ICD-10 Holiday Gift Guide

December 8th, 2015
ICD-10

You’ve made your shopping list and checked it twice. But, lo and behold, you’ve got some healthcare professionals—whether they’re your clinic’s staff, your peers, or your doctorly family and friends—on your list, and you don’t have a clue as to what to get them. Fear not, my head-scratching shoppers! Healthcare professionals went through the biggest change since the Affordable Care Act this past October. It wasn’t an easy switch, but they got through it. Thus, it’s perfectly fitting—and funny—for you to gift them some ICD-10 merch this holiday season. Behold: the ICD-10 Holiday Gift Guide, crafted with care to help you find the perfect gift for every healthcare professional and medical biller/coder in your life.

ICD-10 Coffee Mugs

From an “ICD-10 Survivor” mug to an array of cups featuring specific codes (like struck by balls, burn due to water-skis on fire, and struck by turtle), there are many options out there for all the caffeine-guzzling docs and therapists in your life.   

ICD-10 Apparel

Nothing makes for a great conversation starter like a bizarre medical diagnosis code illustrated on a comfy t-shirt. Check out these ones from Zazzle: other superficial bite (i.e., vampires), walked into a lamppost, and bitten by squirrel. Want something warmer for those chilly winter months? Go for a spacecraft crash pullover.

ICD-10 Art and Games

ICD-10 Illustrated—the brilliant folks behind Struck by Orca—is an amazing website whose team has been working to add some levity to the otherwise super-serious diagnosis coding transition. They’ve created several items that are perfect for gift-giving:

ICD-10 Wall Art
Image from ICD10illustrated.com

The Packaging

Once you’ve nabbed your ICD-10 gift, it’s time to wrap it—and what better way to encapsulate your present than with bitten by squirrel wrapping paper. Once you’ve sealed the gift and tied it with a bow, add one final touch: an ICD-10 holiday greeting card.

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Ta-da! You now have a wealth of gift ideas for every medical professional on your holiday shopping list. Now, you just need to worry about your enigmatic great aunt.


ICD-10 FAQ Take Two

October 23rd, 2015
ICD-10, ICD-9, Insurance, Preparation, Transition

Rob Base and DJ E-Z Rock said, “It takes two to make a thing go right.” If that’s the case, then you can’t get more right than a second helping of our ICD-10 FAQ. (Missed part one? Check it out here.)

General Questions

Will ICD-10 eliminate the need to provide extensive detail within patient documentation?

Absolutely not. While ICD-10 makes it much easier to communicate detailed diagnostic information via codes, the transition to the new code set actually will make detailed documentation even more important. CMS explains why here: “If complete information is not captured in clinical documentation, the result will be incomplete documentation for coding that then can impact revenues through delays, missed revenues, outcome measures that don’t clearly or accurately reflect the quality and complexity of the care that is being delivered.” Furthermore, if you don’t do your own coding (i.e., your practice has a coder), then it’s even more important that you provide all the details necessary for proper code selection within your documentation.

I run a cash-based clinic, so I don’t need to worry about ICD-10, right?

The only exceptions to the ICD-10 transition mandate are HIPAA non-covered entities. So, the only way a therapist would be exempt from the transition is if his or her practice qualified as a non-covered entity. Remember, if your patients submit invoices to their insurance companies for reimbursement, you’ll need to provide the appropriate diagnosis codes. And as of October 1, those codes must be ICD-10.

The Grace Period

What happens if Medicare rejects my claim because my ICD-10 code isn’t a valid code?

As explained in our first FAQ, even with Medicare’s grace period, providers still must submit a valid ICD-10 code from the correct family of codes. However, in the event that you submit an invalid code—and, as a result, receive a claim rejection—you will “have the opportunity to resubmit the claim with a valid ICD-10 code,” this CMS resource explains.

What is a “valid” code?

Often referred to as a “billable” code, a valid code is one that has been built out to the highest possible level of specificity. In other words, you’ve added as many characters as you can to the code—including a seventh character, if the code requires one. (For more on seventh characters, check out this blog post.) For example, the code M70 (Soft tissue disorders related to use, overuse and pressure) would not be a valid code, because additional specificity is possible. However, the code M70.11 (Bursitis, right hand) would be a valid code, because you cannot add any additional characters to that code to make it any more specific.

