Of course, you sometimes see a therapist and none of the codes really fit you. That is you do not have a condition that one of the codes represents. In that case, your therapist can treat you and not submit the code, but the insurance company will not pay for the treatment.
Some therapists think the codes are meaningless. They may have a point. No code or diagnosis truly captures who you are and what is needed to help you. But they are anything but meaningless. They will not be meaningless if your record is read in open court or if you are applying for life insurance or want a job, where some type of clearance is required. Having the wrong code or one that exaggerates your condition can cause you many problems.
Some therapists do not understand that. In order to get you coverage, they will select a code as if they pulled it out of a hat. This is another way to say that they get paid without you feeling the pinch of writing the check yourself. Hey, insurance companies are rich so, who cares? You should. Let me give you just one example of why. There are many others.
One of my “colleagues" once stated that in order to get paid, he often gives a patient a diagnosis of Depressive Disorder NOS (Not Otherwise Specified). Code 311.00. "Is not everyone depressed?" he asked rhetorically. To some therapists, this diagnosis is a catchall. When in doubt they give it to patients and insurance companies usually pay for more treatment than they might for an Adjustment Disorder, one of the milder diagnoses, However, if you knew exactly what Depressive Disorder NOS 311.00 meant, you may not necessarily feel comfortable having this label applied to you, especially if it really does not describe you. To clarify, let's look at the codebook:
If we look up Depressive Disorder NOS in The Diagnostic and Statistical Manual DSM-IV p. 350, we see the following:
Examples of Depressive disorder Not Otherwise Specified include:
Premenstrual dysphoric disorder in most menstrual cycles during the past year symptoms (e.g. marked depressed mood marked anxiety, liability decreased interest in activities regularly occurring in the last week of the luteal phase( and remitted within a few days of onset of menses) These symptoms must be severe enough to markedly interfere with work or school
Minor depressive disorder of at least two weeks of depressive symptoms but fewer than the 5 items required for major depression
Recurrent brief depressive disorder: Depressive episodes lasting from more than 2 days up to 2 weeks occurring at least once a month for 12 months ) not associated with menstrual cycle)...
Post psychotic depressive disorder of schizophrenia: A major depressive disorder that occurs during the residual phase of schizophrenia
A Major depressive disorder superimposed on delusional disorder, psychotic disorder NOS or active phase of schizophrenia
Situations in which the clinician has concluded that a depressive disorder is present but it is unable to determine whether it is primary due to a medical condition or substance induced.
Now if your eyes focused on words such as: “markedly interfere with work or school”; Post psychotic depressive disorder of schizophrenia; residual phase of schizophrenia ; delusional disorder, psychotic disorder NOS or active phase of schizophrenia; a medical condition or substance induced, you are one step ahead of therapists who give such diagnoses out like candy.
The rules therapists are supposed to go by say that if you truly meet the criteria for Depressive Disorder NOS, in all likelihood at least one of the above conditions apply to you. Of the above conditions, the most benign might be #1 or #2. But even then, according to the criteria, you may have trouble working or going to school. Just about, any of the above could be seen as a risk by an employer, or life insurance company. If you were a witness in court in any type of litigation, such a diagnosis could be used to call your testimony into question.
In a perfect world, it might not matter much. Your records, that your therapist holds in trust for you are confidential. But as we have seen in the sections: How Confidential Are Your Confidential Communications with Your Therapist? And Confidentiality in the 21st Century coming soon, your records and treatment information are not absolutely confidential.
Codes matter. They matter a lot.