Last week, we discussed the Pyramiding principle. Today I want to further that discussion by giving another example of how pyramiding works.
It is vital to your peace of mind to understand exactly how the Pyramiding principle works. You may think that because the doctor has diagnosed three
conditions you should get three ratings, but when you end up getting only one
rating, you'll pretty much feel like this guy.
The bottom-line rule of Pyramiding: A single symptom can only be
rated once. One symptom, one rating. This means that if three diagnosed
conditions cause the same one symptom, then only one will get a rating,
whichever gives the highest rating.
On to our example. Bert has three diagnosed
conditions: Hiatal Hernia, Gastroesophageal Reflux Disease (GERD), and
A Hiatal Hernia is a condition where the
stomach pushes up into the chest cavity through the diaphragm. It can cause
chest pain, trouble swallowing, and heartburn (GERD).
GERD (or “heartburn”) is a condition where
the acid in the stomach shoots up into the esophagus, often causing burning and
scaring of the lining of the esophagus.
Barrett’s Esophagus is a condition where
the lining of the esophagus changes and could become cancerous. It is caused by
Hopefully with these definitions you can
already see the problem we face with these three conditions. Each one causes
the next. A hiatal hernia causes GERD, and GERD causes Barrett’s Esophagus. It
can then be deduced that a hiatal hernia causes both GERD and Barrett’s
Esophagus, so they are both just symptoms of the hiatal hernia. Only a single
rating can be given in this case. A symptom can only be rated once, and a
single rating for the hiatal hernia already encompasses all the symptoms of the
Bert would only get one rating under code 7345, Hiatal Hernia.
Three diagnosed conditions, but only one rating.