What to do post ER visit?

A

Anonymous pilot

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About a week ago I was driving and began to feel faint out of nowhere so I pulled over, ended up puking, and was pretty shook up about everything happening so quickly that I had a friend pick me up and take me to the ER to get checked out. If I’m being honest I wasn’t really thinking in the moment and was probably overreacting. Anyway, got an EKG, fluids, and vitals checked and doc said I was just likely dehydrated. However, on the diagnosis for my ER visit record it now says “syncope and near syncope.” I asked why the doctor had put syncope even though I never lost consciousness. They said that it automatically gets grouped with near syncope. After my visit, I come to find out my whole family got hit with some type of stomach bug and had all fell sick very quickly (if I had known this I wouldn’t have gone in).

I’m wondering if I need to tell my AME about this for my next medical appointment or disclose the visit on the medxpress form. It was all situational and I am otherwise perfectly healthy.
 
You first need to understand that the insurance footprint of an E R visit is sufficeintly large that they will find it. So you HAVE to report it. From the htte hospital's medical record dept: Order up the Dovc's dictation, any studies done and lab.

Ordinarly for near syncope, if the ER doc's dication is concordant with cardiogenic syncope, we need:

Stress treamill to HR >= (220-Your Age) and nine minutes' duration on the 3 minute Bruce protocol (google it).
Seated Echocardiogram
24 hour Rhythm monitor.
Opinion of a cardiologist that this was "vasovagal".

If we have all this we can defend "issunace in the office".

Non report---> and they find out, is revocation of certificates.
They can if they see fit make a class 4 felony (not being forthcoming with an agency of the federal administration) stick.

B.
 
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This seems extreme, I was simply sick and felt lightheaded for a brief moment. If there are clear notes in my er record of it being from dehydration, do I need to do all of that cardio work up? That all feels unnecessary when there was no doubt that it was vasovagal.
Do you suggest I tell my AME now and see what can be done to either avoid this altogether or get certain tests out of the way now?
 
As a physician I am getting to the point that I recommend all pilots interested in keeping their medical stay away from any modern medical institution/physician/hospital/ER. You WILL end up with a potentially disqualifying ICD10 code. Unfortunately, we have to put a bunch of codes that MAY be possible in the chart to justify billing levels, reason for additional testing/imaging/labs, etc. That is not counting the number of incorrect codes that get entered in an EMR and never corrected later. Its a sad state, but these codes serve primarily to interface with insurance and billing and have nothing to do with actual health of the patient.

Edit- and now with more insurance companies combining all of these databases its becoming impossible for a simple minor visit to get something checked out to stay under the radar.
 
bbchien said:
You first need to understand that the insurnace footprint of an E R visit is sufficeintly large that they will find it. So you HAVE to report it. From the htte hospital's medical record dept: Order up the Dovc's dictation, any studies done and lab.

Ordinarly for near syncope, if the ER doc's dication is concordant with cardiogenic syncope, we need:

Stress treamill to HR >= (220-Your Age) and nine minutes' duration on the 3 minute Bruce protocol (google it).
Seated Echocardiogram
24 hour Rhythm monitor.
Opinion of a cardiologist that this was "vasovagal".

If we have all this we can defend "issunace in the office".

Non report---> and they find out, is revocation of certificates.
They can if they see fit make a class 4 felony (not being forthcoming with an agency of the federal administration) stick.

B.
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Thank you for your response,
Since I know all of those tests would come back fine and that this was just a fluke of being sick…should I be worried at all about deferral? I have already worked through a special issuance before and just got my regular 1st class. When you say “issuance in office” does that mean without having to be also approved by OKC?
Should I go to my AME now to get started on those cardio related tests?
 
You should report on the medxpress the diagnosis you were given. You are not responsible for knowing every ICD code in your file. Someone could find those codes if they went looking, but no one's provided any evidence of the FAA doing that. And if you're honestly disclosing the diagnosis and condition, you're not violating any law.

bbchien said:
You first need to understand that the insurnace footprint of an E R visit is sufficeintly large that they will find it. So you HAVE to report it. From the htte hospital's medical record dept: Order up the Dovc's dictation, any studies done and lab.