What constitutes a family of codes?

In ICD-10, “families” of codes are typically indicated by three-character headings. According to CMS, “Codes within a category are clinically related and provide differences in capturing specific information about the condition.” For example, M70 appears at the top of the family of codes for soft tissue disorders related to use, overuse, and pressure. All of the codes that are listed underneath that heading belong to that family of codes.

Because Medicare won’t reject claims solely for lack of coding specificity, does that mean that the current diagnosis coding specificity requirements set forth by National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) will be more flexible in ICD-10? Will I be in compliance with NCD and LCD policy as long as my ICD-10 code is in the correct family of codes?

No. As explained in this CMS document, the grace period announcement “does not change the coding specificity required by the NCDs and LCDs. Coverage policies that currently require a specific diagnosis under ICD-9 will continue to require a specific diagnosis under ICD-10.” That said, the transition won’t affect the expected level of specificity; in other words, you’ll code to the same level of specificity in ICD-10 that you did with ICD-9. There is, however, one very important exception to that statement: laterality. “LCDs and NCDs that contain ICD-10 codes for right side, left side, or bilateral do not allow for unspecified side,” CMS notes.

Does Medicare’s grace period apply to Medicaid?

No. The grace period guidelines only apply to “Medicare fee-for-service claims from physician or other practitioner claims billed under the Medicare Fee-for-Service Part B physician fee schedule,” this resource explains, adding that the grace period “does not apply to claims submitted for beneficiaries with Medicaid coverage, either primary or secondary.”

Will commercial payers observe a similar period of flexibility following the transition?

The official grace period announcement only applies to claims billed under Medicare Part B. Thus, it’s up to each individual private payer to determine whether it will offer a period of flexibility and to define the parameters of that flexibility.

The Seventh Character

Is there any new information on the difference between “A” and “D” with respect to rehab therapy encounters?

This has been such a hot topic of debate that one of the attendees of a recent CMS national provider call brought it up during the Q&A portion of the meeting. Here’s the exact answer the CMS representative provided, as noted in this call transcript: “There is no specific hard set definition of what active treatment is. There are some examples that are given in the official guidelines, such as surgical treatment, emergency department encounter, and that type of situation. So they’re—it’s not an all-exhaustive list. But what I think is probably clearer is that for the subsequent encounters, usually those are where there’s routine healing or a problem with the healing.”

How do I know which seventh character to use for a chronic or recurrent musculoskeletal condition, like those found in chapter 13 (which contains the “M” codes)?

Seventh characters do not apply to the codes listed in chapter 13. Most of the seventh character-eligible codes that rehab therapists will use occur in chapter 19 (a.k.a. the injury chapter).

Coding for Aftercare

I was under the impression that aftercare codes should not be used as primary diagnoses. Is this true in ICD-10?

While you may have been discouraged from using aftercare codes (i.e., “V” codes), as primary diagnosis codes in ICD-9, that is not the case in ICD-10—at least not according to the official ICD-10-CM guidelines for coding and reporting: “Z codes may be used as either a first-listed (principal diagnosis code in the inpatient setting) or secondary code, depending on the circumstances of the encounter,” the guidelines read. Furthermore, regarding R codes such as the one for gait abnormality, the guidelines offer the following explanation: “Codes for signs and symptoms may be reported in addition to a related definitive diagnosis when the sign or symptom is not routinely associated with that diagnosis, such as the various signs and symptoms associated with complex syndromes. The definitive diagnosis code should be sequenced before the symptom code.” So, as with a lot of ICD-10 guidance, the context of the patient’s situation appears to influence the order of the codes.

It doesn’t seem like there are a lot of codes available to represent specific surgeries. Why is that?

While there is not an aftercare code for every single surgery, in many cases, the proper way to designate the phase of treatment (i.e., indicate that the patient is receiving aftercare) is to code for the original acute injury and add the appropriate seventh character (which would be “D”). So, if, for example, the patient who underwent rotator cuff surgery had originally strained his or her right rotator cuff, you would indicate that you are providing aftercare by using the code S46.011D, Strain of muscle(s) and tendon(s) of the rotator cuff of right shoulder, subsequent encounter.

