Peripheral Edema - is it disqualifying?

A

Askies329

Guest
I’m going to apply for my first class medical soon, but I’m worried about getting disqualified because of swelling in my feet.

For context, I saw a cardiologist for other issues a few months ago to be cautious (heart is good and healthy - no issues) but also for my feet swelling which I thought may have been tied to my heart. It’s not. I just have slow lymphatic flow in my legs. It’s not painful or anything. It’s more of a cosmetic issue for me, but I’m not sure if an AME won’t see it that way? I’ve had it since I was a teenager.

Also something I’m worried about is I saw a psychologist last year only two times just to vent to someone about my son’s medical issues. Didn’t get a diagnosis or anything - that I know of. Have any of you called a medical provider to see what they recorded?
 
You should get your medical record from the psychologist. You have to report the visit and the FAA won't care what your assessment is. They will insist on reviewing those records (along with the cardiologist's records) to make their own determination, and you can bet that there is a diagnostic code used for those visits. You may as well review those yourself before applying for any medical and consult with an experienced physician (or post here) for advice on the next steps.

Don't fill out a MedExpress form until you know more about what the FAA will require.
 
FAA is going to at least require a serum creatinine, urinalysis and echocardiogram.
As for the psychologist, Dave is right- get the record. If the diagnosis is reactive anxiety and there have been no meds now or in the past the AME can now make a declaration and issue you.....
 
bbchien said:
FAA is going to at least require a serum creatinine, urinalysis and echocardiogram.
As for the psychologist, Dave is right- get the record. If the diagnosis is reactive anxiety and there have been no meds now or in the past the AME can now make a declaration and issue you.....
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Thanks… I will ask for medical records just to be sure. I’ve never had meds prescribed for anxiety in the past or anything. Those two visits are the only time I ever saw a therapist. Can’t help but be nervous anyway :(
 
dbahn said:
You should get your medical record from the psychologist. You have to report the visit and the FAA won't care what your assessment is.
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No, he doesn't have to report it. The Medxpress instructions say so explicitly:

"List visits for counseling only if related to a personal substance abuse or psychiatric condition."

According to the OP, these visits were related to neither personal substance abuse nor a personal psychiatric condition. Based on his description,
these visits are not reportable. Of course if he reports them anyway, he'll get the microscope treatment and everyone here will complain about how unreasonable the FAA is.

And the medxpress must be filled out to the best of your knowledge.
 
Lindberg said:
No, he doesn't have to report it. The Medxpress instructions say so explicitly:

"List visits for counseling only if related to a personal substance abuse or psychiatric condition."
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That's why he needs to get the psychiatrist's records to know what was recorded for the visit. He'd have a tough time pleading lack of knowledge if the diagnosis was one of many "psychiatric conditions", often up-coded by the psychiatrist to justify charges for the visit. He doesn't know the diagnosis and needs to find out what it was. He didn't even think there was a "diagnosis or anything" (his words), which would be extremely unusual.
 
Lindberg said:
No, he doesn't have to report it. The Medxpress instructions say so explicitly:

"List visits for counseling only if related to a personal substance abuse or psychiatric condition."

According to the OP, these visits were related to neither personal substance abuse nor a personal psychiatric condition. Based on his description,
these visits are not reportable. Of course if he reports them anyway, he'll get the microscope treatment and everyone here will complain about how unreasonable the FAA is.

And the medxpress must be filled out to the best of your knowledge.
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One should not contradict Dr B unless one is more experienced in dealing with the FAA.
 
Bad Advice, Lindberg. How do you know he didn't call it "Anxiety disorder" (BTW that's a condition). So is Adjustment disorder. Both are, since June 26th, isusable, but No AME is gonna do that without seeing the record.

Terrible advice.
 
bbchien said:
Bad Advice, Lindberg. How do you know he didn't call it "Anxiety disorder" (BTW that's a condition). So is Adjustment disorder. Both are, since June 26th, isusable, but No AME is gonna do that without seeing the record.

Terrible advice.
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I don't know anything other than what the OP wrote. Neither do you. My statement is based on what he wrote.
 
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Lindberg said:
No, he doesn't have to report it. The Medxpress instructions say so explicitly:

"List visits for counseling only if related to a personal substance abuse or psychiatric condition."

