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Warning: Don't expand BPH in the diagnosis/impression, leave as is. - sm
Posted: Mar 21, 2013
I got a style error minor deduction for this, because it could also refer to "benign prostatic hyperplasia." I was actually aware of this terminology controversy in the medical community in terms of what the actual meaning is, but I've never once had "benign prostatic hyperplasia" dictated in over 18 years of MT, regardless (has anyone else?). However, I should somehow intuit that Nuance wants it done this way (though I've been expanding it for over 2 years now with never a correction before) and was given a point deduction rather than an "FYI" NonError. Though I guess if they actually say "benign prostatic hypertrophy" anywhere else in the report (rather than just saying BPH throughout the report, never once expanded, as in this case), then you'd get dinged if you didn't expand it.
Forewarned is forearmed. I just can't believe this place sometimes.
Not expanding BPH - Anonymous
[ In Reply To ..]I have never heard of NOT expanding a diagnosis and I have been doing OP reports/acute care for 35 years! Some of these things just blow me away!
Well, I found an old thread from here (see link) with some interesting opinions. - OP
[ In Reply To ..]Like I said, I was aware that it is a misnomer* (so, technically speaking, we should always be changing it to benign prostatic hyperplasia, hah, like melenic vs. melenotic/melanotic), though I've never, ever once had "benign prostatic hyperplasia" dictated (would still love to hear if any others have). The dictators obviously haven't caught up to this misnomer at all, the way they somewhat have with IUGR (restriction vs. retardation), for example, and I'm sure they nearly all consider the term benign prostatic hypertrophy perfectly synonymous with benign prostatic hyperplasia (what the condition really is).
Like I said, just a warning. You might need to be careful with IUGR too, if that ever comes up.
Despite what some posters are implying in the below thread, you wouldn't be "changing that patient's diagnosis" by using hypertrophy instead of hyperplasia, since benign prostatic hypertrophy doesn't even really exist. They're not 2 separate conditions; benign prostatic hypertrophy is exactly the same diagnosis as benign prostatic hyperplasia, just an historically inaccurate way of saying it.
http://forum.mtstars.com/285688.html
*BPH involves hyperplasia (an increase in the number of cells) rather than hypertrophy (a growth in the size of individual cells), but the two terms are often used interchangeably, even amongst urologists.[1]
Could the 1 disliker (so far) please explain to me what they dislike about the above post? - OP
[ In Reply To ..]Seriously, rather than a hit-and-run disagreement, it might be helpful to all of us if you explained *why* you have a problem with it?
It is not just a misnomer and you ARE changing the diagnosis - RHIA, CCS
[ In Reply To ..]You ARE changing the diagnosis. The conditions are different according to the ICD-9-CM classification.
There is more to this than a supposed misnomer. Melena/melanotic IS a misnomer, but this usage of hypertrophy and hyperplasia is not the same.
They may be different for coding purposes, but they're not *medically* different diagnoses. - OP
[ In Reply To ..]Once again, there technically is no such thing as benign prostatic hypertrophy.
"Prostate disorders, excluding prostate cancer, are located within category codes 600 to 602 in the Tabular List of Diseases. One of the most common prostate diseases is benign prostatic hyperplasia (BPH). ... Sometimes physicians call this disorder benign prostatic hypertrophy, although that is a misnomer because BPH causes the gland to enlarge from an increased number of cells (hyperplasia), whereas hypertrophy causes enlargement of an organ from the enlargement of the cells themselves (e.g., muscle hypertrophy occurs from weight lifting)."
Is there a difference with this in the upcoming ICD-10-CM compared to 9? (see link) I hate to think of patients being charged differently for what is really, truly the same thing.
http://www.icd10data.com/ICD10CM/Codes/N00-N99/N40-N53/N40-/N40
[Edit: p.s. Yes, I see what you mean, amazing. Are there are actually different charges for 600.00/01 vs. 600.90/91? Or I guess that would be facility/office specific? And please don't CAP at me with any more replies; I haven't yelled at you, and I'm trying to be respectful, despite the tone you initially took.]
| ICD-9 codes covered if selection criteria are met: | |
| 598.0 - 598.9 | Urethral stricture |
| 600.00 - 600.01 | Hypertrophy (benign) of prostate |
| 600.10 - 600.11 | Nodular prostate |
| 600.20 - 600.21 | Benign localized hyperplasia of prostate |
| 600.90 - 600.91 | Hyperplasia of prostate, unspecified |
http://www.aetna.com/cpb/medical/data/1_99/0079.html
Explanation - RHIA, CCS
[ In Reply To ..]Reimbursement is based on the procedure, in this case. As you can see, the procedure is approved for only those diagnoses. And that is just for that one insurer. Others may differ.
