Can Anybody Give A Good Definition?

[JT24usn]

I am trying to find a good definition of marked or definite interference? That is the difference under 7328 diagnostic code for 40-60%. I can't get a straight answer on the net. I'm at 20 percent right now. Anybody's assistance would be greatly appreciated.

7328 Intestine, small, resection of:

With marked interference with absorption and nutrition, manifested by severe impairment of health objectively supported by examination findings including material weight loss 60

With definite interference with absorption and nutrition, manifested by impairment of health objectively supported by examination findings including definite weight loss

[killemall]

My gut tells me marked means somewhat here and there and definite means absolutely no doubt always present

[NavyWife]

Yes, what killemall said...

This was all I could find:

"marked"

in medical terms means Really Noticeable. For instance, someone with a bad sunburn might have "marked erythema of the skin," and a pregnant woman might have "marked distension of the abdomen."

"definite"

--known for certain; - established beyond doubt or question; definitely known

[JT24usn]

That makes sense, but definite is the lower of the two under diagnostic code 7328. Marked is 60% and definite 40%.

I had a cp for vitamins deficiency. Dr opined that my vitamin d deficiency is due to my sc 7328 small bowel resection and 7318 cholecystectomy.

Now I have and increase for 7328/7318 on appeal (I'm rated at 20%). They are saying I don't have any malabsorption or malnutrition. Well the cp examiner gave me the smoking gun. Vitamins deficiency (malabsorption) due to sc conditions. Now I am trying to find out the odds of 40 or 60%. Problem is that I don't know the difference between marked and definite interference. I have a friend that is a rater and apparently it is left up to them to define the two with all medical evidence to paint the picture. Trying to stay positive but hard to do when it is left to the rater.

[NavyWife]

This one is kind of tricky.

Comparing the 2 ratings, the only other difference I noticed was that the weight loss for the 60% rating must be "material" versus "definite" weight loss for the 40%. I think this might be the key part to focus on to get the correct rating for this. I say this because they can't really measure the malabsorption but they can measure the weight loss. Also, they both say," objectively supported by examination findings including weight loss".

This would mean 40% is weight loss that is known for certain. To me, that Would mean weight loss --that was recorded --of ANY amount.

To get the 60% The weight-loss must be "material" which according to the legal dictionary means "significant" or "substantial".

http://legal-dictionary.thefreedictionary.com/material

But what is considered significant or substantial weight loss?

This website defines it as 10% over 6 months. http://www.dads.state.tx.us/qualitymatters/qcp/weightloss/

###To me this sounds like the 20% rating means you can't gain weight, the 40% rating means you have lost some weight while the 60% rating is a significant weight loss.###

7328 Intestine, small, resection of:

With marked interference with absorption and nutrition, manifested by severe impairment of health objectively supported by examination findings including material weight loss 60

With definite interference with absorption and nutrition, manifested by impairment of health objectively supported by examination findings including definite weight loss 40

Symptomatic with diarrhea, anemia and inability to gain weight 20

Note: Where residual adhesions constitute the predominant disability, rate under diagnostic code 7301.

Edited June 10, 2014 by NavyWife

[killemall]

Well done Navywife

[JT24usn]

Indeed, navy wife

Edited June 10, 2014 by JT24usn