According to the OP, these visits were related to neither personal substance abuse nor a personal psychiatric condition. Based on his description,
these visits are not reportable. Of course if he reports them anyway, he'll get the microscope treatment and everyone here will complain about how unreasonable the FAA is.

And the medxpress must be filled out to the best of your knowledge.
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Why did you elide my last sentence?
 
Lindberg said:
I don't know anything other than what the OP wrote. Neither do you. My statement is based on what he wrote.
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What he wrote was that he didn't have a "diagnosis or anything", a statement that flies in the face of common sense, especially with two visits to the same psychiatrist. He's getting advice because it's pretty evident that he's nearly clueless about how the FAA medical process actually works.

This should look like a save by contributors on POA (especially Dr. Bruce), not a degradation into a p***ing match
 
dbahn said:
What he wrote was that he didn't have a "diagnosis or anything", a statement that flies in the face of common sense, especially with two visits to the same psychiatrist.
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Visiting a psychologist does not mean you have a diagnosis of anything, let alone a "personal psychiatric condition," which is what's necessary to make the visits reportable.

dbahn said:
He's getting advice because it's pretty evident that he's nearly clueless about how the FAA medical process actually works.
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You advised him that he must report the visits. That's plainly wrong based on the information he provided. At a minimum, you're making undisclosed assumptions.
dbahn said:
This should look like a save by contributors on POA (especially Dr. Bruce), not a degradation into a p***ing match
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I quoted the medxpress instructions. Bruce is not a higher authority.
 
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Lindberg said:
Visiting a psychologist does not mean you have a diagnosis of anything, let alone a "personal psychiatric condition," which is what's necessary to make the visits reportable.


You advised him that he must report the visits. That's plainly wrong based on the information he provided. At a minimum, you're making undisclosed assumptions.

I quoted the medxpress instructions. Bruce is not a higher authority.
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Yes, that’s what I meant when I said I didn’t get a diagnosis. I would assume the psychologist would have at least mentioned it to me in person something like “Hey, you’ve got OCD” or “PTSD” or something like that. In a way, my visit was pretty basic. She mostly just listened and talked me through some options regarding my son. But I’m still going to call and ask for my records.

It’s interesting to me though how everyone is addressing my psychologist visit more than my edema. I guess that’s not a huge concern…?
 
I’m not. But unless he paid the psych cash and a LOT of it, beLEEVyou me, he has a diagnosis (or he didn’t get paid).

The statement, for example , “he gave me Ritalin, but not a diagnosis” is a fallacy. There IS AT LEAST an insurance diagnosis…..

So with you advice the AME defers because HE KNOWS THERE is AT LEAST an insurance diagnosis….

When, oh when, did you become expert in medical billing.
 
Askies329 said:
It’s interesting to me though how everyone is addressing my psychologist visit more than my edema. I guess that’s not a huge concern…?
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Bruce did address your edema in post #3. The best thing for you to do is find a good AME in your area who does consults, and go do that.
 
bbchien said:
I’m not. But unless he paid the psych cash and a LOT of it, beLEEVyou me, he has a diagnosis (or he didn’t get paid).
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It's quite common to pay cash for counseling, especially around here, very few are in network or even accept insurance. There are also diagnoses codes for things like relationship trouble, which wouldn't be reportable to the FAA. Regardless, the OP said he wasn't diagnosed with something. If a poster is going to give advice based on a contrary assumption, he should say so.

The statement, for example , “he gave me Ritalin, but not a diagnosis” is a fallacy. There IS AT LEAST an insurance diagnosis…..
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I missed that from the OP.
When, oh when, did you become expert in medical billing.
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Where did I claim to be?
 
Askies329 said:
It’s interesting to me though how everyone is addressing my psychologist visit more than my edema. I guess that’s not a huge concern…?
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It shows which of those conditions poses the highest risk of causing an expensive and very long term delay and permanent threat to an operation that requires a class 1 medical, if that's your long term goal. The edema is not likely to pose the same risk as the psycholoigical diagnosis.
 
Lindberg said:
It's quite common to pay cash for counseling, especially around here, very few are in network or even accept insurance. There are also diagnoses codes for things like relationship trouble, which wouldn't be reportable to the FAA. Regardless, the OP said he wasn't diagnosed with something. If a poster is going to give advice based on a contrary assumption, he should say so.


