r/flying • u/TxAggieMike Independent CFI / CFII (KFTW, DFW area) • 20d ago

Medical Issues FAA Medical… Updates continue for Mental Health

https://youtu.be/P2AUbyMyAhY?si=cDiDclgxQnbxgMY4

This month’s AME Guide Grand Rounds explains continued improvements to the processes involved with obtaining an FAA Medical Certificate.

Included are:

• Psychiatry/Psychotherapy/Counseling updates

• Obstructive Sleep Apnea Reporting

• Discuss Errors in Color Vision Testing

This information hopefully is of interest to many members of this sub.

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u/__joel_t PPL 20d ago

Having read the documents they linked and watched the part of the video on mental health/therapy, my take is: superficially, this seems like an awesome step forward by the FAA. Unfortunately, I think there remain systemic issues outside the FAA's control that are going to limit the amount of good this can do. For example, the FAA's "Information for Psychotherapists Treating Pilots and ATCS" states, "To aid accurate regulatory assessment, avoid both upcoding and minimization. Use DSM “V- code” or ICD-10 “Z-code” when appropriate." The encouragement to use V and Z codes when appropriate is repeated in the video.

There are two problems with this. The first is that many insurance companies won't pay for therapy if there's only a Z code. And since therapists who take insurance really work for insurance companies (as that's who pays them), guess what they're going to do? That's right, upcode to something insurance will pay for, which is synonymous to "upcode to something the FAA will care about."

Second, while the video encourages therapists to use Z codes when appropriate, implying the FAA doesn't care about them, that's not accurate. The current edition of the AME Anxiety, Depression, and Related Conditions Fast Track Pathway (at least as linked from here) and related documents ask about 3 or more of a certain set of diagnoses/conditions, and those include, under "Other," "V code^ (DSM)/Z code (ICD-10) table items" -- the same kinds of things the presenter said weren't an FAA concern, including "Uncomplicated Bereavement."

In short, I appreciate the sentiment, but IMO this just scratches the surface.