'BAD'? 'NEC'? as it relates to a DX

Hello All,

This is my first post. I was looking on my insurance docs and found some 'words' that I am not familiar with and a Google search didn't help.

The context is that they are included after my DSM #.

For example,

296.66 BAD, MIXED-FULL REMISS

I think I know what the 'mixed' means. Sometimes my mood is UP . . . sometimes my mood is DOWN. Correct? I guess by 'FULL REMISS' - they mean at the moment the beast is 'in control' and I am a 'normal' dude? My understanding is that it can come back at any time. However, we make it harder for it to come back on us if we eat good, exercise, get plenty of sunshine, good rest, AVOID stress (as much as possible) - correct?

What in the heck do they mean by the 'BAD'? That doesn’t look good! Grin.

Next up:

296.89: MANIC-DEPRESSIVE NEC

Any ideas on what the 'NEC' means?

And finally . . .

296.63: BAD, MIXED-SEVERE

I imagine severely sick, with mixed states, but again - the word 'BAD'.

I understand that 296.63 and 296.66 are BP 1 and that 296.89 is BP 2. I have never heard of a person jumping from one to the other. My limited understanding is that most start out with BP2 and then as they get older, the odds of them 'morphing' into BP1 are high. Not a pleasant thought.

Or, are my shrinks just having a hard time 'splitting the hairs'? After all, they are only human to.

Any help would be appreciated.

Thank you!

im2old4this

Yesterday I read the term Bipolar Affective Disorder.... so maybe that's your BAD??

Sorry, I don't know anything about insurance terms.

Trippin,

Thank you for your reply.

After I read your reply I Googled Bipolar Affective Disorder. I found your viewpoint repeated over and over. "Affect" equals mood.

So, apparently the two terms are synonymous. Strange.

I guess kind of like calling an old dog an 'old dog' or calling it a 'mutt'. Here is one example of many:

BIPOLAR AFFECTIVE DISORDER - FACT SHEET

Bipolar affective disorder is also known as manic depression or bipolar depression. It is a mood disorder in which the sufferer experiences marked mood swings which are beyond what most people experience.


Now, any one got any ideas what is meant by 'NEC'?

Trippen, I enjoy your sig line. That is cool. I'm not judging but I am curious, do others judge you negatively when you talk about being BP but that you don't use meds? Who cares with others think. No one knows you better than yourself.

One of my hopes/wishes in life is to be med-free (Wellburtin - 3 tabs of 150 mgs per day, Seroquel 300 mgs at bedtime - 3 tabs of 20 mgs of Ritalin a day, and up to two mgs of Klonopin per day).

The Ritalin is for ADD (inattentive type). Plus, it helps with depression. The Klon is for anxiety. I tend to be an anxious person. Genetics. Somedays I go without any Klon.

My shrink retired last month. The dude that took over her practice . . . He was ONE and DONE. He wants to taper me off of Ritalin. He would not write a Klon script. He labeled them as 'bad' drugs. 'Highly addictive'. Well . . . if he would have checked my 8 years history (I'll be fifty in May) of using those two meds - he would have found that neither has been abused. I have been taking basically the same dose of those two EXCELLENT meds for the last 8 years . . .

Additionally, the shrink above wants me to take 300mgs of Seroquel at night and during the day. I tried a 150 during the day (like around 1pm) and I could barely finish the work day. I teach elementary P.E.. And I could barely jog. I could not catch a ball. Seroquel is very sedating and after 25 years of teaching elementary PE and having 3 daughters of my own (all under the age of 11) - I do not need to be a ZOMBIE during the day. I need energy during the day.

My brother is a MD. General practice. His thoughts were some docs just don't prescribe those medications because of the POSSIBLE hassle with them. He said personally he does not prescribe narcotics anymore.

However, big bro also said I need Klon and Rit to do my job. So, find a shrink that will prescribe what has worked for you in the past. Hence, I'm currently shrink shopping. Anybody got any tips on that? Big bro's thoughts were that the shrink I just got down with is very, very bad. He said, "RUN FROM THAT DUDE!"

I told that shrunk, "Can we try this in the summer? Changing my meds so radically in the middle of the year . . . could result in a BIG CRASH and loss of employment for me." Mr. Bad Doc said something to the effect of "NO! No better time than to start today!"

Big bro said that showed no empathy towards my current position in my life. Then bro asked me a very insightful question: "Did he ask how you were feeling? Did he ask how you were doing?" I reflected back . . . "NO! He did not!" That seems like Psych 101 . . . ask the patient who they are doing . . .