For inpatient stays, the diagnosis may have more of an impact. The payment structure for those is different.
You run into an additional problem with research. If a researcher wants to identify one condition versus another, but you have been misapplying an expanded version that is getting coded, the researcher thinks he is retrieving the actual number of cases, when he is really retrieving inconsistencies introduced by MTs.
Strongly disagree - C
[ In Reply To ..]No acronyms or abbreviations in diagnosis(es)/impression, per Book of Style.
We, as MTs, are to use our critical thinking skills, and if the report is clearly about a man's prostate, BPH expanded to benign prostatic hypertrophy is the correct expanded form.
If, on the other hand, the report is not clear and mentions nothing of the prostate, then leave it as BPH.
End of story.
I disagree - SB
[ In Reply To ..]Benign prostatic hypertrophy is a subcategory of benign prostatic hyperplasia in the ICD-9 codes (see below). Benign prostatic hyperplasia would be the preferred term if no other information is provided. I am sure abbreviations of many other diagnoses could have variable subcatagories in the ICD-9 codes. Maybe we should not be expanding any abbreviations unless the dictator states elsewhere in the report exactly what the abbreviation stands for. But since we are required to expand abbreviations in certain sections, in cases of multiple possible expansions, QA should provide punishment-free education as to what the client wants in these situations. By using the point-deduction method, they are potentially robbing us of income that we otherwise might receive in a bonus, requiring us to know the ICD-9 codes, along with everything else to achieve a bonus status! ((For 4 cents a line!)
See ICD-9 codes below:
600 Hyperplasia of prostate
600.0 Hypertrophy (benign) of prostate 600.00 â€Â¦ without urinary obstruction and other lower urinary tract symptom (LUTS)
600.01 â€Â¦ with urinary obstruction and other lower urinary tract symptoms (LUTS)
600.1 Nodular prostate
600.10 â€Â¦ without urinary obstruction
600.11 â€Â¦ with urinary obstruction
600.2 Benign localized hyperplasia of prostate
600.20 â€Â¦ without urinary obstruction and other lower urinary tract symptoms (LUTS)
600.21 â€Â¦ with urinary obstruction and other lower urinary tract symptoms (LUTS)
600.3 Cyst of prostate
600.9 Hyperplasia of prostate unspecified convert
600.90 Hyperplasia of prostate, unspecified, without urinary obstruction and other lower urinary symptoms (LUTS)
600.91 Hyperplasia of prostate, unspecified, with urinary obstruction and other lower urinary symptoms (LUTS)
"Benign hyperplasia" is not listed there - Wondering where you got it
[ In Reply To ..]Benign hyperplasia of the prostate isn't even listed there, and I am mystified as to how you determined it was the "preferred term." As it happens, 600 cannot be used at all and the 600.9 entries are nonspecific. That's what the 9 means.
We don't code like that, nor do we do it from a list like that. Your assumptions are what is known as "incorrect coding."
The whole point above was that you should not be expanding ambiguous acronyms. Period. Perhaps you should address that with management at Nuance.
I am a former MT, as it happens, but everywhere I worked followed the rule that you expanded only clear and unambiguous abbreviations and acronyms. It seems I got out just in time.
Expanding - me
[ In Reply To ..]There is no way on this green earth you've never heard NOT to expand if the abbreviations mean different things and they do not say which it means.
Right, do not expand BPH - RHIA, CCS
[ In Reply To ..]Regardless of what the article in Wikipedia says, you should not expand BPH unless you know whether hypertrophy or hyperplasia is intended.
In the ICD-9-CM, the disease classification system used in the United States, benign prostatic hypertrophy and benign prostatic hyperplasia are classified differently. If you supply the wrong expansion, the case will be coded incorrectly. Incorrect coding affects more than wording on a report, potentially affecting reimbursement, hospital and national disease statistics, and medicolegal liability, and even the medical histories of the patient's relatives.