Using Multiple Codes

Shouldn’t the primary code be a symptom/complaint code (e.g., difficulty walking), because this code reflects the reason the patient came to therapy?

In some cases, your primary treatment diagnosis code can be a symptom code that reflects what you, as the therapist, are treating. For example, let’s say a patient with Parkinson’s comes to you because he or she is having difficulty walking. In this particular case, you could use a code from the gait abnormalities section (the R26 family of codes) as your primary treatment diagnosis because you, as the therapist, are not treating the Parkinson’s. However, if you are actually providing treatment for an underlying condition, you are encouraged to code for it first, if possible, because it better supports the patient’s medical need for your services. For a more in-depth discussion of coding for medical necessity, check out this blog post.

How should I order my codes?

You should submit the codes in order of significance with respect to medical necessity. For more details on using multiple diagnosis codes, check out this blog post.

Should I include codes for comorbidities?

You should include as many codes as necessary to explain the complexity of the patient’s condition to the fullest extent possible. Remember, though, that you cannot code for what you cannot diagnose (with respect to your scope of practice). For referral patients, we recommend working with your referring physicians to ensure you’ve accounted for as many pertinent diagnoses as possible—and that you’ve selected the most accurate, specific codes possible to represent those diagnoses.

Transitional Logistics

Considering that the transition goes by date of service, will claims for dates of service on or before September 30 be paid if I submit them with ICD-9 codes after October 1?  

Payers theoretically should be equipped to handle claims with pre-October 1 dates of service—and thus, ICD-9 codes—even when those claims are are submitted after October 1. However, we strongly suggest finalizing all notes for dates of service on or before September 30 prior to the transition on October 1. Why? Because there’s no way to know for certain that all payers will truly be ready to handle that distinction. So, just be aware that if you submit pre-October 1 claims after October 1, you may experience delays in payment or have to deal with appeals or claim resubmission for those dates.

How does the transition work for those billing inpatient services?

As CMS explains here, “…for inpatient facility reporting, date of service is defined

as the date of discharge.” So if, for example, a patient is admitted to the hospital on September 27, but he or she isn’t discharged until October 2, you would use ICD-10 codes on the claim. Conversely, if that patient is discharged on September 30, you would use ICD-9 codes on the claim.

How should I handle claims with dates of service that span the transition?

There are different rules for different settings and claim types. To review the requirements for each, check out this MLN Matters document.

Additional Help Resources

What’s the deal with the ICD-10 Ombudsman?

CMS has named an ICD-10 Ombudsman “to be a one-stop shop for you with questions and

concerns and to be your internal advocate inside CMS.” His name is Dr. William Rogers, and he’s a practicing emergency room physician who has been the director of CMS’s Physicians Regulatory Improvement Team since 2002. You can reach him at icd10_ombudsman@cms.hhs.gov.

Where can I go for specific coding questions?

The American Hospital Association (AHA) provides a portal where you can submit specific clinical coding questions here. If you take advantage of this free resource, keep these guidelines in mind:

  • Do not ask the service to code your entire superbill.
  • Do not send an entire patient record and ask for proper coding.
  • Do not simply ask for the appropriate code for a certain disease or procedure.
  • Do not ask about payments, coverage issues, or general equivalence maps (GEMs).
  • You must submit supporting medical records documentation with your question.
  • You must specify whether the question refers to a specific clinical setting (e.g., skilled nursing facility, home health, or a particular provider type/specialty).

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There you have it: a second ICD-10 FAQ to make it outta sight. Don’t see an answer to your questions? Check out part three here.

 


New Survey: Practitioners Confident in Preparation, But Concerned About Costs

March 10th, 2015
ICD-10, Preparation

The healthcare industry at large has faced the music: everyone is switching to ICD-10 on October 1, 2015. That means every HIPAA-eligible professional is finally in the full swing of preparation, but seeing as how experts have been urging folks to prepare for roughly two years now, it’s unsettling that most of those practitioners still feel unprepared. According to a Healthcare IT news article summarizing a recent survey from Navicure and Porter Research, only 21% of physician practices surveyed said “they’re on track with their preparations for the switchover.” But while physician practices are running behind the preparatory timeline, they’re not crying about it. On the contrary—they’re actually “optimistic,” the Navicure and Porter Research survey revealed. Furthermore, a whopping 81% of practices surveyed are “confident they will be ready for the transition.”