I got a Feb 18th appointment with a different shrink. I will never see the above one again. As stated above, he was 'one and done'.

Thanks again!

PS: on my meds - they are all generic. Insurance company pulled the plug on branded Seroquel. Therefore, I am not able to take the longer lasting kind. The old shrink said she would write a letter to the insurance company about 'me doing better on the branded' but she never got around to it. I mentioned it to BAD Doc, He said, "NO . . . we are not going to call/mess around with insurance companies..." He had my scripts already 'cookie-cuttered' out before he even said a word to me. Before he ever say me.

Wondering about your time line on your sig "Dx'd on 4.06.2010, unmedicated since 14.10. 2011"

April 6th, 2011 was your DX. Since there is no 14th month - what do you mean by '14.10.2011'? Did you really mean to write Oct. 14, 2011?

Since you are not on meds - what do you do to control your symptoms?

Thanks for sharing!

NEC is an (outdated) code that stands for "not elsewhere classified". It is synonymous with the more common NOS (not elsewhere classified). In the DSM, these codes describe disorders that are impairing but do not fit the exact criteria for officially specified diagnoses.

She's not in the USA. Other countries put the day before the month, I think.

Thank you all for the help with the codes. Someone on another forum suggested I call the insurance company. Calling my insurance company is a joke. It is so stressful as to potentially trigger an episode!

Thanks again to you all!

But . . . that still does not make sense to me. Here is her quote:

DX'd with BPII on the 4.06.2010, unmedicated since 14.10.2011, so far it's working for me

The first date I clearly understand to mean: April 6th 2010 -- April being the 4th month, 06 being the sixth day of the month, and 2010 being the year.

Now lets look at the other date in comparison:

14.10.2011

I understand the above to mean the tenth day of the month, the year to be 2011 - but there is no 14th month - hence my confusion.

The first date is actually the 6th month (June) 4th day. The second is 10th month (October) 14th day. Right, Trippin?

Thank you
I don't neccessarily care what others think (especially not strangers) but it was made known to me by some that being med free is either highly irresponsible or that I cannot legitimately have bipolar if I'm unmedicated. So my signature is a kinda STFU to anyone who even wants to be judgmental and so far has stopped anyone from being on my case about it.

You're welcome

A LOT of mindfulness Lol. I try to live in the moment and behave like a surfer. I take each wave as it comes and remind myself that the tide will change.

I keep a sleep routine that works for me, I've also incoroprated visualization exercises for hypo nights. I give myself timeouts when agitated and ready to rip someones head off for breathing too loud.

I drink gingerale when the anxiety has my stomach so knotty I can't eat, practice the breathing exercises I learned here and from my first pdoc. Helps for panic attacks. I also take VERY hot showers to sooth the skin crawling anxiety I have within mixed episodes.

I do a lot of music therapy (no science to it I promise. I just either lock myself up for HOURS with the volume on max straight into my earphones, listening to every metal song I know (it helps me process the words and feelings my mind cannot) and I also have a bloody good cry while doing so. Its cathartic to say the least.

Dance music helps to motivate me to get up and wash my arse and take care of my daughter when I feel like I'm made of concrete. Its not full proof, and doesn't always work, but when done in baby steps, the ball normally does get rolling at some point because I'm OCD too, so perfectionism helps fight the depros. Organising is another depression warrior, sometimes I'm thankful I have OCD.

For hypo I also use music, the singing keeps my mind focused on the lyrics, (so that's a break from the F1 racing track in my head) the dancing and cleaning wears me down enough to fall asleep at some point.... I've gone 5 days and 4 nights zero sleep. So I love this tactic.

I also use a lot of distraction techniques, like having a movie marathon or reading my murder mysteries. It gets me out of my own head for a while. Sometimes (if I can actually mustre the energy for opposite action, I go to a friend instead of curl up in a ball and pray I cry myself to death. I never stay long, but atleast I try...

I also journal, and post here. Emotional purging is a must, especially among folk who understand because it validates my experience, which in turn helps to not kick start a borderline episode. (I'm a mixed bag of fun ain't I? ...)

When I'm in an actual crisis? Like suicide or wanting to slice open my thigh from the looping OCD based thoughts? That's when I phone my sister or cousin. Well usually they instinctively call and go "Lia what's wrong? Talk to me"... then I spill my guts and let them witness the abyss that is my mind.