As long as you leave it as BPH, the coder can query the physician for the correct wording. Querying is an official process that can get the problem of using abbreviations in impressions and final diagnoses corrected...not just for one term, but across the board. Clinical documentation improvement specialists are also able to address this issue.
Reiterating my reply above... - OP
[ In Reply To ..]Is there a difference for this with the upcoming ICD-10-CM compared to 9? (see link) Hopefully they've got it right this time and are not classifying them differently, since, once again, they're really the same thing.
http://www.icd10data.com/ICD10CM/Codes/N00-N99/N40-N53/N40-/N40
"Benign prostate hyperplasia (BPH): A condition that causes an increase in the size of the prostate gland in men, commonly causing difficulty in urination; also referred to as benign prostatic hypertrophy."
http://www.anthem.com/medicalpolicies/policies/mp_pw_a053318.htm
The problem is not what it is, but what you are doing with it - RHIA, CCS
[ In Reply To ..]The problem is that you are taking it upon yourself to decide what the provider SHOULD HAVE MEANT. It is not your responsibility, but the provider's.
You may see this as a value-added service, but it is not. You are interfering with someone else's professional judgment on the sneak...they can't even tell you are doing it.
When you change things like this you DO make it possible for patients to be charged incorrectly. You DO cause legal problems for doctors and hospitals. That is why they are telling you to STOP CHANGING THIS! Some facility probably asked them to have you stop.
If you wonder what the attraction is with EHR templates and VR that never goes through an MT editor ... this is it. The physician, who is legally liable for the content of the record, becomes the only party generating it. No more "transcription did it" excuses.
If you want to police documentation, there are better-paying and more appropriate jobs in which to do it.
Excellent post. - nm
[ In Reply To ..]nm
THANK YOU. (NOT) - OP
[ In Reply To ..]Once again, they are exactly the same condition, and in over 18 years of doing MT, I have never once heard "benign prostatic hyperplasia" dictated. Ever. So where you think the dictator may have actually been saying that, it may have really been an MT who was told or had decided to always expand to hyperplasia since that is the correct terminology. I would be interested to know if, when queried, any provider said it really should be "hyperplasia" rather than "hypertrophy" there, but I'll take a pass on any more replies from you. Too bad this couldn't have continued as a civil discussion, but you took it out of that realm with your continued yelling.
Oh, and they certainly should be able to tell if we are doing it, because they're *supposed* to read their reports before signing them. I've never had a report come back to me saying that the -dictator- didn't want "BPH" expanded to benign prostatic hypertrophy. If any particular dictators have an issue with that, I would hope and expect they would make a point of dictating "hyperplasia" since that is such a remarkable exception. Like I said, I bet you're seeing a lot more "hyperplasia" (if you even are) than was ever actually dictated due to MTs' decisions, not dictators'.
Don't worry, I won't be introducing any more "MT inconsistencies" with BPH in my reports, not with this MTSO anyway. I have been told to just go ahead and expand to the common "benign prostatic hypertrophy" elsewhere, actually. I guess that would be an "MTSO inconsistency" you'd be dealing with there. And if a researcher doesn't know to compile both terms, there's going to be a lot more trouble with that research than whether or not an MT or an MTSO or a dictator arbitrarily decided to use one versus the other.
"Some facility probably asked them to have you stop." Guffaw. Yeah, that was definitely evident from the rationale I received after disputing it (which rationale was really based on an over-interpretation of the drug indications for Flomax). Something that a facility had an issue with would be disseminated in an account-wide e-mail, and I'd be asking others about that here, if they'd been told that for their accounts too, not just giving a warning about my unique QA decision.
Excellent post! - nm
[ In Reply To ..]xx
OP, thanks for starting a much more valuable than - usual thread. I have learned from reading
[ In Reply To ..]everyone's posts. It does seem that, right as your reasoning is, technically speaking it needs to be left unexpanded to not possibly lead to a coding error.
I'm not at all happy with that either since I'd bet my next paycheck if we all start doing that some are going to get dinged by QA for leaving it as an abbreviation.
I don't work for Nuance, but are you required - like I am - - VP
[ In Reply To ..]to have a Stedman's Abbreviations as part of your employment? If so and you are supposed to be expanding according to it, Stedmans has the primary expansion (listed in red on the electronic version) as benign prostatic hypertrophy, and you are correct.