Even though private practice physicians are confident they’ll be ready before the deadline, the study did highlight some immediate concerns: According to HIT Consultant, 41% of those surveyed aren’t sure if “they’ve budgeted for ICD-10,” and 59% “are most concerned about ICD-10 cash flow impact and revenue.” Other cited concerns included questionable payer readiness and potential productivity lags. While payer preparedness is out of practices’ control, they can control productivity—to an extent. As Navicure explains in its survey report, “Even with a well-trained staff, industry estimates indicate that staff productivity will decline by 52 percent for the first 3-6 months following the transition.” And decreased productivity has a ripple effect: “Lower productivity means slower claims turnaround and slower reimbursement.”

In addition to sharing the survey results, Navicure also emphasized some key takeaways, which I’ve summarized below.

  1. Many survey respondents said they were waiting on vendor software updates to test ICD-10. My advice: Don’t wait for your vendors. There are ways to test internally without vendor involvement.
  2. Develop a budget ASAP, and investigate how partnering with your bank and improving your billing processes can help ease the financial burden of the transition.
  3. Plan for decreased productivity, and pinpoint how to mitigate it. One way to do that? “Trend denials pre- and post-implementation to benchmark performance and fully monitor revenue cycle efficiency and staff productivity,” explained Navicure.

While Navicure and Porter Research surveyed private practice physicians, the results likely ring true for many PT practices, too. Feeling a bit unprepared yourself? Don’t sweat it; check out this webinar for your ultimate ICD-10 to-do list.


Don’t Delay Your ICD-10 Prep

June 19th, 2014
ICD-10, Preparation

You’ve heard it plenty by now: ICD-10 has been delayed until October 1, 2015. But just because Congress delayed the inevitable doesn’t mean you should dilly-dally on your prep work. After all, the early bird gets the worm, and in this case, the well-prepared bird will experience a smoother transition and more accurate reimbursements. Sounds like a good worm to me. Need further convincing? Here’s why you shouldn’t delay your ICD-10 prep:

Change is inevitable.

When faced with change, many of us like to dig our heels into the ground and resist to the bitter end. Perhaps that’s why ICD-10 got delayed for the third time earlier this year. As Jon Lindekugel, the president of 3M Health Information Systems, explained, “The vote to delay ICD-10 is a vote for the past, not the future of health care.” But whether we switch to ICD-10 or skip right to ICD-11, we will not use ICD-9 forever. Change is inevitable, and resistance is futile, so why bother? Embrace the change; address it straight on. The sooner everyone prepares, the better off we’ll be. (See bit above about early birds and worms.)

There’s a lot to do.

ICD-10 requires a good deal of preparation, including:

With so much to do, time truly is of the essence. It behooves you and your practice to have as much time as possible. In other words, don’t procrastinate.

Wasting dollars doesn’t make any sense.

ICD-10 will have a significant impact on finances. In fact, the AAFP advises providers to have at least three months’ worth of extra cash revenue available, while others recommend having at least six months’ worth on hand. If you can’t save that much, Heidi Jannenga suggests “having a plan B, such as a line of credit or supplemental income to ensure your clinic’s viability during the transition.” In line with the theme of this blog, though, she warns not to wait on this because “you’ll have to vie for financing and pay higher interest rates.” Ultimately, the longer you hold off on preparing for ICD-10, the more at-risk your practice will be for inaccurate reimbursements or worse, denied claims. As Avery Hurt explains in this Physicians Practice article, “Thorough preparation is the key to sailing through this transition with your finances in good shape.”

How are you handling the ICD-10 delay? Now that you know why you shouldn’t procrastinate, what are you doing to move your prep plans off the back burner?