I missed that from the OP.
Where did I claim to be?
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You did not know, that to get paid, the psychiatry professional has to “assign” a diagnosis? (Unless he paid cash?)
 
It sure does. You took the word of the OP, who said he doesn’t have a diagnosis. That is 100% untrue ( unless the OP paid cash.

And then you gave advice based on that assumption, doctor…..
 
bbchien said:
It sure does. You took the word of the OP . . . .
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Perish the thought. I should have assumed he's lying or doesn't know what he's taking about.

And actually, what I did was quote the Medxpress instructions. It seems that the FAA believes you can have counseling without a diagnosis that requires reporting, and that's it's common enough to mention. I guess the folks who wrote the Medxpress instructions don't know anything about psychiatry or medical billing or insurance either. I'll take some comfort in that.
 
Lindberg said:
Perish the thought. I should have assumed he's lying or doesn't know what he's taking about.

And actually, what I did was quote the Medxpress instructions. It seems that the FAA believes you can have counseling without a diagnosis that requires reporting, and that's it's common enough to mention. I guess the folks who wrote the Medxpress instructions don't know anything about psychiatry or medical billing or insurance either. I'll take some comfort in that.
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Well the folks who wrote medxpress know to demand the CPT/ & billing codes from the encounter and do routinely and debunk the "no diagnosis" claim, regularly. They then demand to see the text of the dictations. And you gave it as advice, wWhich for just what medxpres sez is okay, but globally is TERRIBLE advice. The pilot, (and AME) that issues get the retraction and demand letter and then no light sport, Mosaic..... So on the whole that's lousy advice and sets the guy up for NO FLYING EVER.

At least the AME if he sees it meets the June 25 2024 guidelines andcan make a declaration and issue the man, if the diagnsois is a permitted one....and then the psychiary dictation does not become part of the National medical record, (protected only by a FOIA letter).

TO THE POINT. You contributed a whole lot assuming the OP can read the instructions for himself, anyway.....or maybe you meant something else.....There is a whole lot more to getting a certification and nto getting the dreaded denial, that a literal reaiding of the MEdXpress instructions.
 
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bbchien said:
Well the folks who wrote medxpress know to demand the CPT/ & billing codes from the encounter and do routinely and debunk the "no diagnosis" claim, regularly. They then demand to see the text of the dictations. And you gave it as advice, wWhich for just what medxpres sez is okay, but globally is TERRIBLE advice. The pilot, (and AME) that issues get the retraction and demand letter and then no light sport, Mosaic..... So on the whole that's lousy advice and sets the guy up for NO FLYING EVER.

At least the AME if he sees it meets the June 25 2024 guidelines acan make a declaration and issue the man, if the diagnsois is a permitted one....and then the psychiary dictation does not become part of the National medical record, (protected only by a FOIA letter).

TO THE POINT. You contributed a whole lot assuming the OP can read the instructions for himself, anyway.....or maybe you meant something else.....
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You seem upset. The first response in this thread told the OP unequivocally he has to report. That's just flat out wrong.

I corrected the incorrect statement, explicitly citing my authority and assumptions.

You claim I'm wrong, based on your own different assumptions. What's troubling in that is stating your assumptions as facts. That's not helpful to the OP or to others who come along later and get the false impression that all counseling visits have to be reported.

As for the OP reading the instructions himself, well, that would eliminate half the posts and 90% of the wrong answers in this forum.
 
So he doens't have to report visits to a licensed healthcare professional? Pardon me!

(Last I heard that was a class 4 felony). May be you have some newer information? But you forgot about box 19, Lindberg. Good work! (Jeepers! the things one has to do to try to help out guys for free on this board).

Askies 329, just remember when you don't report you can say some guy handled "Lindberg" on the internet said, "I didn't have to report the visits "just last year". It doesn't work like POA: where a poster can go back and delete the references to a licensed healthcare professional....and then claim it never happened...and then get busted in the investigation.

askies123 said:
Also something I’m worried about is I saw a psychologist last year only two times just to vent to someone about my son’s medical issues. Didn’t get a diagnosis or anything - that I know of. Have any of you called a medical provider to see what they recorded?
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So to reiterate, at 1 year ago the onus is upon the pilot to report in box 19; and for AME to figure out what the diagnosis is/was, and belieeve-you-me there was a diagnosis (unless askies paid cash, and some do!).

