Using Medical Diagnoses in Neuropsychological Evaluations

[Balmoral]

For those that conduct neuropsychological evaluations, do you include medical ICD in your formal diagnoses (especially if you were the one diagnosing them)? I typically just use the DSM V diagnoses but I have seen some, from psychologists, that formally list ICD medical codes such as photophobia, vestibular imbalannce, nausea, diffuse axonal injury, etc.

When these things occur, I discuss them in my summary/conceptualization but I don't make it a practice of actually listing them formally under my impressions.

Anyone do this? Maybe in medical settings? I guess my question is related to scope of practice. Thanks for any feedback!

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[Therapist4Chnge]

I only use ICD-9 Dx's, as 99% of the referrals I receive are for medical conditions.

IMHO the DSM-V is a steaming pile of hot garbage.

 

[WisNeuro]

I will only diagnose those things for which I have explicitly evaluated. Otherwise noting patients report and chart review conditions in other areas of my report.

 

[AcronymAllergy]

I will only diagnose those things for which I have explicitly evaluated. Otherwise noting patients report and chart review conditions in other areas of my report.

Ditto. If the patient reports vestibular imbalance, for example, I'll mention that in the report, but it's not something I'd directly assess or diagnose myself.

ICD codes are typically included when filling in billing/encounter information, though (e.g., memory problem, personal history of traumatic brain injury, etc.).

 

[WisNeuro]

Yeah, when filling in billing/encounter I throw in whatever the referral question is (TBI/Dementia/memory loss/etc). For my diagnostic section though, if I didn't evaluate it, I don't diagnose it. Way too many chart diagnoses based on no actual eval IMO.

 

[PsyDr]

In Mary Pepping's book, "how to start a private neuropsychology practice", the author indicates that billings operate by a "rule of 3". In other words, in order to get something under medical vs. mental health, 2 out of the 3 parts have to be medical. The PhD/PsyD is already one in mental health. The procedure code for neuropsych is considered medical. If you use an ICD-9 it goes under medical. If you use a DSM, it goes under mental health. Reimbursement nuder medical is slightly higher but with less BS on the insurance side.

Reading it so you don't have to.

 

[Balmoral]

I will only diagnose those things for which I have explicitly evaluated. Otherwise noting patients report and chart review conditions in other areas of my report.

Ditto. If the patient reports vestibular imbalance, for example, I'll mention that in the report, but it's not something I'd directly assess or diagnose myself.
ICD codes are typically included when filling in billing/encounter information, though (e.g., memory problem, personal history of traumatic brain injury, etc.).

Yeah, when filling in billing/encounter I throw in whatever the referral question is (TBI/Dementia/memory loss/etc). For my diagnostic section though, if I didn't evaluate it, I don't diagnose it. Way too many chart diagnoses based on no actual eval IMO.

Thanks this has been helpful. I definitely see how medical codes are included for billing/encounter purposes, it just threw me when I saw neuropsychological evaluations that listed medical Dx in their diagnostic impression section. I guess even with the neurological screens I do, I'm less comfortable diagnosing them myself and refer to the neurologist/specialist for confirmation. For example, when I suspect visual neglect, I'll note it in my conceptualization and refer to a neuro-opthal. Mainly much of my concerns are related to mTBI cases...

 

[AcronymAllergy]

Thanks this has been helpful. I definitely see how medical codes are included for billing/encounter purposes, it just threw me when I saw neuropsychological evaluations that listed medical Dx in their diagnostic impression section. I guess even with the neurological screens I do, I'm less comfortable diagnosing them myself and refer to the neurologist/specialist for confirmation. For example, when I suspect visual neglect, I'll note it in my conceptualization and refer to a neuro-opthal. Mainly much of my concerns are related to mTBI cases...

"Personal history of traumatic brain injury"

That's about all I'll typically include for mTBI.

And agreed with respect to listing the (other) medical diagnoses in my own diagnostic impressions section. I feel like you're opening yourself up for liability there, as it's potentially coming across as though you've diagnosed that condition yourself. For dementia, TBI, mood disorders, etc., sure; for hypertension, diabetes, CKD, etc., nope.

 

[WisNeuro]

Bottom line: If you are listing pre-existing diagnoses, just make it clear that it's from chart review. If you are listing conditions as suspected and want to make a recommendation that a qualified provider should rule it out (e.g., suspect chronic ischemic change, sleep apnea, etc) just make sure that you are not offering a diagnosis, just suspect that it is there and may be contributory.