How to Test ICD-10 Inside Your PT Practice

May 21st, 2014
ICD-10, Preparation

Mandatory implementation of ICD-10 is slated for October 1, 2015 (at least that’s what Medicare has implied). That means your physical therapy practice has just the right amount of time to properly prepare. One key aspect of preparation is testing, both inside and outside of the clinic. Later this month, we’ll cover how to test with entities outside of your practice. Today, though, let’s discuss testing within your practice to ensure that your staff can correctly use the new codes and that each internal process works.

Before You Begin

  1. Nail down the list of people at your practice who interact with codes (e.g., billers, front office staff, and therapists).
  2. Identify your practice’s most frequently used ICD-9 codes and their ICD-10 equivalents.
  3. Learn how your staff identifies correct ICD-9 codes and how they plan to do that with ICD-10 codes.
  4. Determine whether those processes make the best sense for the new code set.

Implement Dual Coding

To confirm that your staff can correctly use ICD-10 codes, we recommend dual coding, or reporting and verifying both the ICD-9 code and the correct ICD-10 equivalent for all patients. Not only will this help you and your staff get acclimated to the new code set, but also it will allow you to identify the ICD-10 codes most frequently used in your practice and specialty. Note that most payers are not currently accepting ICD-10 codes, and many may not accept them before the official transition date. So check with your payers before submitting any claims featuring both ICD-9 and ICD-10 codes.

Test Internal Processes

Depending on how your practice currently codes, you may need to alter your current coding processes. For example, with ICD-10, it’s important that PTs select ICD-10 codes that address the exact patient condition they’re treating as opposed to simply carrying over the referring physician’s codes. Once you understand your current processes, test them for ICD-10, and then adjust accordingly. Continue this method until your clinic establishes workflows that truly work for ICD-10 across all teams and applications.

Have you started testing ICD-10 within your practice? What advice do you have for other PTs?


Breaking News: ICD-10 Implementation Delayed Until October 1, 2015

April 1st, 2014
ICD-10, ICD-9, Transition

Note: This is not an April Fools’ joke.

On March 31, the US Senate voted 64-35 to approve a House-drafted bill that includes a provision to push the ICD-10 deadline back a year—all without a single mention of ICD-10 during a nearly three-hour Senate floor debate. The main purpose of the bill—HR 4302—was to enact a one-year “fix” of the Sustainable Growth Rate (SGR) formula, thus preventing a 24% cut in Medicare’s physician reimbursement rate. This legislation represents the 17th temporary Medicare fix since the passage of the Balanced Budget Act was in 1997. According to an APTA press release, “the final bill replaces the cut with a .5% provider payment update through the end of the year and no update from January 1 to April 1 in 2015.” In addition to the SGR patch and the ICD-10 delay, the bill includes one-year extensions for the therapy cap exceptions process and the Geographic Pricing Cost Index (GPCI). The bill now awaits President Obama’s signature, which, according to social media buzz, should occur today.

As this article explains, no one is quite sure how an ICD-10 delay made its way into the SGR fix bill. Although the legislation was the product of a bipartisan effort, there were senators from both sides who vocally opposed its passage, citing the importance of paying for the quality—not the quantity—of healthcare services. However, in the midst of all this passionate debate, not a single Senator mentioned ICD-10—much to the chagrin of the associations that so vehemently opposed the implementation delay, including the College of Healthcare Information Management Executives (CHIME), the American Health Information Management Association (AHIMA), the Medical Group Management Association (MGMA), the American Medical Association (AMA), the Health Information and Management Systems Society (HIMSS), and the Centers for Medicare and Medicaid Services (CMS).

So, why the silence on ICD-10? One theory is that lawmakers were simply unaware of the ICD-10 provision and its potential implications. As this Government Health IT article suggests, “Perhaps if the Senate had voted down the bill, regrouped, come back with another stab at permanent SGR repeal, someone would have noticed Section 212 saying that HHS cannot mandate ICD-10 as the standard code set before Oct. 1, 2015.” But now that the delay is happening, the healthcare industry must face the financial consequences. CMS estimates that the total cost of delaying implementation will fall somewhere between $1 billion and $6.6 billion, and Resultant founder and healthcare consultant Joe Lavelle projects that waiting another year could cost each of his clients anywhere from $500,000 to $3 million, according to the Government Health IT article.

