General Question

LeavesNoTrace's avatar

Could someone please explain my diagnosis?

Asked by LeavesNoTrace (2387 points ) 2 months ago

As some of you who’ve read my past posts know, last year was a bit traumatic for me. My Mom passed away somewhat suddenly on New Year’s day 2013, I cut ties with my severely abusive father, ran away to Ecuador for five months, came back to NYC and started a new career, and finally ended a very complicated relationship on New Year’s eve 2014.

I’ve been seeing a counselor since December to try to work through some of the trauma. Overall, with everything I’ve gone through, I’ve felt surprisingly stable and strong. My work performance is good and my social life is decent. I get sad sometimes but usually I’m able to pull through and see the positives in my life despite the absolute hell and abusve I’ve been through.

My therapist says that I seem very well-balanced so I was shocked when I got a statement with a billable medical code (296.55) for “Bipolar I disorder, most recent episode (or current) depressed, in partial or unspecified remission”.

This is really surprising. My therapist never mentioned anything any sort of psych disorder so I emailed her for some clarification and asking if we could go with a less stigmatizing diagnosis for the sake of my work privacy (I don’t want HR seeing). She said we could talk about it at my next session but that it was “just paperwork” and “not a big deal”.

Has anyone else ever received this diagnosis? What does it mean?

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27 Answers

Smitha's avatar

Well she has not confirmed diagnosis of bipolar I guess she is just assessing you for bipolar. I guess you need to consult a psychiatrist who specializes in illnesses like Bipolar which is basically a medical disorder that effects behavior and the brain. Only they would be able to confirm. As for what you describe does not sound like proper psychosis, it sounds like psychological and stress induced. So it would be better to see a psychiatrist.

lynfromnm's avatar

I’m not sure counselors are qualified to diagnose anyone. Usually that takes a psychological evaluation. Your therapist may not think the terminology is “a big deal”; if it isn’t she should be willing to change it. If I may ask, has this person prescribed any meds? If so, what?
Bi-polar is not usually a term applied to a person who is working through a series of recent devastating events. I’m bothered that this diagnosis was never discussed with you, and I hope you take the opportunity to question your therapist closely at your next session. You have a right to know. If you are dissatisfied with your discussion, change therapists.

Judi's avatar

It is illegal for work to find out. They don’t get any of your diagnosis information and your insurance can’t tell them.
The only time this might present a problem is if you go to get life insurance.
Talk to your counselor. If she is not a psychiatrist I don’t know if she is even allowed to actually diagnose anything. She may have done to to insure that insurance would pay but that would piss me off. I would expect a diagnosis like situational depression or something. That might not preclude you from life insurance.

LeavesNoTrace's avatar

@lynfromnm I’m haven’t been prescribed any meds nor do I really want to take any. She’s a counselor, not a psychiatrist so she wouldn’t be able to prescribe anything if needed, I’d need to see someone else.

@Judi Thankfully, I’ve already gotten life insurance so I’m thinking it won’t be a problem.

Is anyone familiar with what Bipolar I Disorder, Most Recent Episode Depressed – In Partial Remission means? I’m not finding a good functional definition anywhere.

hearkat's avatar

In order to file a claim with your medical insurance carrier, the health care provider must provide a diagnosis code. The code chosen is not always the actual diagnosis, but sometime best representation of the complaint for which the patient sought treatment.

LeavesNoTrace's avatar

@hearkat Okay, I thought so as well. I’m still wondering why she chose this one instead of grief/bereavement which also has a code.

hearkat's avatar

@LeavesNoTrace – I don’t know much about how the DSM is structured, but since it is over a year since your mother’s passing, there may be time limits on the use of that code – this is purely speculation on my part. Another code to consider might be PTSD due to the history of abuse – one of my therapists used that with me, but that was over 20 years ago.

BosM's avatar

It’s an ICD-9 code used for billing Mental, Behavioral and Neurodevelopmental disorders (F01-F99). ICD-9’s are being phased out and replaced by ICD-10’s in Oct 2014. Check out the link below for more info.

From the literature it appears Bipolar disorder Includes manic-depressive illness, manic-depressive psychosis, and manic-depressive reaction. Your diagnosis may be related to one of the depressive conditions. Discuss this with your therapist, request a copy of your medical record, and ask if incorrect codes might exist. Medical Coders can make mistakes.

http://medishare.com/tools/icd9cm/296.55

JLeslie's avatar

Are you bipolar? Do you have manic episodes? Mental health records are really a problem in my opinion, in that the person themselves can be denied their own records! It isn’t like a regular medical record. I would ask your therapist why she thinks you are bipolar and not just depressed or anxious? Bipolar is not seen as fleeting, like depression can be. I don’t accept that she did it just for coding. For what? Insurance fraud? Do you get covered by insurance for bipolar and not for going through a really difficult time and being depressed? When I say I don’t accept it, I mean she should not be doing that, but she very well might have.