Excuse typos... it's very early.
Good point. I don't think there's any requirement for an acronym reference. - OP
[ In Reply To ..]I'm from a buyout some time back that had different editing standards, so I may just be missing this, will double-check. But I'm pretty sure not.
Interestingly, my Stedman's Electronic Medical Dictionary (version 7.0, 2007, supplied by my bought-out company) only shows benign prostatic hyperplasia for BPH (in addition to Bachelor of Public Health). So there you've got Stedman's inconsistencies gumming up the works too.
stedman's expansions in red - msdaisy
[ In Reply To ..]I told a QC person the same reasoning you stated above. Stedman's primary expansions are in red and that is what I used once, and her reply was well we really can't be sure that was the meaning or that is what Stedman's means for us to apply...how great an answer, huh
Some comments to all posters here: - MT
[ In Reply To ..]In no particular order:
1. Maybe all MTs should give up our careers since you think VR is the solution for the coding issues. I guess I will take up coding then.
2. I have a doctor who ALWAYS says benign prostatic hyperplasia. Should I really be typing hypertrophy? ABSOLUTELY NOT! He WANTS me to type hyperplasia. I will get a nasty e-mail if I do not type want he wants. He signs them off EVERY time. I have never heard a peep out of our coder. I wonder if she is asking the doctor about each report that says hyperplasia instead of hypertrophy. If she was, he would start saying hypertrophy after a while, no? I have another doc who will tell me straight out during the dictation "I know I should say XYZ, but I am old school and prefer ABC." Sorry, but this issue is on the doctors, not the MTs. I have ALWAYS been told to ALWAYS expand in the impression. The doctors have never corrected it. The coder has never corrected it. I would like to see this coder transcribe a report.
3. The CAPS are for emphasis, not for arguing...you have to relax on that. LOL
4. The original poster should not have been penalized for this.
5. My doctors EXPECT me to "figure out" what they mean, and I do. If there is any question, I send them a blank. They appreciate it. End of story.
LOL, NOPE, SORRY, I WON'T GIVE UP MENTIONING CAPPING ̢ۥ - OP
[ In Reply To ..]VERSUS OTHER WAYS OF SHOWING EMPHASIS ̢ۥ AS BEING RUDE. (You get a pass, though. This time. 
)
It's common Internet knowledge, and if that poster doesn't know it yet, it's about time they learned. Especially on a forum that gives you the options of a Rich Text Editor with italics and underlining and bold, etc. Or one can even just use asterisks (like I do sometimes, especially when I've forgotten to switch to Rich Text) or such.
Hey, out of curiosity, about how old is your "benign prostatic hyperplasia" doc? Younger, I'd guess?
Thank you, I definitely shouldn't have been penalized, just a NonError Comment if they wanted to make it known. This is my biggest kvetch about Nuance QA ... the lack of use of FYI-like NonErrors instead of actual deductions for these kinds of issues. The inconsistencies with QA are never-ending. Next week I'll probably be told I should have expanded BPH to benign prostatic hypertrophy, and then I'll have to copy and send this QA's decision to dispute that.
I'm beyond exhausted with trying to cope with the constantly changing goalposts. The game is so rigged against us that it seems stupid to even attempt to play. I know a lot here have given up as far as bothering with disputing Fiesa anymore (or even reading it) ... almost hoping I can get to that state of hopelessness soon myself, meh. I'm very, very close to it.
Rules are tough.... - MT
[ In Reply To ..]Because they are always changing the rules. Every account I have had insist you use AAMT BOS, but then you are corrected constantly because of their "preferences." I find that I do what I KNOW I should do (I like CAPS, that's why I mentioned it :) lolol) Then I just adjust to their quirks and made up rules. I have one doctor who fights me on spelling. I finally know now there are certain words he just WANTS to spell wrong and now I type what he wants, make of note of f the voice file he yelled at me in to cover my behind, and continue on. One doctor insists of neural foramen as a pleural and the other insists on neural foramina as the singular. MTs are the glue that hold these doctors together, regardless of what that coder says. They cannot spell, they make SO MANY mistakes...you know how many times they talk about a male patient with ovaries? Geesh! We are constantly correctly them...heaven forbid we miss one of THEIR mistakes and they act like WE are stupid. Anyway, back to my Egyptian, deaf with a speech impediment doctor (not even kidding). Have a nice day everyone!
