ABC ... 123 ... Know your ICD9s & CPTs

Part of me wants to break out into song....or cryout Bingo.

Recently I had a Nuclear Bone Scan to determine the level of bone remodeling around the tip of my hip implant in my femur, to see if there is a difference from before "failed implant" status. Today I received a Lovely call from my local hospital saying I had a copayment of $649.00 for the scan that has a base cost of $2456.08(per the negotiated rate between my insurer and my husbands company). My policy is a 10%copay up to $2500 "out of pocket" maximum per year.

Before you have any conversation with an insurance company or a provider, especially if they have differing opinions arm yourself with these basics to sort out what may be the difference of a extraordinarily large out of pocket fee.

Know your ICD9s (diagnosis codes) and CPTs (procedure codes). These numbers are the most critical for determining whether or not the procedure you are having is covered and at what cost to you and the insurer. At a later date I will discuss the fascinating world of codes and how they make the difference between being paid and not. Sometimes there are alternatives.

Check if provider verified your benefits via a phone call as opposed to on-line.

Ask for a contact ID or name of person you speak to and take notes of the converstaion. As the person if there is a contact ID that tracks the call/conversation. Some insurance companies use representatives names

If there is a discrepancy, request a conference call with your insurer and provider. They usually will try, especially your insurance company.

What a Couple of Weeks ... and a Bit of Backstory

Day One Post Surgery

Two weeks ago,  I started the next series of surgeries to try to alleviate the ongoing, never ending pain in both my legs due to my mulit-focal osteonecrosis in both hips and knees.  This makes surgery 18 or 19.  I cannot keep up.  After careful consideration and meeting with our friendly specialists across the country the decision was to target the leg/joint that had the best chance of recovering fully, which is the right knee.  We had a 80% shot at success.

The hip revision specialist I saw, at Rush Orthopedics, in Chicago, Dr Wayne Paprosky, said to me, I see 1000s of patients a year with complex hip revisions, but only see a handful of people like you... (again, not the special I am looking for). He agreed we needed to target the right knee first so that it could handle the hip revision surgery.  The downside was that we knew that the weaker leg, with the failed stem implant, would be a challenge to manage, however that surgery is far more extensive,  has a much higher level of risk, and not straight odds of success. So, we went for it.

The plan was a right knee scope and bone marrow aspirate stem cells (from the iliac crest), which we did, with a possible micro fracture. A knee scope is no big deal, but a micro-fracture is a whopping kick-ass drilling into the bone surgery to bring blood supply to the surface to help regenerate cartilage. It results in a much longer recovery, much longer non-weight bearing, and a much much longer time (two months rather than the current three weeks) in a CPM (at 6 to 8 hours a day).

CPM MACHINE

We were braced for the worst case scenario surgery which is usually what happens, but that wasn't the case.  Thank Goodness, because based on what is going on it would have been a horrible horrible recovery! The last 14 days were bad enough. The good news is that the knee recovery has been relatively straight forward, until my hiccup yesterday, but that is the way it is with a knee that has had 5 surgeries (I guess).  This is going to take four times as long to recover.  I am practicing patience

More importantly, what I did not anticipate were two things. 1) The extent that my left leg, which is the weaker of the two legs due to end-of-stem pain, would not manage the "loading" required to support the early phases of recovery and 2) a dental infection for which I had an emergency root canal Monday before last. Both kicked my ass to kingdom come. Post-op and the first two days of recovery were looking good. I was alert, talking medical research etc. On the morning of the third day, I stood to pivot on the left leg, which overloaded the femur and the loose titanium stem in my leg (which I felt rotating) and then I was screaming in pain all the way back to PT (physical therapy). That single movement wreaked havoc on my body, and tipped the scales of my wellbeing. I ended up on heavy duty pain killers, to buffer the discomfort. Jesus that was rough. Then, the tooth, for which I was pro-active about taking care of (fixing an old filling) prior to surgery, because I know that dental problems/germs can cause problems at elevation (I went from sea level to 8,000 feet) turned into a full on dental infection. I went into surgery wondering why the tooth had not recovered from the treatment I had at home, but was so focused on surgery, that I ignored the signals. The weekend before last I was holding on for dear life repeating to myself that I just needed to get to Monday, pouring large amounts of Indica tincture on my tooth to stop the waves of excruciating pain. I had onboard lots of pain killers for the left leg. I even wanted Larry, my husband, to take the tooth out with pilers, that was the indicator that maybe it is more than a sensitive bite. Last Monday, I was able to get an appointment with a local dentist, who was able perform an emergency root canal. It was a good thing because it was pretty nasty.

For 10 days we were in triage mode. The infection triggered concerns of infection impacting the replaced hip, so I was placed on 2000mg of antibiotics a day. And, because there are so many weak links in my body, we have been playing "whack a mole" trying to calm down overloading parts. The medical team got into full gear to get me a wheelchair, a raised commode so I did not have to overload my left leg (I never thought I would be so happy to have a raised toilet seat), additional ice machine components which help with pain. Thankfully things are calming down. It was a rough ride. A lot of stress. I am thankful, we are around that bend. My husband, Larry, has been a hero managing everything. I finally started feeling somewhat like myself this weekend. My knee is finally progressing and getting stronger. (I like those stem cells). It is clear I need to focus on getting my hip replacement replaced, which we do have a plan for, but right now the focus is to get the knee ready to rock and stabilize it so it doesn't require more surgeries...that would be grand.

What I learned:

1- The thing that you worry about is usually not the thing that will go wrong.
2- Don't ignore continued dental pain. Chomping on a bad tooth can result in a root canal.
3- Keep your focus and wits about you
4- Have a sense of humor.
5- Have a great team! (which I do!)