Ordinarly for near syncope, if the ER doc's dication is concordant with cardiogenic syncope, we need:

Stress treamill to HR >= (220-Your Age) and nine minutes' duration on the 3 minute Bruce protocol (google it).
Seated Echocardiogram
24 hour Rhythm monitor.
Opinion of a cardiologist that this was "vasovagal".

If we have all this we can defend "issunace in the office".

Non report---> and they find out, is revocation of certificates.
They can if they see fit make a class 4 felony (not being forthcoming with an agency of the federal administration) stick.

B.
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I had an actual syncope episode, unlike the OP, with a known cause, like the OP, and didn't need to do any of this. I was treated in the ER and they ruled out cardiac causes, like the OP. All was reported to the AME and FAA, and no one ever asked me for a stress test or anything else. That was several medicals ago, it's now PRNC.

OP: Fill out the form honestly and take it to your AME for a consult.
 
Tokirbymd said:
...Unfortunately, we have to put a bunch of codes that MAY be possible in the chart to justify billing levels, reason for additional testing/imaging/labs, etc....Its a sad state, but these codes serve primarily to interface with insurance and billing and have nothing to do with actual health of the patient...
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My future son-in-law (he already asked me for her hand) is no longer becoming a medical doctor b/c he was coached by existing doctors away from the profession. Your response seems to comport with the feedback he received. So sad. My daughter is starting her 3rd year of her pharmacy PhD despite getting feedback to stay away. I sure hope these problems are solved. Sad young professionals are being scared away from noble professions.
 
bbchien said:
You first need to understand that the insurnace footprint of an E R visit is sufficeintly large that they will find it. So you HAVE to report it. From the htte hospital's medical record dept: Order up the Dovc's dictation, any studies done and lab.

Ordinarly for near syncope, if the ER doc's dication is concordant with cardiogenic syncope, we need:

Stress treamill to HR >= (220-Your Age) and nine minutes' duration on the 3 minute Bruce protocol (google it).
Seated Echocardiogram
24 hour Rhythm monitor.
Opinion of a cardiologist that this was "vasovagal".

If we have all this we can defend "issunace in the office".

Non report---> and they find out, is revocation of certificates.
They can if they see fit make a class 4 felony (not being forthcoming with an agency of the federal administration) stick.

B.
Click to expand...
Thank you for your response
However, this feels excessive. I fell sick suddenly and that’s how my body reacted. I never actually fainted, only felt lightheaded. Doctors note states likely dehydration, and no cardiogenic concern.

If I discussed this event with my AME would they not see that as enough explanation to not have to check the “dizziness or fainting spell” box and move on? I’ve heard from others you don’t want to disclose anything you don’t need to.

But what would you recommend? Tell my AME now and get started on those tests you mentioned to have ready for my next appointment? And by “issuance in office” do you mean that if I had all the provided tests and doctors notes that I shouldn’t be concerned about deferral? I’ve already worked through a special issuance for my first class one time and I would like to avoid that process again.
thanks
 
Mahneuvers said:
My future son-in-law (he already asked me for her hand) is no longer becoming a medical doctor b/c he was coached by existing doctors away from the profession. Your response seems to comport with the feedback he received. So sad. My daughter is starting her 3rd year of her pharmacy PhD despite getting feedback to stay away. I sure hope these problems are solved. Sad young professionals are being scared away from noble professions.
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Perhaps it wouldn't be "noble," but if physicians would refuse to treat lawyers the problems with insurance and lawsuits would probably be resolved rather quickly.
 
Mahneuvers said:
My future son-in-law (he already asked me for her hand) is no longer becoming a medical doctor b/c he was coached by existing doctors away from the profession. Your response seems to comport with the feedback he received. So sad. My daughter is starting her 3rd year of her pharmacy PhD despite getting feedback to stay away. I sure hope these problems are solved. Sad young professionals are being scared away from noble professions.
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Don’t get me wrong. I love what I do(surgical oncology). And working for a hospital system where I get paid for my efforts regardless means I get to practice without regard for reimbursement. But I still get caught up in the pseudodiagnosis ICD10 code to justify the test or procedure I think is right, and I see the 10s-100s of diagnosis codes layered on patients with a click just to justify the next thing. And if we don’t support our billing level or diagnostic test with this code, it gets denied by insurance which is a whole other rabbit hole of problems. Some is lawyer driven, but lately the majority is insurance driven. Still a noble profession when done for the right reason, but you sacrifice a large part of your humanity and soul to stay sane.
 
