Serious question...

[Shikima]

Looking at ICD-10 coming out and reflecting on DSM....

Is it really necessary to differentiate if a mood disorder is mild, moderate or severe?

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[Therapist4Chnge]

Absolutely.

A mild depression looks considerably different than a severe depression. There are also metrics (e.g. BDI-2) that go with each term.

 

[Monkey House]

Yes - treatment is very different for each type. In some cases CBT may be appropriate and meds not the first line - in others cases the exact opposite.

 

[whopper]

IMHO it does lend to better treatment cause now I have an idea of how the patient was doing in terms of severity. This does matter.

 

[Therapist4Chnge]

I think outside of psych the ICD-10 may be a bit more unwieldy. I actually prefer the greater detail (from the cursory review I've done of ICD-10 coding), but I'm concerned with how insurance will "adjust" to things.

 

[Shikima]

Sure I get that you use the severity of depression as a metric to determine how they present initially and how they respond to the subsequent treatment. I agree with this point.

But is it really necessary for diagnosis codes? It is going to change the outcome? Change the billing amount?

And I really disagree that treatment really changes significantly.... You'll add and combine medications towards symptoms remission, they may/may not agree to talk therapy and in reality you won't be using a 'different' kind of CBT for example.

 

[F0nzie]

A waste of time IMO

 

[hamstergang]

But is it really necessary for diagnosis codes? It is going to change the outcome? Change the billing amount?

I could see insurance companies deciding that various severities warrant different services -- more time inpatient, more frequent outpatient visits, etc. Or is this not the case? I don't know, I'm just making things up.

And I really disagree that treatment really changes significantly.... You'll add and combine medications towards symptoms remission, they may/may not agree to talk therapy and in reality you won't be using a 'different' kind of CBT for example.

If I deemed the depression mild, I would not recommend medication first line but instead recommend therapy. If severe, I would recommend medication first line. So it does matter in my view.

 

[Shikima]

Actually, severity of depression is not an admitting or continued inpatient criterion by insurance companies. And you'll want the least restrictive environment for care anyways as insurance companies and courts prefer this.

And it's also splitting hairs if medication vs talk therapy will be first line in mild depression. I'm not so concerned or focused upon that point, rather, does billing mild/moderate/severe depression matter?

 

[TexasPhysician]

It's important for insurance companies to find ways of denying payment for services. Not to mention that it takes up non-billable hours to learn new codes.

 

[Shikima]

It's important for insurance companies to find ways of denying payment for services. Not to mention that it takes up non-billable hours to learn new codes.

This.

Or is it a government conspiracy?

 

[clausewitz2]

Our resource utilization people pitch a fit if someone is on our inpatient unit with a non-severe mood disorder. They claim they get more push back from insurance in these cases.

 

[notdeadyet]

Our resource utilization people pitch a fit if someone is on our inpatient unit with a non-severe mood disorder. They claim they get more push back from insurance in these cases.

Which seems fair. Why on earth would someone with mild depression be hospitalized?

 

[Shikima]

So, why have mild, mod, or severe?

Depression is depression. The NV symptoms are different for each person, with and without anxiety. Some have psychosis and some don't. HPI is responsible for this along with a ROS.

 

[Therapist4Chnge]

Depression isn't a homogenous disorder, so I don't think it can be boiled down to depression is depression.

 

[Shikima]

Depression isn't a homogenous disorder, so I don't think it can be boiled down to depression is depression.

Right... so, how can we concretely say mild, moderate, or severe?

 

[st2205]

Which seems fair. Why on earth would someone with mild depression be hospitalized?

Because the system and our society is not equipt to deal with the backlash of calling a spade a spade.

I have too much to say about this thread. I'll have to return later, but I tire of how steadfastly we justify the positive results of measures that are meant to help the bottom line of insurance companies but is sold under the euphemisms of "better care" and "improved outcomes." It closely resembles the scam of training where any task labeled "educational" suddenly has the whole system falling at its feet admiring the emperor's handsome attire.

 

[Ceke2002]

I can see the differentiation being necessary/useful for treatment formulation, monitoring of treatment response, and so on, but why on earth would an insurance company need to know the ins and outs of a duck's behind when it comes to what you're treating a patient for? Why is it any of their business in the first place? You're the Psychiatrist, you've deemed it necessary that this patient requires treatment, you denote what that treatment should be owing to the fact that you're the one who actually went to medical school, so unless the insurance companies have their own Doctors to independently examine the patient themselves and decide the patient does not in fact require treatment, then the insurance companies should just mind their own business and let you guys get on with your jobs (which I imagine would be a lot easier if you didn't have umpteen dozen different billing codes to deal with).

 

[Shikima]

I won't even get side tracked with pharmacists attempting to dictate pharmacologic management based on the side effect profile and BEERS list only.