VR as a solution for coding issues - Another Anon
[ In Reply To ..]This coder has obviously never done any VR editing or QA. If we left things as is according to VR, no one would get paid, and the coders and clinical documentation staff would be wasting a lot of time trying to figure things out. The AHDI Book of Style addresses expanding abbreviations ad nauseum if anyone cares to refer to that. I only do QA for one facility, but I would think some of this would be at the discretion of the facility and/or the providers, not necessarily what the MT was "taught." My facility's preference is to transcribe the abbreviation (BPH) when dictated or the expansion when dictated, with the exclusion of preop/postop diagnoses in operative reports. In years past, when the MTs expanded abbreviations, we ran into issues with some of them making incorrect choices and being totally wrong because most abbreviations can have several meanings. This is a good discussion; even coders now seem to realize that MT has a place in the food chain.
Got off track somewhere - sm
[ In Reply To ..]You seem to have goten the wrong impression above ... the discussion was not about typing something the coders wanted. It was about typing an accurate reflection of the physician's intent, i.e. what he intended to say.
If he says only BPH and there is no other evidence in the record, you cannot know if he meant hypertrophy or hyperplasia. You cannot assume either one.
For the record, coders do not code based on revenue or anything other than the physician's intent. They choose codes based on the documentation, not on which is preferred or which is worse or which gets paid. If there is a question about it, they query.
If your doctor says hyperplasia, that is what he should get. Your coder will code hyperplasia. No one was suggesting you should do anything different.
According to BOS second edition. - sm
[ In Reply To ..]When an abbreviated diagnosis, conclusion, or operative title is dictated and the abbreviation used is not familiar or has multiple meanings, the meaning may be discerned if the originator uses the extended term
elsewhere in the dictation or if the content of the report somehow makes
the meaning obvious. If the extended form cannot be determined in this
way and there is easy and immediate access to the patient̢۪s record or to the
person who dictated the report, the MT should use these as resources to
determine the meaning. If these attempts are unsuccessful, the abbreviated form should be transcribed as dictated, then flagged, requesting that the originator provide the extended form.
BOS - anon
[ In Reply To ..]That is correct about the BOS, UNLESS you have specific instructions on that particular account within the SPECS that say to always/never expand abbreviations. All are different for each hospital/clinic/dictator.
I have been dinged for expanding/not expanding many times and try my best to read every instruction.
WARNING!!! - anon
[ In Reply To ..]All the people that do not work for Nuance, why are you giving your "OPINION."
We go by MT instructions specifically, and believe me, they are different for EACH account. I spend more time reading specific instructions and specs than I do editing. ALL these instructions supercede the BOS, and all the other things that YOU or I think.
Eeew. Some of us were trying to help. - Vamonos Pest
[ In Reply To ..]FYI... there are account specs AT EVERY COMPANY. You're not that special.
Warning - karma cat
[ In Reply To ..]Don't you see that this is just another way for the industry to exploit and humiliate you? What else are they going to have you do to try to see how much time can be wasted instead of making money? It's a conspiracy.
I thought the rule was if an acronym had more than one meaning, if you are not absolutely sure--sm - anon
[ In Reply To ..]then you do not expand the acronym, even in the diagnosis heading. Therefore, unless the physician expands the term later in the report (rarely in my experience unless it is a Urology report), then I always leave it at BPH. I figure the onus is on the doctor to differentiate the meaning.
My bugaboo lately has been OFS, a swallow eval of some sort but not OSS. Have not been able to document it so I do not expand.
If it were me, and I could not be certain of the abbreviation I would - MT
[ In Reply To ..]I would most certainly put
__________ (BPH).
This way, my behind is covered, as in diagnoses we MUST expand all unless lab values according to my facility rules. BPH is not the only one where it can be more than one thing and I have done this before (blanking and then putting the abb).
One question: Is it too much of a bother for the dictator to actually STATE the real words instead of putting the abbreviation? First time right for dictators. Or oh excuse me, this is only somebody's medical document and their life, so I suppose that is too much to ask (sarcasm obviously).
bph expansion - msdaisy
[ In Reply To ..]the only way to be certain of the term to expand is, if a medication that treats this is named somewhere in the document.