Half Fast said:
Perhaps it wouldn't be "noble," but if physicians would refuse to treat lawyers the problems with insurance and lawsuits would probably be resolved rather quickly.
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Substitute “lawyer” with “politician “ or “insurance executive” and that would be more accurate
 
Lastly- for those looking to keep your medical above a basic med level but still keep your health in check. Look for a physician (holistic, MD, DO) in your area that is willing to work for cash, no insurance, and on the periphery of modern medicine. I don’t mean neglect important things. But maybe avoid an insurance claim for something that may not be real or permanent or important. Eat healthy, exercise, get plenty of sun, plenty of good sleep. I’ve got a few docs in my area hat ascribe to this and are on board. But I’m lucky as I know how to navigate the system. I just hope I don’t get taken in an ambulance somewhere after an accidental etc.
 
Anonymous pilot said:
Thank you for your response
However, this feels excessive. I fell sick suddenly and that’s how my body reacted. I never actually fainted, only felt lightheaded. Doctors note states likely dehydration, and no cardiogenic concern.

If I discussed this event with my AME would they not see that as enough explanation to not have to check the “dizziness or fainting spell” box and move on? I’ve heard from others you don’t want to disclose anything you don’t need to.

But what would you recommend? Tell my AME now and get started on those tests you mentioned to have ready for my next appointment? And by “issuance in office” do you mean that if I had all the provided tests and doctors notes that I shouldn’t be concerned about deferral? I’ve already worked through a special issuance for my first class one time and I would like to avoid that process again.
thanks
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It’s their ball, their stadium and their league. Your alternatives are to (1) take the bus, or (2) drag it out.

Email me after you get denied (as you can only rarely get all that done in the 60 days they’ll give you.

Oh there is a third way…email me after the denial. Reasonableness is not in their vocabulary.

Was your Special Issuance “reasonable”? YGBSM…. and btw the ER doc does’t know squat about hearts at 12,000 feet.
 
Does anyone have an example of the FAA randomly pulling records and looking at ICD codes? Bonus points if they took action based on non-disclosure of an ICD code that didn't reflect the ultimate diagnosis.
 
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Lindberg said:
Does anyone have an example of the FAA randomly pulling records and looking at ICD codes? Bonus points if they took action based on non-disclosure of an ICD code that didn't reflect the ultimate diagnosis.
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I don't think it's the codes themselves that the FAA cares about. It's the written diagnosis that's used to support the code.

The docs don't care about the FAA. They do want to get paid based on how the visit or procedure is described and coded, and that's often done by the office staff who themselves are usually trained on how to code for maximum reimbursement. And it's even worse than that. Electronic medical records result in doctors filling in blanks (or dictating input) based on templates that support higher coding.
 
Tokirbymd said:
As a physician I am getting to the point that I recommend all pilots interested in keeping their medical stay away from any modern medical institution/physician/hospital/ER. You WILL end up with a potentially disqualifying ICD10 code. Unfortunately, we have to put a bunch of codes that MAY be possible in the chart to justify billing levels, reason for additional testing/imaging/labs, etc. That is not counting the number of incorrect codes that get entered in an EMR and never corrected later. Its a sad state, but these codes serve primarily to interface with insurance and billing and have nothing to do with actual health of the patient.

Edit- and now with more insurance companies combining all of these databases its becoming impossible for a simple minor visit to get something checked out to stay under the radar.
Click to expand...

dans2992 said:
How long until we see lower life expectancies for airmen because they must avoid doctors.

Frankly, this is ridiculous.

