so I'd like to make it easy for her.

No advice here but it is encouraging to hear that your PCP is being agreeable. Mine, not so much... but I'm switching on the first so hopefully I'll get one that at least LOOKS at the DS info packet I bring (she wouldn't include it in my records btw).

I'll need the same info so I'll just keep track of this thread so hopefully I'll have the info when I need it again in 3 months.

 

[southernlady]

Cool.

Do you know the ICD-10 codes for the semi-annual lab orders? The ones Diana mentions are strictly for bariatric surgery: K91.2 (POST-SURGICAL MALABSORPTION), Z98.84 (BARIATRIC SURGERY), Z09 (SURGERY FOLLOW-UP).

My new doc asked if I knew the codes to pin on each lab test. There is an old "annual lab" pdf from this site that uses old codes for malabsorption, weight loss, dehydration, fatigue, (I found a site to convert to ICD-10) and then on the old lab order is a list of vitamin deficiencies, but the codes were cut off the xerox. Does anyone know the codes for vitamin deficiencies or what I should tell my PCP? She's being exceptionally agreeable so I'd like to make it easy for her.

http://bariatricfacts.org/threads/generic-ds-lab-order.191/ New codes were added. I retired the slip that had the old ICD 9 codes.

 

[BebeZed]

http://bariatricfacts.org/threads/generic-ds-lab-order.191/ New codes were added. I retired the slip that had the old ICD 9 codes.

My PCP took one look at that list and told me some of the tests didn't exist... you just have to wonder about that. LOL

 

[southernlady]

My PCP took one look at that list and told me some of the tests didn't exist... you just have to wonder about that. LOL

YOUR PCP needs an education, LOL

I would say, just write the order and let me and the lab sort out whether they exist or not.

 

[BebeZed]

YOUR PCP needs an education, LOL

I would say, just write the order and let me and the lab sort out whether they exist or not.

That's eventually what I did... and then she said that insurance wouldn't pay for most of it and it would cost me "thousands of dollars." I said fine and got it but ended up going to Direct Labs because it was actually cheaper for me that way.

And yes, she need to be educated. The scary thing is... I may have to go back to that insurance in a few months because of an income change. You can bet I will fight them to get another PCP because that's ridiculous.

 

[Clematis]

thanks @southernlady That's exactly what my PCP needs.

 

[DianaCox]

First of all, is this a new insurance company since your DS? If it is, they CANNOT refuse you for treatment of a pre-existing condition, no matter what it is.

Second, if it is the same insurance company, I STILL don't think they can refuse to provide you with services for a medical condition you have acquired, no matter how. But just in case, you can have it coded as the current equivalent of 579.9: Short description: Intest malabsorption NOS

Convert to ICD-10-CM: 579.9 converts directly to:

• 2015/16 ICD-10-CM K90.9 Intestinal malabsorption, unspecified

 

[Clematis]

Same insurance company which does not cover bariatric surgery or related complications. There is nothing in the EOC that states they won't cover labs, per se, but that's never stopped them before. They could claim there wouldn't be a need for labs if I had not had an unauthorized surgery. better to try to avoid the problem than battle it out later.