With no indication that President Obama will exercise his veto rights, this bill should become law today. We’ll update this post as the story unfolds.


ICD-10 Codes for St. Paddy’s Day

March 13th, 2014
Codes, ICD-10

Ah, St. Patrick’s Day—loved by the Irish and anyone else looking for an excuse to wear green, party, or eat Jiggs dinner. It’s a quintessential holiday, but where there’s revelry, there’s also the potential for accidents and injuries—especially on a day where green beer consumption starts at breakfast. For those whom the Irish eyes don’t smile upon, there’s an ICD-10 code for what ails you.

Getting in the Spirit

You start the day with a St. Paddy’s Day parade, but you pay more attention to the floats than where you’re walking: W22.02xA Walked into lamppost, initial encounter. You decide that parades aren’t for you, and instead go searching for a lucky four-leaf clover. In your frollicking, though, you encounter poison ivy instead: L24.7, Irritant contact dermatitis due to plants, except food. From there, you decide to take in a Riverdance class: Y93.49 Activity, other involving dancing and other rhythmic movements. If nothing goes wrong at the class, perhaps you assume the luck o’ the Irish is back on your side and decide to take in some libations.

Celebrating

You’ll find propylene glycol in green food coloring, which is what bars use to dye their beer green. It’s an unfortunate circumstance if you find yourself intolerant of food coloring—or worse, if the food coloring has gone bad: T52.3 Toxic effects of glycols

Let’s say the food coloring has no effect on you, so you imbibe. First, you might feel R42 Dizziness and giddiness. As you explain to fellow bar-goers that it’s St. Paddy’s Day and not Patty’s Day, you find that they all take you less serious, because of your R47.81 Slurred speech. Next thing you know, you’re drunk: F10.129 Alcohol abuse with intoxication, unspecified, and as you laugh boisterously, you W07.XXXA Fall from chair. Fortunately, it’s only your first time doing that (initial encounter). Unfortunately, when you fall, you bump into a man reminiscent of Sea Bass from Dumb & Dumber. He says things; you say things. And the next thing you know, there’s a bar brawl: Y04.0XXA Assault by unarmed brawl or fight, initial encounter.

Clearly the bar scene isn’t for you, but perhaps a Dropkick Murphys’ concert is: Y92.252 Music hall as the place of occurrence of the external cause. Alas, the Dropkick Murphys rock a little too hard for you: H83.3X9 Noise effects on inner ear, unspecified ear.

Waking Up the Next Day

In addition to definitely seeking medical treatment for everything that befell you the night before, you realize you also are tremendously hungover: R51 Headache and R11.2 Nausea with vomiting, unspecified.

The above is clearly a tale of woe—and a tale of St. Paddy’s Day don’ts. So, don’t become an ICD-10 code. Enjoy the occasion and all its festivities responsibly. Have a safe—and magically delicious—St. Patrick’s Day!


17 Super Specific, Super Bizarre ICD-10 Codes

March 3rd, 2014
Codes, ICD-10

Come October 2015, healthcare professionals will go from using the library of 13,000 codes in ICD-9 to that of 68,000 in ICD-10. As The New York Times explains, the new code set “allows for much greater detail than the existing code [set], ICD-9, in describing illnesses, injuries, and treatment procedures. That could allow for improved tracking of public health threats and trends, and better analysis of the effectiveness of various treatments.”

With 55,000 new codes, ICD-10 is much more specific than its predecessor. In fact, The Wall Street Journal reports that “Much of the new system is based on a World Health Organization code set in use in many countries for more than a decade. Still, the American version, developed by the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, is considerably more fine-grained.” How fine-grained? Well, one code for suturing an artery will become 195 codes, and there are 312 animal codes all together. Beyond that, some codes, most of which specify cause or location, seem downright nutty—borderline unbelievable even. Here are some of the most bizarre:

  • Z63.1 Problems with the in-laws

    Put the whole family in one room during the holiday season and things can get ugly.

  • W55.29XAOther contact with cow, subsequent encounter

    We’ve got “kicked by cow” and “bitten by cow.” Lo and behold, we’ve also got “other contact with cow.” I wonder what that other contact is? Tail whip? Noogie?

