DSM IV Code – 296. 296 is the DSM-IV code for Major Depressive Disorder.
ICD-9 Procedure Code – 300.4 – Depression with anxiety.
A young woman – 16 years old, that we know was found in her bedroom by her parents last week. They found her dead. After months of diagnoses codes like these, she found it necessary to terminate her life. Winter mornings during the school year should find young girls texting their friends, cramming for a test later in the day, reading notes left the day before by boys, or trying to decide what to wear for the day ahead. On this day, this child lay motionless — the impending school day, drive home, or dinner-table discussion would not be an issue.
Clinical definitions of depression, anxiety, bi-polar, or suicide carry with them guidelines for diagnoses, procedure codes for reimbursement, protocols for management. In a local hospital, social workers cubical, psychiatrist office, and school counselor’s files, undoubtedly there are notes detailing the causation, treatment plans, and medication regimes. Hours of discussion between caregivers, providers, and family members took place; events of the past 24-hours may have been noted as an option, a potential event, or possibly an inevitable event.
Teachers, friends, family, clergy all will devote a portion of their day to questioning what happened – and why. Second-guessing a conversation, a meeting, a tweet could have created a different end to this day. Social media will ensure news of the death gets to all those who need to know – and countless others that don’t need to know. Close friends will blog, text, tweet their innermost feelings about their friend. Others who knew of her through a friend, attended the same camp, or were a friend of a friend of a friend will discuss the death as if they were “BFFs.”
And parents will hug their children tightly without sharing any words.
In healthcare, the world typically is reduced to a series of electronic notes and procedure codes. The procedure codes characterize an individual; reimbursement, treatment, coverage, care management are all dictated by three or four digits. A child’s pain is converted to a four-digit description. The ability of a parent to gain cost-effective care is dictated by a numeric value. The ability to gain care and access to providers is at the discretion of a single decimal point.
After the child’s death, the digits are reduced to one – number of deaths. The family will move through the necessary steps of bringing a life to its end. Concerned teachers, family, clergy will gather the child’s friends; using the death an opportunity to avoid a similar fate occurring in the life of another child. Within days, new discussions will fill the digital world of Facebook and friends will move on to the next event that fills an emotional void.
For a few short moments, electronic medical records and appointment schedules, social media and support groups, will be replaced by real human emotion.
Fortunately there is not a CPT or MSDRG procedure code for raw emotion.
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