Do other countries also operate this way?
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I've been kinda wondering about this for quite a long time. As an increasingly frustrated patient in the system, I have seen so many times the docs have entered notes and codes that clearly don't make sense, not running labs that should be fundamental...... sometimes I recon it's based on their expert knowledge in working the insurance nonsensical systems, but sometimes I wonder if it's just rushing for lack of time, guessing, etc...and even driven my wrote procedures mandated by their big corporate bosses and by the insurance companies.
Tokirbymd said:
Lastly- for those looking to keep your medical above a basic med level but still keep your health in check. Look for a physician (holistic, MD, DO) in your area that is willing to work for cash, no insurance, and on the periphery of modern medicine. I don’t mean neglect important things. But maybe avoid an insurance claim for something that may not be real or permanent or important. Eat healthy, exercise, get plenty of sun, plenty of good sleep. I’ve got a few docs in my area hat ascribe to this and are on board. But I’m lucky as I know how to navigate the system. I just hope I don’t get taken in an ambulance somewhere after an accidental etc.
Click to expand...

for the last 10 months or so, I have been on a deep dive rat trail learning about metabolic health & diet, and have gotten myself onto a strict keto diet (mostly carnivore)...have seen lots of great result. Increasingly I want to find a doc like you describe...not necessarily the no insurance part, but yeah, maybe that...the other stuff for sure.... Sadly the only ones I've found so far in my area that do functional type medicine are Chiropractors ( or maybe other non MD/DO type docs), so they can only do so much
 
dbahn said:
I don't think it's the codes themselves that the FAA cares about. It's the written diagnosis that's used to support the code.
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Ok. Does anyone have an example of the FAA randomly pulling records and looking at ER possible diagnoses? Bonus points if they took action based on non-disclosure of a possible diagnosis that didn't reflect the ultimate diagnosis.
 
dans2992 said:
I honestly think the FAA kills more people with their medical rules than they “save”.
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their only concern is "protecting" the public from a random pilot having an arrest/stroke/syncopal episode at the wheel and crashing into an elementary school. (yes I know that would be rare but that is the FAA listening to the politicians). The FAA cares 0% about the actual health and well being of its pilot community.
 
Lindberg said:
Ok. Does anyone have an example of the FAA randomly pulling records and looking at ER possible diagnoses? Bonus points if they took action based on non-disclosure of a possible diagnosis that didn't reflect the ultimate diagnosis.
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The FAA likely won't. But a future event or disclosure would trigger a records review by AME/OK and if older records show up with those codes there and you failed to report, then you're screwed.
 
I'll give an example of the ICD10 code debacle. A few years ago our hospital system switched EMR providers. There was a database merge with every diagnosis from a previous visit for that person (acute or chronic alike) and every diagnosis code was brought into their record. For some patients it's in the 100s. In addition, there were a lot of patients records that got mixed up (same name etc). Every time one of these patients showed up in the office/hospital, the only way through this was a manual confirmation that was the patient but we just had to leave all of those other ICD10 diagnoses in there as "inactive" as there was no time to go through each one to confirm or deny if that happened in the past and reconcile/resolve it. If it was a current problem we could use the old code, or re-enter. So yeah, now every patient I see has an "inactive" diagnosis code list that goes for several pages. While I don't care about those old codes clinically, if a lawyer/admin type were to look at it they may interpret that as unreported disqualifying conditions.
 
Tokirbymd said:
The FAA likely won't. But a future event or disclosure would trigger a records review by AME/OK and if older records show up with those codes there and you failed to report, then you're screwed.
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Hypothetically, or you know of this happening?
 
Not sure if this is really the case as I am not an AME. I would think that the issue here is not some code, which by the way is more often than not assigned by someone who is not a doctor or what is colloquially known as a physician extender, but the reason the pilot was seen and evaluated. You mention it on your form, discuss it with your AME, and your AME should know what to do. I think, the FAA could care less about the individual pilot, they care about the media circus should that pilot bring attention to themselves and their was something no matter how remote that the FAA could have done to prevent said pilot from being attention to themselves. So they cast a wide net and do not worry about catching some who should not have been caught.
 
Brad W said:
maybe we need a MOSAIC type re-write of the medical side of things....
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Medical reform happened years ago when Congress enacted BasicMed. Applicability of FAA aeromed regs on the private pilot population made so little sense even Congress, arguably the most effed up assembly of people on earth, saw merit in giving PPs an alternative.
 