And for Askies, again, reactive anxiety disorder, situational depressive disorder are issuable if no meds (in the past 2 years) and are a yawn. But you have to show it to be so. Get the record, it most likely gonna be an AME yawn and declaration.

dbahn said:
This should look like a save by contributors on POA (especially Dr. Bruce), not a degradation into a p***ing match
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Thank you, Dave.

Done with this.
 
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bbchien said:
So he doens't have to report visits to a licensed healthcare professional?
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That's correct, you do not have to report all visits to health professionals. I quoted the relevant exception above, and there are others.
But you forgot about box 19, Lindberg.
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I forgot nothing. I quoted the instructions for box 19 in post #5, my first post in this thread.
 
Lindberg said:
No, he doesn't have to report it. The Medxpress instructions say so explicitly:

"List visits for counseling only if related to a personal substance abuse or psychiatric condition."

According to the OP, these visits were related to neither personal substance abuse nor a personal psychiatric condition. Based on his description,
these visits are not reportable. Of course if he reports them anyway, he'll get the microscope treatment and everyone here will complain about how unreasonable the FAA is.

And the medxpress must be filled out to the best of your knowledge.
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box 19 sez licensed health care professional. And he doens't know if he has been given a diagnosis. Everyone else here is telling him to find out what his peper work sez......Making the claim vs substantiating "no diagnosis" are worlds apart.....and believeyou me, he has a diagnosis if insurance was involved.
1722814708917.png


Sigh.
 
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bbchien said:
box 19 sez licensed health care professional. And he doens't know if he has been given a diagnosis. Everyone else here is telling him to find out what his peper work sez......Making the claim vs substantiating "no diagnosis" are worlds apart.....and believeyou me, he has a diagnosis if insurance was involved.
View attachment 132098

Sigh.
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Well, I didn’t hijack this one! :rofl:

I think the lesson here, “Askies329,” is print out the application(s) and FAA requests and go over them with a qaulified AME (of which B Chien and GoFlightMed are) then decide the risk/reward of the various piloting privelages available to you. You need to fully understand the options and potential consequences of going one way if you have a potential medical issuance issue. Once it’s in writing with the FAA, it’s there forever.

I wish I had heeded my own advice.
 
bbchien said:
box 19 sez licensed health care professional. And he doens't know if he has been given a diagnosis. Everyone else here is telling him to find out what his peper work sez......Making the claim vs substantiating "no diagnosis" are worlds apart.....and believeyou me, he has a diagnosis if insurance was involved.
View attachment 132098
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Why do you insist on ignoring the FAA's instructions for that item?

Screenshot_20240804-194731.png


Sigh.
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Indeed.
 
So you still don’t get it. FAA ‘s instructions ( mine I’ve taken from the advisory to the user, which you get from the MedExpress site download) Look for the icon on the upper right as you log in.

Do you ACTUALLY think that your block gives the airman protection, when the 50+ page pdf associated with the site sez opposite?

One visit to the psychologist.. okay, maybe a consult. Two? How ‘bout treatment?

Your block is intended for lcsw, lcdac, lpc’s, clearly. Guess which these refer for psychiatric evaluation and treatment: the PhD Psychologist! I do believe the OP said Psychologist, right?
Your quote: “ unless the consultatations resulted in referral for psychiatric evaluation…”. So it appears that DID happen.

You appear to only admit parts that suit you discourse…and the give it as advice. GREAT strategy! Are you an attorney, also? That’s what is called a failed word parse.
 
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bbchien said:
Your quote: “ unless the consultatations resulted in referral for psychiatric evaluation…”. So it appears that DID happen.
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That refers to consultations under an EAP program. Does that apply here? Did the OP consult with anyone who referred him for psychiatric evaluation?