Good luck trying to guess - which abbreviations to expand or not
[ In Reply To ..]Most of the times I don't expand because there is a possible altenative expansion, I have been dinged by QA, and my challenges rejected because "usually the abbreviation means thus and so." You can't win with this system!
Geez, I'm thoroughly confused after reading all the below. - Anon
[ In Reply To ..]Thought I could safely expand to benign prostatic hyperplasia when talking about the prostate as Stedmans defines benign prostatic hypertrophy as "Erroneous term that is often considered a synomyn of nodular hyperplasia of prostate." I took that to mean it was never correct to use benign prostatic hypertrophy when referring to the prostate.
It is confusing, but worth thinking about and making a decision on how to proceed. - OP
[ In Reply To ..]I basically agree with you, it really should be like "melena" in that we just change the dictated misnomer to the correct term, but I wouldn't be willing to risk it on this one yet, at least not at Nuance. Per the feedback I got, we can't know what was "intended." And supposedly there may be different charges based on which word is used, though that wasn't really answered by those "in the know" and makes no sense and hopefully is really simply a doubling-up coding-wise in order to make it easier for them to just choose one or the other and not have to query a dictator; if not, and patients are really being charged differently based on benign prostatic hypertrophy vs. hyperplasia in a medical record, I sure hope someone finds out and makes a big stink about it because that would be unfair and I'd think even possibly illegal since they are indeed referring to exactly the same medical condition.
So unless hyperplasia or hypertrophy is actually dictated in full elsewhere in the nondiagnostic section of the report, I'm now going to leave as a blank with BPH in parens behind it when given as a diagnosis, as per poster MT's suggestion (which does correspond with BOS directives), i.e., _____ (BPH).
However, BOS-3 also states: 9.1.8 Multiple/Uncertain Meanings
"When an abbreviated diagnosis, conclusion, or operative title is dictated and the abbreviation used is not familiar or has multiple meanings, the meaning may be discerned if the originator uses the extended term elsewhere in the dictation or if the content of the report somehow makes the meaning obvious. If the extended form cannot be determined in this way and there is easy and immediate access to the patient’s record or to the person who dictated the report, the MT should use these as resources to determine the meaning. If these attempts are unsuccessful, the abbreviated form should be transcribed as dictated and the report flagged with a request for the originator to provide the extended form." (emphasis mine)
I'm not going to pend/flag for this (unless account specs require it in terms of number of allowable blanks), nor am I going to check past records to see which version might have been used because there's no way for me to know for sure without also checking the voice file whether just the initialism BPH or the extended version was really dictated in other reports. Like I said before, I'd be willing to bet that more than a few instances of "benign prostatic hyperplasia" are actually due to MTs or MTSOs/QAs making a decision just like you mentioned above, not reflecting what was actually dictated (or intended, since no way to know that if only BPH is dictated throughout the report).
Nobody said patients were charged differently here - sm
[ In Reply To ..]No one said patients were being charged differently for this particular term. The possibility of that can occur with other terms, however.
That information was shared with you so that you could see the impact your work has in the larger picture.
Elsewhere on this board, there are posts going on about how important accuracy is in your work, how it can impact patient safety and patient care, etc. Yet when someone points out a very legitimate concern about expanding an acronym that has two expansions if you are unable to determine which it is, there is uproar. (Not from the OP, though.)
The most amazing thing is that the advice RHIA, CCS posted was exactly what the BOS said. Probably where she got it to begin with.
This situation is not the same as melena. That is a mispronunciation or word misuse based on confusing sounds. BPH simply stands for two different things. It is the physician's purview to specify which of the two.
The suggestion in a someone's post above that coders wanted this expanded so they could avoid querying is nonsense. They said you should NOT expand it so the people who are responsible for querying (coders and CDIs) could do so. In other words, follow the BOS guideline on this so that the problem can be addressed with the physician.
They. are. not. two. different. things. - OP (nm)
[ In Reply To ..]nm
Really simple solution - anon
[ In Reply To ..]Do what your company/client wants you to do.
End of story.
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WARNING!!!