  • V97.33XD Sucked into jet engine, subsequent encounter

    I really hope they mean hot tub jet—or oomph, that’s awful.

  • V91.07XA Burn due to water-skis on fire, initial encounter

    I feel like this code exists simply because of daredevils vying for YouTube glory.

  • W22.02XD Walked into lamppost, subsequent encounter

    This seems like a scenario that should be in this Windows Phone commercial.

  • W49.01XA Hair causing external constriction, initial encounter

    Do they mean your actual hair or the Tony Award-winning musical Hair?

  • V80.730A Animal-rider injured in collision with trolley

    But what happened to the animal? Did it not collide with the trolley?

  • W56.22xA Struck by orca, initial encounter

    It’s so awesome of a code that it spawned a book, website, and artistic movement—not to mention this brilliant image.

  • Z62.1 Parental overprotection

    Psychology Today warned us about this.

  • V61.6XXD Passenger in heavy transport vehicle injured in collision with pedal cycle in traffic accident, subsequent encounter

    So the passenger in the heavy transport vehicle gets hurt in the collision with a pedal cycle? Okay.

  • V95.41XA Spacecraft crash injuring occupant, initial encounter

    Eyes to the skies, people. They’re coming.

  • X52 Prolonged stay in weightless environment

    For this diagnosis, space really proves to be the final frontier.

  • S30.867A Insect bite (nonvenomous) of anus, initial encounter

    I’m not going to even touch this one, except to say that there doesn’t seem to be a venomous version of this code.

  • R46.1 Bizarre personal appearance

    This goes out to Lady Gaga.

  • S10.87 Other superficial bite of other specified part of neck, initial encounter

    Vampires are real.

  • T63 Unspecified event, undetermined intent

    For when your patients provide absolutely no details regarding what ails them.

Fairly nutty, right? But just like the wackiest of laws, these codes exist because they’ve happened to someone at some point. And when it comes to a patient’s medical record, I think we can all agree that we’d rather err on the side of specificity than vagueness.

Know a weird ICD-10 code? Share it in the comments.


Valentine’s Day Woes? There’s an ICD-10 Code for That.

February 5th, 2014
Codes, ICD-10

If you’ve done any shopping lately, you might have noticed the influx of pink and red decorations, the increase of candy displays, and the uptick of jewelry commercials. Hallmark’s favorite holiday is upon us. Of course, no holiday is without unfortunate incidents—not even the lovey, dovey Valentine’s Day. No matter what goes awry, though, trust that there’s an ICD-10 code for it.

Struck by Cupid’s Arrow

When love strikes, it takes the form of an arrow. Interestingly, ICD-10 has codes for assault with knives, daggers, and pipe bombs, but no arrows. Thus, we must settle for “X99.8, Assault by other sharp object.”

Butterflies

Remember the crazy flip-flopping of your stomach right before your first kiss? Those, my friends, are butterflies, and there’s an ICD-10 code for that: “F06.4, Anxiety disorder due to known physiological condition.”

Flowers? For Me?

One in five people have allergy or asthma symptoms, but that doesn’t stop us from showing affection to our loved ones by presenting them with bouquets of flowers. They are so pretty, after all, even with all the sniffling and sneezing: “J30.1, allergic rhinitis due to pollen.”

Chocolate Overload

If life is like a box of chocolates, there is one thing you know you’re going to get if you overindulge: “K30, functional dyspepsia,” a.k.a. a belly ache.

Every Rose Has Its Thorn

Roses are arguably the most romantic flower, which is probably why they’re so popular on Valentine’s Day. Watch out for those thorns, though, because they’ll get ya: “S61.230, Puncture wound without foreign body of right index finger without damage to nail.”

Poppin’ Bottles

From fancy dinners to grand romantic gestures, champagne is almost as common on Valentine’s Day as it is on New Year’s. But if you’re not a skilled bottle popper, you could end up with a black eye: “T15.91XA, Foreign body on external eye, part unspecified, right eye, initial encounter”

Set the Mood

So many Hollywood romance scenes feature rooms filled with ceremoniously positioned, white lit candles. But who is lighting all of them? And isn’t it time consuming? I recommend a stick lighter for that job or else you’re bound to burn your fingers on the matches: “T23.011A, Burn of unspecified degree of right thumb (nail), initial encounter” and “23.12, Burn of first degree of single finger (nail) except thumb.”