Here's what AMAS says:

Counseling
If the initial provider a pilot or controller seeks out for assistance is unable to provide adequate counseling, the pilot or controller may be referred to a counseling specialist, psychologist or psychiatrist. Again, reporting to the FAA may not be reportable depending on the condition (e.g. family counseling for a child’s drug use or marital counseling).
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Counseling, Depression and Psychological Support - AMAS

Introduction Many Americans are affected by psychological stressors in their every day lives. Sources of stress vary widely ranging from arguments with family members, pressure from bosses and management, urgent deadlines to meet, unrealistic workloads, financial difficulties or the prolonged...
www.aviationmedicine.com
 
bbchien said:
Yes. IT DEPENDS ON THE CONDITION. The advise given is to get the diagnosis. There IS a diagnosis.
Lindberg, you have a consult awaiting in the other string: https://pilotsofamerica.com/communi...iggered-by-submitting-additional-docs.148229/


So I say to you, WHATEVER....
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So, yes, she did say she had to use a diagnosis for insurance purposes. I did go through insurance. But the psychologist sent me a letter. The gist of it is "...she presented with difficulties adjusting to some life circumstances. Her difficulties might be considered situational and temporary in nature." So as I said, it was regarding my son's medical issues and I needed to talk to someone. Do I need anything further than this? Also, is there a way to directly message you too?
 
Askies329 said:
So, yes, she did say she had to use a diagnosis for insurance purposes. I did go through insurance. But the psychologist sent me a letter. The gist of it is "...she presented with difficulties adjusting to some life circumstances. Her difficulties might be considered situational and temporary in nature." So as I said, it was regarding my son's medical issues and I needed to talk to someone. Do I need anything further than this? Also, is there a way to directly message you too?
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Find out what the actual diagnosis was (and the specific code that was used).

Even if you choose not to report it on this application, the diagnosis can slip into your own medical record and reappear later on in your training or career, when it becomes much harder, more expensive, and time consuming to clear up.
 
dbahn said:
Find out what the actual diagnosis was (and the specific code that was used).

Even if you choose not to report it on this application, the diagnosis can slip into your own medical record and reappear later on in your training or career, when it becomes much harder, more expensive, and time consuming to clear up.
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I called my insurance provider as well to find out the codes. There were two: 90791 and 90837. I don't know which was used specifically for each visit, but they were used separately. Just from doing my own amateur Google searches, it seems like she just billed it for psychotherapy. No psychiatric disorder or anything like that.

Also, another question (hope it doesn't stir up a debate lol) is I clarified with my cardiologist what my leg edema diagnosis really was. I got the medical records and it was recorded as venous insufficiency (not peripheral edema I guess). And thrombosis was negative in all categories, if that helps. Is that a concern? Maybe I'm overthinking this, but I just want to make sure I'm good to go for an AME exam.
 
@Askies329 - If at all in doubt then you can schedule a consult with your AME. Just the same as booking the actual FAA physical only difference being you do not present a MedXpress form that can be used by the Doc. Same scheduling (meaning do not explain over the phone - just book the appt). Same payment (meaning no insurance but if ~$150 is too much then save yourself and get out now while it is still cheap - lol). But hand no papers over to the people at the front desk and just have a verbal consult with the Doc.

I did that because I had something and I am not a Doc so I had no idea and didn't want to get surprised. So I asked (my health question) to the same AME that I was going to go see in a few months anyhow for my actual FAA physical.
 
Better to overthink it now than wish you had done so later. If you're not in a rush, I suggest that you wait and see if one of the active MDs on this board has specific advice based on those codes. They are "procedural" codes and may not reflect the actual diagnosis used.

No matter what, my only advice is to get all of the records, including the billing information, from the provider then speak with a knowledgeable AME before you fill submit the MedXpress form.
 
Askies329 said:
I called my insurance provider as well to find out the codes. There were two: 90791 and 90837. I don't know which was used specifically for each visit, but they were used separately. Just from doing my own amateur Google searches, it seems like she just billed it for psychotherapy. No psychiatric disorder or anything like that.

Also, another question (hope it doesn't stir up a debate lol) is I clarified with my cardiologist what my leg edema diagnosis really was. I got the medical records and it was recorded as venous insufficiency (not peripheral edema I guess). And thrombosis was negative in all categories, if that helps. Is that a concern? Maybe I'm overthinking this, but I just want to make sure I'm good to go for an AME exam.
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There no overthinking your medical exam. Now that you have the info, find a good senior AME in your area and schedule a consult. If the AME you've chosen doesn't do consults, he's not the right one, so find a different one. Discuss your concerns with him. If he's confident he can issue your medical, and you're confident in him, proceed accordingly.
 
Get the ICDM-10 codes! (diagnosis)
90791 and 90837 are time/bill evaluation codes.....psychotherapy 90837 strongly imples you were "treated for something....." (even if you were not). GET the full record!
 
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