Nov 01, 2009
Okay, so I got a job offer! Yeah, sounds great but the pay was at low level, but I kept my options opened and I said okay. They do not use the standard counting and count a line if there is only one word. I thought Wow that is strange but maybe the companies I have been for are more on the straight and narrow. Then she told me no contract, just too much paperwork and a lot of "mumble jumble". I thought okay odd but okay. Then said told me it was on a trial bas ...
TTD--A Warning For All
May 21, 2012
Everyone please be aware that TTD is not someone you want to work for. Be aware that you wait 6 weeks for the first check only to find it is short. They are constantly hiring and advertising jobs. They just laid off 16 people last week and now they have new job postings. BE AWARE THAT THEY INTEND TO NOT PAY YOU ON TIME AND PAY WILL BE INCORRECT. Amy and Dawn have developed a greedy practice. I have a long list of previous MTs that have not been paid and the li ...
Warning About A DSL ISP
Mar 14, 2013
I had to give up my $39. a month wireless ISP to comply with client requirements. Had to sign a 2 year contract with the company "C.L." whose ads claim it's only $19. a month. The speed connection for that price is equivalent to dial up. By the time you really have the DSL you need you are up to $63. a month. I also had to get a landline which I did not need. It rings ALL day with wrong numbers and solicitors so is useless to me but I have to pay for it for 2 years. I got my bill on Marc ...
Warning
Sep 12, 2013
I got a warning from my supervisor because I did not get in all my hours ~ I am full-time. I went through the procedure of work availability and everything ~ this was a couple of months ago when we got 15 minutes. I filled out Remedy ticket to be released from work without pay ~ this was when we still had that option. I think I was short about an hour and a half. How can you write someone up for being out of work ~ when we have nothi ...
TAA WARNING
Oct 10, 2013
Just a warning to my fellow laid off colleagues. I was sent for vocational skills assessment testing as a part of the process for TAA. I mentioned to the interviewer that MT had turned into a minimum wage job over the last year or so due to outshoring and scarcity of work, and I was really looking forward to retraining and a career change. The long and the short of it is that this was interpreted by the vocational assessment team as since I was working at a minimum wage jo ...
ARA And S/l Car Pul Mon Ali? Diagnosis Help
Oct 29, 2009
I don't know if I am just not thinking straight or if there is reason I cannot find these. Under diagnoses, doc says the pt has ARA(?), DM, car-pul-mon-ali, P slash atrial fibrillation.... Seriously, I cannot find ARA, no sign of carpulmonali, or P/atrial fibillation. Any ideas at all? I am going to continue to think and search. TIA for any help! ...
Is There A Diagnosis Of...sm
Jan 13, 2010
Degenerative lateral meniscus tear? It sounds like he is saying degenerative. I have not heard of "degenerative" lateral meniscus tear. tia. ...
Is This One Diagnosis?
Feb 08, 2010
LEFT SHOULDER STRAIN CERVICAL AND TRAPEZIUS MYALGIA If so, would there be a comma put in? TIA. ...
Diagnosis And Med
Mar 27, 2010
s/l hypergolactanemia. The patient is on s/l promaxitine. ...
Diagnosis
Apr 26, 2010
1. AIDS 2. Meningitis versus AIDS "sulfa patty"? ...
UDI As A Diagnosis
Feb 16, 2012
Urogenital Distress Inventory is the urologic term I know but this is listed as a diagnosis and has to be written out naturally. Anyone know it? Thanks. ...
Diagnosis INR
Sep 10, 2013
If "elevated INR" is listed in the diagnosis, would INR be expanded to international normalized ratio? Thanks!! ...
Rant Warning!!!!!
Nov 01, 2009
I have spent the enitre morning doing ASR on an ER doc who does not pronounce anything correctly, eats loudly and talks with her mouth full, yawns but does not stop talking and says things that make absolutely no sense at all. I beg anyone who this sounds famiiliar to to email Support and ask that she be removed from ASR. I have done half my usual line count today because of this horrid woman, and I can't even F11 because of the stupid limit!!!!! My irritation factor is th ...
Warning To All About Keystrokes
Jan 21, 2010
Warning to all about Keystrokes. I have had no work in a week and they tell me I cannot have a backup account as there are no openings, yet their website says they are hiring. This first happened over the holidays which is expected, but they said work would pick back up in January. I have never worked for a company that does not offer a backup account. What a joke! ...