Stewartb said:
Medical reform happened years ago when Congress enacted BasicMed. Applicability of FAA aeromed regs on the private pilot population made so little sense even Congress, arguably the most effed up assembly of people on earth, saw merit in giving PPs an alternative.
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Yeah, but they still stuck in the one-time 3rd class requirement. Unfortunately, I don't think it can be removed without another act of Congress. Hold not thy breath....
 
Lindberg said:
Ok. Does anyone have an example of the FAA randomly pulling records and looking at ER possible diagnoses? Bonus points if they took action based on non-disclosure of a possible diagnosis that didn't reflect the ultimate diagnosis.
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In today's world, nothing needs to be "pulled" as in yesteryear. It's possible that the FAA has far more access than we can imagine, and they may proactively be doing things we don't want. I mean, Google does, and the US Gov't has far more access to things.
 
And we sign HIPPA acknowledgements and have to provide names of who we allow info to be shared with. So much for privacy.
 
Half Fast said:
Yeah, but they still stuck in the one-time 3rd class requirement. Unfortunately, I don't think it can be removed without another act of Congress. Hold not thy breath....
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The statute says that the FAA must adopt regulations that permit pilots to fly if they meet the requirements of the statute. It doesn't prohibit the FAA from adopting more permissive regulations via the NPRM process. That why they were able to recently modify the rules to allow BasicMed pilots to act as a safety pilot without being pilot-in-command.

But still, "Hold not thy breath...."
 
bbchien said:
Yes this is happening.....ask any vet, for example....
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We've all seen the cases from years ago of failure to disclose government disability. That's entirely different. I'm asking about the FAA actually randomly searching airmen's medical records, and/or the FAA punishing an airman for not disclosing ICD codes that don't reflect an ultimate diagnosis.

It's often stated here that airmen should over disclose things that aren't legally required because "the FAA can find it." I'm just looking for evidence that's actually a thing.
 
Docs can see your scrip meds on a database. I know that from recent office visits. I presume the FAA has access to the same.
 
Lindberg said:
We've all seen the cases from years ago of failure to disclose government disability. That's entirely different. I'm asking about the FAA actually randomly searching airmen's medical records, and/or the FAA punishing an airman for not disclosing ICD codes that don't reflect an ultimate diagnosis.

It's often stated here that airmen should over disclose things that aren't legally required because "the FAA can find it." I'm just looking for evidence that's actually a thing.
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It comes to the pilot in the form of "The FAA has become aware of....." or "The FAA quality assurance branch has become aware of...." and then you're off to the races. I've helped reply to a goodly number orf those.

.....believe what you wish. Apparently President "O" solved the issue of cross-database permissions by "Headering" or "renaming" all various bureaucracy databses the same. YMMV.
 
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I'm not about to disclose any records here. But you should recognize that if anyone is in a position to know it would be someone such as I. Or maybe that doesn't suit you?

Capt Chrisman retired. lost all his certificates. That's public knowledge....I can talk about that. And it IS the same thing. Just one particular database.

I do recall one demand for information, that came from a pscyh hospitalization. Since the airman didn't report any such to me, it was HIS problem.
 
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bbchien said:
I'm not about to disclose any records here. But you should recognize that if anyone is in a position to know it would be someone such as I. Or maybe that doesn't suit you?
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It's an appeal to authority, so no. And I don't even know you, so why would it? It's not necessary for you to disclose any medical records here. Are you asserting that you have direct knowledge of cases where the FAA has taken action based on randomly searching insurance records and finding ICD codes unrelated to an ultimate diagnosis? What were the general circumstances? Answering that wouldn't reveal anyone's medical records. And if certificate action was taken, that should be public.

bbchien said:
Capt Chrisman retired. lost all his certificates. That's public knowledge....I can talk about that. And it IS the same thing. Just one particular database.
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Seems to be one of the disability cases mentioned earlier.

www.pilotsofamerica.com

First of 4 Pilots indicted for lying on Medical is Sentenced.

GREGORY JAMES CHRISMAN was sentenced 09/15/2020 to two years probation, lost his pilot certificates and it's unemployed. Chrisman previously worked as a commercial pilot, and this prosecution arises from false statements that Chrisman made on medical certifications submitted to the Federal...
www.pilotsofamerica.com www.pilotsofamerica.com
 
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