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!


ICD-10 Has 312 Animal Codes—And There’s a Good Reason for That

March 10th, 2014
Codes, ICD-10

By now, you’ve probably heard more than a few ICD-10 jokes—”a man walks into a lamppost…” for example. And although they’re pretty funny—and not entirely unfounded—there’s actually a reason why ICD-10 contains so many ultra specific diagnostic codes, at least according to Richard Averill, senior vice president of clinical and economic research at 3M Health Information Systems. Here’s some of what Averill has to say (paraphrased) in response to some very good questions posed by Tom Sullivan, editor of Government Health IT (also paraphrased):

Q: Macaws are (almost entirely) native to South America, so why does the US need codes for macaw injuries?
A:
Remember the avian flu? Well, that was originally transmitted by a bird. If the US experiences another bird-source outbreak, we’ll have the necessary codes to accurately report it to the United States Centers for Disease Control and Prevention (CDC).

Averill also points out that most of the codes people are using as punchlines are actually already in ICD-9; there are just many more in this new set, which brings us to another question.

Q: The sheer volume of codes has a lot of people concerned. Considering that most practitioners will only ever use a small subset of the codes, why are there so many?
A:
The coding system is similar to a dictionary in that even though there are 470,000 words in the unabridged version, we only use a fraction of a percent of those words in a typical conversation. But the fact that 470,000 words are available to us doesn’t make it any more difficult for us to carry on a conversation. The same goes for the coding system. In most situations, you’ll only use a small subset of the codes. But there may come a time when you wish to describe something out of the ordinary, and in that case, the unusual codes will be there for you to use.

According to Averill, the large number of codes came about not as a result of bureaucracy, but rather because the medical community asked for this level of specificity to better do their jobs. Additionally, Averill says: “John Hopkins Bloomberg School of Public Health noted that to further research in the area of non-fatal injuries, we must be able to more accurately describe the nature of the injury sustained and correlate the nature of the injury with the mechanism of the treatment and outcome.” In short, he says, “they’re arguing that we need the detail to really understand outputs.”

Q: Could we put the ICD-10 data to use? Perhaps to determine the likelihood of injury based on sport?
A:
Yes. If we as a country require providers to report these injuries at that level of specificity, we’d have a national database we could use to track trends. We could also go one step further by tracking patients who suffer football-related concussions during childhood, for example, to see if they also experience learning difficulties or seizures later in life. However, right now providers are not required to record such detailed information.

Q: What’s the best example of how ICD-10’s specificity can actually help improve health management?
A:
In ICD-9, there’s no way to code which trimester a pregnant woman is in, which is an incredibly important piece of information to have if you’re treating someone for preeclampsia or other complications. Also, using ICD-9, “in rheumatoid arthritis [cases], we don’t even know what joint is involved. And so if we’re really trying to understand care, and a patient has rheumatoid arthritis in the knees, hips, and so on, [his or her] ability to recover from, say, a stroke may be significantly impaired, especially compared to having rheumatoid arthritis only in [his or her] little finger.”

According to Averill, there are many cases in which ICD-10’s specificity is actually incredibly beneficial to the healthcare community as a whole. There aren’t “just a couple of examples.” And we couldn’t agree more. Who knows what brilliant insights will come from the data that specifies whether a patient sustained his or her injury in an opera house or an art gallery?

As HealthLeaders Media writer Cheryl Clark points out here, there are lots of reasons why ICD-10—and all of its specificity—will be a very good thing:

  1. It’s a much-needed update to outdated or non-existent 1970s medical terminology
  2. It improves public health tracking
  3. It discourages fraud
  4. It allows providers the opportunity to code reasons for patient non-compliance
  5. It details accidents and injuries in a way that will allow for trend identification
  6. It better describes—and allows tracking of—adverse events that take place within a healthcare environment (clinic, hospital, etc.) as well as those that result from medical device complications
  7. It allows providers to track the specifics of procedures based on level of difficulty
  8. It creates jobs
  9. It supports the transition to EHR/EMR

So what do you think? Do you see the benefits of ICD-10’s specificity or do you think 68,000 codes is a bit much? Tell us in the comments section.


