HIV and ID Observations

More absurd paperwork follies, this time from our friends at a mail-order pharmacy:

Here, confronted with the challenge of refilling a patient’s HIV medications — which for the record he has been receiving unchanged for over 3 years — the pharmacy decides for the first time to reject the request and send the prescription back to us (by fax of course), including a cover sheet that reads, “Required Information Missing — Pls complete ASAP.”

(No doubt they saved plenty of time by omitting 3 letters in the word “please.”)

Is there a problem with the dose? The instructions? Is there a concerning drug-drug interaction? Did we forget a key component of the regimen?

No, no, no, and no. The problem is that each medication now requires its own “Diagnosis Code,” those inscrutable numbers that already bedevil our billing sheets. Otherwise the pharmacy won’t get paid.

Of course you could ask what else could darunavir, ritonavir, raltegravir, and lamivudine be used for besides HIV, or “042” in ICD-9-ese. Or ask why suddenly now they require the code, since they never did in the past — it’s not as if the indications for these drugs have somehow changed.

And does someone really check to see that the diagnosis code matches the medication? Just to make sure, next time I need to refill HIV meds at this particular pharmacy, I plan to put 380.4 down — that’s “ceruminosis,” or ear wax, in case you’re wondering.

I’ll let you know what happens.