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October 12, 2011

BehindTheMedspeak: Burned by water-skis on fire? There's a code for that.


From Anna Wilde Mathews' September 13, 2011 Wall Street Journal front page story: "Today, hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. Apparently, that doesn't allow for quite enough nuance.

"A new federally mandated version will expand the number to around 140,000 — adding codes that describe precisely what bone was broken, or which artery is receiving a stent.

"It will also have a code for recording that a patient's injury occurred in a chicken coop."


More excerpts from the WSJ article follow.

The federal agencies that developed the system — generally known as ICD-10, for International Classification of Diseases, 10th Revision — say the codes will provide a more exact and up-to-date accounting of diagnoses and hospital inpatient procedures, which could improve payment strategies and care guidelines. "It's for accuracy of data and quality of care," says Pat Brooks, senior technical adviser at the Centers for Medicare and Medicaid Services.

Billing experts who translate doctors' work into codes are gearing up to start using the new system in two years. They say the new detail is welcome in many cases. But a few aspects are also causing some head scratching.

Some codes could seem downright insulting: R46.1 is "bizarre personal appearance (see code)," while R46.0 is "very low level of personal hygiene (see code)."

It's not clear how many klutzes want to notify their insurers that a doctor visit was a W22.02XA, "walked into lamppost, initial encounter" (or, for that matter, a W22.02XD, "walked into lamppost, subsequent encounter").

Why are there codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting — but not while shopping, wonders Rhonda Buckholtz, who does ICD-10 training for the American Academy of Professional Coders, a credentialing organization.

Code V91.07XA, which involves a "burn due to water-skis on fire (see codes)," is another mystery she ponders: "Is it work-related?" she asks. "Is it a trick skier jumping through hoops of fire? How does it happen?"

The WHO, for instance, didn't see the need for 72 codes about injuries tied to birds. But American doctors whose patients run afoul of a duck (see codes), macaw (see codes), parrot (see codes), goose (see codes), turkey (see codes) or chicken (see codes) will be able to select from nine codes for each animal, notes George Alex, an official at the Advisory Board Co., a health-care research firm.

There are 312 animal codes in all, he says, compared to nine in the international version. There are separate codes for "bitten by turtle" and "struck by turtle." (See codes.)

With the move to ICD-10, the one code for suturing an artery will become 195 codes, designating every single artery, among other variables, according to OptumInsight, a unit of UnitedHealth Group Inc. A single code for a badly healed fracture could now translate to 2,595 different codes, the firm calculates. Each signals information including what bone was broken, as well as which side of the body it was on.

October 12, 2011 at 04:01 PM | Permalink


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B02.O16.J10, BOTN while reading BOJ ;-)

Posted by: Joe Peach | Oct 14, 2011 12:14:10 AM

Creating thousands more jobs.

I had wondered, but V9107XA probably covers a fire in a water-ski store.

Posted by: John A | Oct 13, 2011 3:05:54 AM

From all my reading by various pundits, expert and otherwise, ICD-10 will add 5-10 million in needless expense to a large hospital,which does not include the estimated waste of time by medical professionals. Such granularity in coding for payment will add not one moment of life to the patient who has to suffer through one more question prior to treatment.

Posted by: Matt Penning | Oct 12, 2011 8:03:03 PM

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