None of this is an exact science, tbh I probably have the least professional coping skill set on this site. Buuut. My thought process was, I coped for 10 years before I knew this beast's name, I'll damn well find a way to cope now that I have actual ammo.

The most helpful tool I have tho?
My family. My daughter is so young but so intuned. She gives me space when she senses I need it. My family backs off when the earphones go in and when I physically can't move, my mom and brother take care of Jordan while I'm trying to melt my concrete muscles.

They are a Godsend, all 3 of them and idk where I would be without their willingness to accommodate me.

Hopefully starting therapy soon, so that should help a ton.
Correct thank you

Its the 4th of June and the 14th October

Yeah, that makes sense. Thanks! Now . . . can Trippin reveal 'the secrets to being symptom-free WHILE not on meds?!

LOL that's a MYTH!

I'm by no means symptom free, I actually cycle like clock work (atm I'm weekly) for months at a time before bp decides to shake it up.

So just as I get used to my cycle, bp goes and turns shyt upside down and I have to surf in the dark for a while... Until I get the hang of my new pattern.

The only time I was in remission was for a few months after my med withdrawl was complete. But now I have no such luck

So . . . why not on meds again? Just curious. I admire you handling the illness without medicine. I'm too big of a 'wimp' to even try that. Plus, I have a young family. Three beautiful daughters, ages 6, 8 and ten. I don't want to put them through would could potentially be a nightmare if I stopped my meds.

My MD brother also admitted himself once when his Abilify was 4-5 days late due to the insurance company messing up his mail order . . .

I hear you! My daughter is 10, so I understand not wanting to be a nightmare, it was the fear of being her nightmare that lead me to a pdoc and a dx.

Why I don't take meds? A myriad of reasons.

Firstly, I'm not anti meds, my first combo was great and kept me functional and at a full time job while I had just lost my grandpa, my brother and my father within 3 months of eachother.

It was when I got retrenched due to the company closing down and having to use state care as opposed to private medical aide, that meds became an issue.

1. For me, I think they're helpful during crisis, and would seek them out should I feel I need them, but I'm not interested in daily med management. Especially not AP's (antipsychotics), studies posted right on this website report a link between longterm AP use and brain atrophy. Stupid is too high a price to pay. I will much rather keep my hallucinations AND my brain. :P

2. What pushed the button to flush my meds was a horrid reaction to lithium and a pdoc who was unavailable for the next 4 months. I was retarded, had zero memory to speak of (with some permanent gaps), couldn't string an intelligent sentence together (spoke at 4th grade level because my vocabulary had gone missing) suddenly was unable to spell or pay any type of attention. I was perpetually hungry, and ate myself broke. I developed horrid acne, and please let's not forget I had zero fine motor skills, kind of like a baby, but instead of having no grip and poor sense of direction I looked like I had severe parkinsons. This crushed what little self-esteem I had, and kept me isolated because I was too humuliated to be in public.
Besides allll of that, I was flat, complete apathy, no joy, no sadness, no hope. I was merely existing, watching my life go right by without me.

3. So I couldn't live like that. I had NO intention of waiting on a pdoc who refused to help. I had zero acces to a different one. According to him, because I wasn't suicidal, and my bloodwork was normal, that spelled stable. Stupid, *cough *cough, I mean stable, was too high a price to pay. I missed my sharp mind, my sarcasm, my sense of humour. My. SPUNK!
I missed my emotions, every level of them, from the "I'm so high I'm deeply inlove with life" to the " YTF did I have the audacity to wake up today? Shoulda died in my sleep stupid b1tch! "

I missed being me. This is the only me I've ever known. A me I had learned to grow accustomed to, grown to adapt to. A me that my friends and family had accepted and adapted to. That muted zombie version of myself caused much unrest in my head. I felt alien in my own skin and didn't recognize myself in the mirror. I had no spark, no smile, and even my actions my reactions were completely alien.

4. I also drew the line at meds being thrown at me to fix problems that other meds caused. This was my pdoc's initial solution. Don't take me off the retard-making meds, and try something new, just add meds to make me stop shaking like an alcoholic in public.

That's a deal breaker and will remain one should I ever decide to give meds another shot.

Sooo, like I mentioned earlier. I decided fk this shyt. I've handled being me for 10yrs armed with only lots of insight and zero knowledge, I can bloodywell learn how to handle me even better now that I know I really have more issues than Playboy

Ps. You're NOT a wimp. You're choosing the safest path for yourself and your family.

Trippen, thanks for the PS regarding me being a wimp. That was kind of you and gave me a nice feeling. Thank you.

