Medicare - False Diagnosis ??

MarieIG said:
Agree that if this is the case - her doctor should explain that to her as clearly as you did.
Click to expand...

youbet said:
You may find that without the diagnosis some of your DW’s blood work or other tests are not covered by Medicare. Screening tests frequently aren’t. But paying for these things yourself is the right thing to do so report and show this doc you want things done the right way.

Sadly, physicians coding what in reality are “check-ups” (not covered) get flexible to save patients money with Medicare.
Click to expand...


Yeah, I think this is it. Not fraud, just technical terminology. Mine is coded as level 2 IIRC. DW is worse but not official "end-stage renal failure" yet. DW's kidney doc is not too worried as here GFRs are fairly stable and he says she's likely to die from something else before dialysis BUT the diagnosis is still a form of kidney failure. Hope this helps (and hope it's correct.)
 
RetiredHappy said:
99.99999999% of the doctors don't cheat with false diagnosis. It is often our own over reaction.
Click to expand...
On the other hand, I think there is a lot more of what Judge Wapner called "puffery".
Such as, when my son was in a hit and run, he was on his skateboard and a bicycle ran him down and knocked him unconscious for a short time. The bicyclist was no where to be found. A good Samaritan saw him and got an ambulance which took him to the emergency room. I was looking over the coding and looking up coding, and saw the coding for stitches up to 1-1/2' long laceration was one code and over 1-1/2" was a different code, obviously longer lacerations pay more. I measured the scar in his scalp and it was 1" long, but billed as over 1-1/2". Just a little puffery, and I'll bet it is common.
 
Silver said:
Since she is a retired nurse I'm sure she knows her glomerular filtration rate (GFR), and probably trends them in order to accurately assess her ongoing kidney function. We all have chronic kidney failure as we age. Most of us just don't live long enough to die from it. I think it's more of a terminology issue then clinical issue.

GFR naturally declines as we age, and since they are clinically categorized by lab results, it could be that she has just naturally moved into another stage. As per the National Kidney Foundation, stage 2 is actually very good.

GFR

My guess is that this is just a normal documentation of the aging process, with nothing negative intended at all. But I guess it depends on her most recent GFR.
Click to expand...

Nice link.I wonder if the Electronic medical record automatically adds the diagnosis. Sort of a pain the the neck for the doctor since it is a common issue, probably doesn't need action. and leads to the patient leaving and filing a report with Medicare. The previous doc who avoided the issue was better off
 
DW = Dear Wife

Similarly, DH= Dear Husband, DD = Dear Daughter, etc. etc.
 
Last edited:
I would tell him, "If it's no big deal, take it off." There is a risk she might need care, and an unfamiliar doctor (or even one in your same town) would see that and take off down the wrong diagnostic path.
 
DW reported this to Medicare, they called the DR told her the concern. The DR called DW, still refused to change the diagnosis..... DW got a new DR...... Our neighbor had the same thing happen to him, he also got another DR this past week
 
LakeRat1 said:
DW reported this to Medicare, they called the DR told her the concern. The DR called DW, still refused to change the diagnosis..... DW got a new DR...... Our neighbor had the same thing happen to him, he also got another DR this past week
Click to expand...
I'd say everybody is better off
 
If the OP's DW has a 60 - 80 EGFR she most definitely has kidney disease. There is no fraud here. There are many people at Stage 2 CKD who are not aware of it. There is no cause for alarm at Stage 2, but she needs to have a DR monitor the EGFR regularly. A PCP can do this. If EGFR trends downward, at some point she will need a nephrologist. Stage 2 is the "watch it" stage. Her doctor should have explained this. This is also a good time to become a little educated about CKD -- especially if EGFR trends down. This link contains a life expectancy chart by age and EGFR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5203814/
She could possibly live a long life and eventually pass many years from now while at Stage 2.

I generally do not like anecdotes, but here is one: DW's cousin barely 50 went to the ER because he had not been "feeling well" for some period of time. Stage 4 CKD. He was immediately put on dialysis daily, and continues to be on dialysis. It might have helped to have a few years for some education and mental preparation for such a life-changing event.

This is not suggesting that dialysis is in the OP's DW's future.

If any mistakes were made, it seems as though the diagnosing doctor should have had some discussion.

Diagnosed at Stage 2 15 years ago. Been through 2, 3A, 3B, and briefly at Stage 4 a few years ago when "they" got me back to 3B with a lot of 24x7 "attention". Since then and with a lot of effort on my part dietwise EGFR varies back and forth between Stages 2 and 3A. Glad to be here.

Don't panic, but don't ignore it.
 
Rustward said:
If the OP's DW has a 60 - 80 EGFR she most definitely has kidney disease. There is no fraud here. There are many people at Stage 2 CKD who are not aware of it. There is no cause for alarm at Stage 2, but she needs to have a DR monitor the EGFR regularly. A PCP can do this. If EGFR trends downward, at some point she will need a nephrologist. Stage 2 is the "watch it" stage. Her doctor should have explained this. This is also a good time to become a little educated about CKD -- especially if EGFR trends down. This link contains a life expectancy chart by age and EGFR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5203814/
She could possibly live a long life and eventually pass many years from now while at Stage 2.

I generally do not like anecdotes, but here is one: DW's cousin barely 50 went to the ER because he had not been "feeling well" for some period of time. Stage 4 CKD. He was immediately put on dialysis daily, and continues to be on dialysis. It might have helped to have a few years for some education and mental preparation for such a life-changing event.

This is not suggesting that dialysis is in the OP's DW's future.

If any mistakes were made, it seems as though the diagnosing doctor should have had some discussion.

Diagnosed at Stage 2 15 years ago. Been through 2, 3A, 3B, and briefly at Stage 4 a few years ago when "they" got me back to 3B with a lot of 24x7 "attention". Since then and with a lot of effort on my part dietwise EGFR varies back and forth between Stages 2 and 3A. Glad to be here.

Don't panic, but don't ignore it.
Click to expand...
eGFR is a rather variable number. In 3 years, mine has varied from 90 to 50 with an average around 70 from 8 results. My doc has told me not to worry about it at my levels and that the numbers ARE, indeed, variable (time to time - even day to day) due to the imprecision of the test (It's accurate - but not precise - IOW if you got tested daily for 3 months and averaged the 90 results you'd have a rather accurate eGFR average but the variability would be all over the place, indicating that the individual numbers are not precise.)
 
ncbill said:
what age is recommended for screening with that test?
Click to expand...
Chronic Kidney Disease is more prevalent as one ages, but a child can have it. So, I can't answer your question (I'm not a doc) but I would think a doc would be checking this in early adulthood (along with other kidney factors in the blood and urine.)
 
You must log in or register to reply here.

Similar threads

N
How To Find Low Cost Lab For Annual Blood Work?
2 3
athena53
athena53
D
Easy Social Security Question (I think)
Drake3287
D
John Galt III
Blood Transfusion options in New Jersey with medicare advantage plan
pacergal
P
S
Care facility expectations
Koolau
Koolau
D
Medicare/Social Security Question
Sunset
Sunset

Latest posts

Back
Top Bottom