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Comment by digikata | Hacker News Reader

So initial vs subsequent encounter are completely different codes? Wouldn't this approach double the number of codes? Why wouldn't this be some other field of data associated with the form instead of mixing it up in the diagnostic 'topic'.

I know nothing about medical diagnosis codes.

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Medical diagnosis codes are all about reimbursement. Doctors do not rely on coding so much as finance dept relies on coding.

Proper coding means more $$, so talented dx coders are valuable.

Separating the code this way may not make sense medically, but it makes a lot more sense when you realize CMS or Blue Cross wants more coded granularity for automatic transmission of accurate financial information.

What does this have to do with anything? Is it just to inject a bit of cynicism?

Because while there's certainly a lot to be gained by a bit of creativity with the coding, the first/subsequent encounter distinction is ill-suited, considering these are binary categories, and any mistakes/attempts to defraud can detected with an sQL query shorter than this paragraph.

Concerning the original question: it's basically denormalized, with the usual tradeoffs. I'd guess it's easier to double the number of codes than to add a new attribute to legacy systems.

Dx codes are a big part of my programming world, I work on medical software. Not trying to be cynical, just offering an insider perspective from someone who just helped hundreds of hospitals and thousands of agencies complete the ICD-10 switch seamlessly with no rejected 485s, no rejected 837I(5010)s or other payer rejections.

Not trying to be cynical, just trying to offer a view into the requirements set before me.

Medical codes date back before modern computer systems - this is what legacy process looks like.

My understanding is that codes are simply a lookup into the structured version of the above document; they aren't "parseable" any more than an MD5 hash is parseable, but they uniquely identify a combination of conditions. As other posters have noted, the complexity required to implement that lookup table is an intentional barrier to entry.

There is a format to the code that allows any code to indicate initial vs. subsequent. It is important for looking for first visit cure vs. multiple visits to cure a condition.

Pretty sure its just a suffix That indicates a second encounter with the patient

Looking at the examples, they end with A for initial and D for subsequent visits.

The codes are used to make the reimbursement system complicated enough that it can be gamed. That's the general purpose of impenetrable bureaucracy.

Actually it's worth reminding that it's the opposite that is true. Bureaucracy, paperwork, are the only known ways to reduce gaming and enforce equal access to justice. O boy I hate paperwork, but it's there for a reason, a good reason.

Maybe that's the intention, but like code, the more complex you make e.g. tax laws, the greater chance there are loopholes (bugs). And there certainly are loopholes, if corporations' low/zero tax rates are any evidence.

It's not really equality when you raise the barriers to entry by giving larger companies an advantage when they can hire people who know how to game the rules, or who can hire lobbyists to write the rules in their favor, or get their own people into said bureaucracy (regulatory capture) and the little guys just don't have the money for any of that. You prevent people from entering the market, resulting in reduced competition.

I've been a HN lurker for a long, long time. Just wanted to say I created an account specifically to upvote this. Thank you.

It's okay and there is no need to be shy about making comments or voting for things. Now that finally, after all this time of being a bystander, your parent convinced you to take this step, please tell us about your story. I just mean to say that person you thanked seemed quite emotional. And you made an account, and thanked them. But I cannot really see what's so special about money turning into more money. That's why you went to primary school. A few dollars made you able to read and write, and now you're using it to save dollars or make more dollars.

So please: expand on the emotion now you've taken the plunge.

That is the initial purpose. Unfortunately bureaucrats tend to value other bureaucrats highly. It's a self perpetuating bureaucracy machine.

"The bureaucracy is expanding to meet the needs of the expanding bureaucracy."

Transparency is the only known way to enforce equal access to government services. Bureaucracy is used to thwart that, via complication that can only be unraveled by (often very highly paid) specialists.

I'm not even sure how you can state that paperwork enforces equal access to justice. It certainly isn't working in the United States, unless you know of magical paperwork that will stop cops from choking black people to death.

An initial consultation is more in-depth, as the doctor is gathering information and diagnosing, whereas subsequent consultations are more about monitoring and fine-tuning the issue. Usually they're also shorter.

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