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.


Should Your Practice Hire an ICD-10 Coder?

February 17th, 2014
Codes, ICD-10, Preparation, Transition

The switch to ICD-10 will trigger a monumental shift in the way medical practitioners code patient diagnoses. In addition to an entirely new coding structure—ICD-10 codes contain up to seven characters, whereas ICD-9 codes max out at five—ICD-10 incorporates much more advanced anatomical terminology. Furthermore, in addition to coding for patients’ conditions, you often will need to submit supplemental codes to describe how and where certain injuries occurred as well as their degree of severity.

The result is increased specificity in coding, but all that slick, souped-up data comes at a cost—time. And as a rehab therapist, you don’t have a lot of that to spare. So rather than trying to manage the transition—and master a code set with five times more codes than the library you’re used to—all by yourself, you might want to consider calling in some backup in the form of an ICD-10 coder.

Medical coders are trained to review clinical documents and patient records and assign numeric codes for each diagnosis and procedure. So basically, when you have a coder, he or she will take your patient notes and translate them into the correct codes. Those codes help paint a clear picture of a patient’s condition and treatment, thus justifying reimbursement from payers.

Unlike large-scale medical organizations (such as hospitals), most small practices do not have dedicated coders, and with ICD-9—which features only about 13,000 codes to ICD-10’s 68,000—that might work just fine. But beginning October 1, 2015, if your practice fails to record and submit the proper ICD-10 codes, you won’t get paid. That’s a lot of pressure to deal with on your own—and that’s where a pro coder can help. Now, your gut reaction is probably, “There’s no way I can afford to hire a dedicated coder.” But considering the potential revenue loss your practice could suffer if you do not code correctly, the investment might be well worth it.

As this report explains, “The medical coders’ role in assuring that all information is accurate and complete is crucial to the economic well-being of the hospital since their entries determine the amount of reimbursement for patients covered by Medicaid, Medicare and other insurance programs. Coder efficiency in timely processing of coded bills maintains the flow of income into the institution.”

To code effectively, such professionals must demonstrate mastery in specific code sets and the ability to translate specific documentation into codes. For that reason, coders competent in ICD-10 are already in high demand among large institutions that currently retain on-staff medical coders. But as I mentioned above, ICD-10 could prompt smaller clinics to invest in trained coders as well—which in turn would drive up the demand even more. So, if hiring a coder to optimize your clinic’s ICD-10 coding and ensure reimbursements sounds like an attractive option to you, you’ll want to start looking for one sooner rather than later. Remember, you don’t necessarily have to add a full-time, in-house coder to your payroll; if you’d rather outsource to a third-party company (which is typically a much less expensive option), there are plenty of good ones out there. Check out the list at the bottom of this article for some suggestions.

And if bringing a coder on board simply isn’t in the cards—or the budget—for your practice, I would highly recommend sending your clinic’s current coding hat-wearer to an ICD-10 training course or two.

How is your practice planning to handle the switch to ICD-10? Would you consider hiring a medical coder? Share your thoughts in the comment section below.


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.


Sample the ICD-10-CM Codes

December 12th, 2013
Codes, ICD-10

The CDC has released a series of downloads for the 2014 update of the ICD-10-CM (diagnosis codes). Each download features an addenda file that details the latest content changes for the 2014 release, and this year they’ve made PDF and XML file formats available. Click here to access the list of downloads.

A couple of things to note:

  1. Some downloads are in a compressed zip format, which is a file type where many files are compressed together into one download. If you right-click the file and select “extract,” you can uncompress all the downloads and choose where all the individual files will save to your computer.
  2. Although this ICD-10-CM release is available for viewing, the codes in ICD-10-CM are not currently valid for use yet, because the mandatory implementation date isn’t until October 1, 2015.

The National Center for Health Statistics (NCHS), under authorization from the World Health Organization, anticipates further updates to ICD-10-CM prior to implementation. Thus, anything you download now is bound to change in some form before October 2015.