You're most

I work in the medical field and work specifically in the coding department. NEC (not elsewhere classified) and NOS are NOT NOT NOT NOT NOT synonyms. NEC is where the physician documents something but it is not found in a coding book therefor it is a specified term, not listed. NOS(not otherwise specified) is a generic term when not enough specificy is given to select a specific type of diagnosis. Ex. a dr documents a fracture. (NOS). then a dr says manubrium fracture of the wrist (NEC) because there isnt a code in the codebook for that diagnosis. Make sense? I have a 4 year degree in this field.

So onto the coding part.

296.66 Bipolar I disorder, most recent episode (or current) mixed, in full remission
I'm assuming they mean your most recent episode was mixed (mania and depression within the same episode) and now it has resolved and you have no current symptoms AT THE MOMENT. This can change as we all know with bipolar.
a quick google search says this about mixed episodes "
A period during which symptoms of a manic and a depressive episode are present at the same time. People who experience mixed states describe feeling activated and “revved up,” but also full of anguish and despair. Rapid, pressured speech can co-exist with impulsive, out-of-control thoughts of suicide and self-destruction or aggression. Hopelessness, irritability, uncontrollable swings between racing thoughts and a feeling of “being in blackness” can all happen over the course of minutes."

296.89 is for Bipolar II. it is an unspecified (NOS) code. I wouldn't pay too much attention to this code since you have a more specific diagnosis with the other code. This is just a provider being lazy and not selecting the right code. You can ask for a copy of your medical records and ask that this diagnosis be taken off of there because it is incorrect. You can also tell the office that they incorrectly billed your insurance for the wrong diagnosis. I am also a medical record auditor and we look at the documentation to make sure if supports the code assignment so i'm sure on this case we would be changing that code to another bipolar I code.

296.63 Bipolar I disorder, most recent episode (or current) mixed, severe, without mention of psychotic behavior
This is basically the same as the first code but the only difference is it is severe and without psychotic behavior. There is a code that you can select for psychotic behavior.

If you have any other questions don't hesitate to ask

Ginaaa wrote:

I work in the medical field and work specifically in the coding department. NEC (not elsewhere classified) and NOS are NOT NOT NOT NOT NOT synonyms. NEC is where the physician documents something but it is not found in a coding book therefor it is a specified term, not listed. NOS(not otherwise specified) is a generic term when not enough specificy is given to select a specific type of diagnosis. Ex. a dr documents a fracture. (NOS). then a dr says manubrium fracture of the wrist (NEC) because there isnt a code in the codebook for that diagnosis. Make sense?

^^^2old says: "I am still confused. I don't get it. Can you say it another way? To me they still seem synonymous. . . Help me to clarify this please."

Another thing - why did they code my ADD as this at different times:

314.01 ADD, CHILD, W HYPERACT

I have three kids. None of them have EVER seen a shrink for ADD (or anything else).

Other times, I am coded as:

314.00 ADD-NO HYPERACTIVITY

Were they just playing 'codes games' to make sure my bill would get paid by the insurance company? Still 'dazed and confused' . . .

Thanks in advance for any insights that any one can share!

Trippin, I love your sense of humor! Thank you . . . I'm having a low day so it was nice to laugh again.

To further confuse me about the coding differences between NOS and NEC, I found this on the net (BTW, I think I'll just throw in the towel and say "WTF do I need to know what it means any way?!" I am an elementary P.E. teacher for a reason - my 13 month older brother is an MD. He can explain it to me if I really want to know . . . probably 15 minutes after posting this . . . I will have forgotten all about it . . . too many years of head meds maybe?! Who knows? It is what it is.):

1. Other (NEC) and Unspecified (NOS) Code TitlesCodes labeled "other specified" (NEC not elsewhere classified) or "unspecified" (NOS not otherwise specified) are used only when neither the diagnostic statement nor a thorough review of the medical record provides adequate information to permit assignment of a more specific code.
   Use the code assignment for "other" or NEC when the information at hand
   specifies a condition but no separate code for that condition is provided.
   Use "unspecified" (NOS) when the information at hand does not permit either a more specific or "other" code assignment.
   When the Alphabetic Index assigns a code to a category labeled "other (NEC)" or to a category labeled "unspecified (NOS)", refer to the Tabular List and review the titles and inclusion terms in the subdivisions under that particular three-digit category (or subdivision under the four-digit code) to determine if the information at hand can be appropriately assigned to a more specific code.
   
   GENERAL INPATIENT CODING GUIDELINES