I hate our medical system for both physical and mental illness.

If you are bipolar you should be told so you can learn more about it. If you aren’t then you aren’t.

snowberry's avatar

I really hope you can get your therapist to reassign the code on this. If you’re not bi-polar, you really don’t want this “tag” hanging over your head, especially with Obamacare and the fact that everyone and his brother being able to read your business, HIPPA not withstanding (thanks, Obamacare)!

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hearkat's avatar

[Mod says] This is in General, so responses must be on topic. Discussion of health insurance coverage and medical records privacy should be discussed in a separate post.

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Cupcake's avatar

Is this helpful?

It seems as though you had previously been diagnosed with bi-polar. Is that true? If so, this code is just saying that you have been diagnosed with bi-polar and that your most recent episode was depressed (not manic)... which makes sense if you sought treatment after a death. You are in partial remission because you are currently undergoing therapeutic treatment (vs. full remission).

sujenk7422's avatar

Bipolar Disorder is used quite frequently these days and in my view is overused. Bipolar Disorder is a dysfunction in the neurotransmission of the brain, meaning that when a person goes through trauma his/her brain is wired to release these chemicals (in communication) to address whatever emotion being felt. The brain can make too much serotonin, dopamine or other chemical. When it dysfunctions in the synapse – releasing and reuptaking these chemicals – mania: being hyper, up and moving, creative, energetic or depressed: can’t get out of bed, goes without eating or bathing. These are the symptoms of bipolar disorder. Any licensed social worker or counselor can assess a person and assign a diagnosis. But to me you sound as if you’ve gone through a major loss, I can relate to losing your mom, I lost mine 11/2012 and still become overcome with sadness at times. Be careful with ready diagnosis because they can definitely attach a stigma to anyone who suffers from emotional issues.

LeavesNoTrace's avatar

@Cupcake No, I’ve never had the word “bi-polar” even come up until now. It’s all very unexpected, I don’t know what to think. She told me we can discuss it at our next session this week and that “it’s nothing major” and that “paperwork is just paperwork”.

I think she kind of arbitrarily assigned me a code for insurance purposes but due to privacy and stigma concerns, it’s really ruffled my feathers.

JLeslie's avatar

@LeavesNoTrace I can’t wait to hear her explanation. I still say it sounds like it skirts insurance fraud. I think doctors expect us to be happy we got our treatment covered no matter how it was accomplished.

hearkat's avatar

I agree with @JLeslie – If you have no previous history of bipolar, this is the wrong code; and if you have no suspicion of bipolar symptoms, than no bipolar code should be used. Something like this would be enough to shake my confidence in the therapist, depending on how she addresses your concerns. You could bring it up in a non-accusatory way, saying you thought it might be a data-entry mistake, that perhaps the actual code is one number off of the 296.55 on your statement. If she continues to downplay your concerns as she seemed to on the phone call – and especially if she indicates that the code used was the code she intended – you may want to suggest that you’re considering reporting her to regulators in your state and finding another therapist.

Providers have to take coding seriously, and can’t just put down something that they know will get paid. When I was in a hospital environment and we saw many rare and unusual cases, I spent a lot of time combing through the books (this was before everything was computerized) to find the correct diagnosis code; now one can type in keywords and have related codes listed – it doesn’t even take much effort.

Cupcake's avatar

@LeavesNoTrace I can’t believe you saw that diagnosis for the first time on your billing sheet. That’s awful. Every therapist I have seen has talked to me about the diagnosis code they will be using… I find anything else unethical.

I don’t get all of the comments about stigma. Who in the world would ever have access to your mental health care billing codes??

LeavesNoTrace's avatar

@Cupcake I wasn’t sure if my employer would for any reason.

Cupcake's avatar

@LeavesNoTrace No. Unless you signed releases with your employer and your mental health care provider that information could be shared (might be required for some jobs that have to monitor the mental health of their employees), diagnoses and billing codes will not be shared.

Even if you go out of work on disability, your employer will not have access to your medical records. They will have a third party review your medical record and make a determination on your coverage without sharing any medical information with your employer.

LeavesNoTrace's avatar

@Cupcake Thanks. I don’t think anything that serious will happen. I pretty weird, but not mentally unstable! :p

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sujenk7422's avatar

In order to “treat” someone they must have a “diagnosis”, it’s all about payment from your insurance company. Without a diagnosis, payment will not be made! Have your counselor give you what she/he thinks is your diagnosis and they have to back it up with psych testing, ask to see these results and any clinical notes they have. It’s your medical information, so you’re entitled to it! Just be careful!

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