TRUE LOVE Down the Wrong Tube

Sweethearts, or Conversation Hearts, are those adorable, yet not-so-appetizingly chalky candies with cutesy sayings like “BE MINE” and “TRUE LOVE” stamped on them. We don’t necessarily like eating them, but it’s the novelty of it. Unfortunately, they’re easy to choke on: “T17.220A, Food in pharynx causing asphyxiation, initial encounter.”

Be Mine?

Have you ever seen so many cards on display? From funny to grandiose, there’s a variety of Valentine’s Day cards to choose from, and you absolutely must find the right one—one that says everything you wish you were talented enough to think of on your own. In the process of flipping through your choices, your soft skin could fall victim to a pesky paper cut: “W45.1, paper entering through skin.”

Lonely Hearts Club

During an episode of Grey’s Anatomy, I learned about broken heart syndrome. After some research, I discovered it’s an actual condition, one that mimics heart attack symptoms and is induced by emotional distress. Valentine’s Day is certainly a day of romance, but—cue the Debbie Downer music—it can also be a day of heartache: “I51.81, Takotsubo syndrome.”

Have an example of a Valentine’s Day gone wrong? Share it with ICD-10 codes in the comments below.


ICD-9 vs. ICD-10: An Example

January 17th, 2014
ICD-10, ICD-10 Example, ICD-9

We’ve talked plenty about ICD-9 and ICD-10, including the differences and improvements. The best way to truly see how much better and more precise ICD-10 diagnosis codes are than ICD-9 is through some examples.

ICD-9-CM ICD-10-CM
Description Mechanical complication of other vascular device, implant, and graft Mechanical complication of other vascular grafts
Number of codes 1 code (996.1) 49 codes, including:
T82.311A — Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.312A — Breakdown (mechanical) of femoral arterial graft (bypass), initial encounter
T82.329A — Displacement of unspecified vascular grafts, initial encounter
T82.330A — Leakage of aortic (bifurcation) graft (replacement), initial encounter
T82.331A — Leakage of carotid arterial graft (bypass), initial encounter
T82.332A — Leakage of femoral arterial graft (bypass), initial encounter
T82.524A — Displacement of infusion catheter, initial encounter
T82.525A — Displacement of umbrella device, initial encounter
Description Pressure ulcer Pressure ulcer
Number of codes 9 location codes (707.00 — 707.09); show broad location, but not stage 150 codes that show more specific location and stage, including:
L89.131 — Pressure ulcer of right lower back, stage 1
L89.132 — Pressure ulcer of right lower back, stage 2
L89.133 — Pressure ulcer of right lower back, stage 3
L89.134 — Pressure ulcer of right lower back, stage 4
L89.139 — Pressure ulcer of right lower back, unspecified stage
Page 3L89.141 — Pressure ulcer of left lower back, stage 1
L89.142 — Pressure ulcer of left lower back, stage 2
L89.143 — Pressure ulcer of left lower back, stage 3
L89.144 — Pressure ulcer of left lower back, stage 4
L89.149 — Pressure ulcer of left lower back, unspecified stage
L89.151 — Pressure ulcer of sacral region, stage 1
L89.152 — Pressure ulcer of sacral region, stage 2
Description Angioplasty Angioplasty
Number of codes 1 code (39.50) 854 codes: Specifying body part, approach, and device, including:
047K04Z — Dilation of right femoral artery with drug-eluting intraluminal device, open approach
047K0DZ — Dilation of right femoral artery with intraluminal device, open approach
047K0ZZ — Dilation of right femoral artery, open approach
047K34Z — Dilation of right femoral artery with drug-eluting intraluminal device, percutaneous approach
047K3DZ — Dilation of right femoral artery with intraluminal device, percutaneous approach
047K4ZZ — Dilation of Right Femoral Artery, Percutaneous Endoscopic Approach

ICD-10 offers a lot more codes and much more specificity, right? That’ll certainly help documentation accuracy.