i think the billing houses will take a huge hit since they can no longer use only one hand for data entry since every code now has a letter before it not just the V&E codes of today...
Posted on 02/15/2014 9:22:20 AM PST by Innovative
Reolubin is one of the country’s 186,000 medical coders who work in the back offices of hospitals. It’s her job to translate doctors’ scribbles into diagnosis codes. Those are sent to insurance companies, which use them to determine how much to pay hospitals for care.
With 14,000 codes, ICD-9 seems puny by comparison. The new manual explodes that code set to 68,000 much more granular and detailed terms to define — very exactly and specifically — what ails us.
There are different numbers for getting struck or bitten by a turkey (W61.42 or W61.43). There are codes for injuries caused by squirrels (W53.21) and getting hit by a motor vehicle while riding an animal (V80.919), spending too much time in a deep-freeze refrigerator (W93.2) and a large toe that has gone unexpectedly missing (Z89.419).
(Excerpt) Read more at washingtonpost.com ...
My personal is injury by falling spacecraft subsequent care. Like that’s surviveable..... And docs have to know this as well. Coders can’t do it all. However coders have been working with this for years. We will be lucky if we get a 2 week education/rollout period. Most of my time is no longer spent taking care of patients. It’s dealing with garbage like this. But pick the wrong code out of the 68000 you don’t get paid. Or you go to jail..... I’m retiring as soon as the last kid is out of school
A vet told me no. Years ago my kids were attacked by what I thought was a rabid squirrel. I dispatched him and took the carcass to a vet for an autopsy to see if it was indeed infected.
He said that the autopsy revealed that parasitic worms had devoured so much of the squirrels brain that it drove it insane. He also said that it probably got it from eating cat poop.
I'm an insurance fraud investigator and have done quite a number of provider fraud cases. On pretty much any Health Insurance Claim form, there are two sets of codes:
1. The diagnostic code (as discussed in this article) which is drawn from the ICD-9 (and now ICD-10). "ICD" stands for International Classification of Diseases, and is established by the World Health Organization.
2. The procedural code or "CPT code" which is the Current Procedural Terminology established by the AMA.
In short, the first code establishes the provider's diagnosis of what the problem is, and the second is the procedure rendered to treat it. A quick example would be a diagnosis of, "laceration," and a procedure of, "sutures." In theory and generally in practice, the procedure should be directly relevant to the diagnosis.
When providers want to play fast and loose, in my experience, it is easier to fudge with the procedure and not the diagnosis. The diagnosis is something that can be relatively easily and objectively confirmed or denied (with some ambiguous exceptions like fibromyalgia and some other soft tissue injuries). The procedural code is what generates the billing and there is more room for manipulation. Whether or not a procedure is appropriate or not becomes a more subjective matter of medical opinion.
Two relatively common scams are known as "upcoding," and, "unbundling." Upcoding is billing for a more extensive or complex procedure than was actually performed. For example, a new patient visit/exam should require more of a physician's time than a routine return visit since the physician will want to collect and review the new patient's full medical history and conduct a comprehensive examination. Sometimes physicians will bill for a more extensive exam than was actually required or performed. "Unbundling," is when there are specific codes for more elaborate procedures that may involve multiple lesser procedures. For example there is a specific code for stitches/sutures. If somebody comes into an ER or doctor's office with a gash that needs five stitches to close, the doctor will do the stitches and bill for the suturing. Virtually all invasive surgeries will mandate sutures to close as part of the surgical procedure, and the codes for those surgeries are supposed to include the closing sutures as part of the surgery, but some physicians or their coders will "unbundle," and bill the code not just for the surgery, but bill the separate code for sutures as well. It would be something akin to buying a car, 'as is' off the showroom floor, and then having the dealership bill you for the car with an extra charge for the tires.
How about a can of shaving cream .
Wow. Cat poop parasitic worms. Mr. Mercat and I are sure that the few squirrels brave enough to live close to our house are insane and/or extraterrestrial aliens. We figure that they go up into the messy nests in the tippy top of the trees (we’ve seen more squirrels go into those than couple possibly fit) and then teleport to the mother ship. Our dogs and cat keep them in some control.
Thanks for the information.
Well, while interesting and peculiar, I could have happily lived without this information...
I would not be able to refrain from laughing if I worked in ER and had a patient with a can of shaving cream up his butt. I’d probably ask, “Did you give any thought at all as to why you were doing this? Have you considered mental help?”
As an easy solution to most fraudulent health charges: have the patient pay the bill instead of some middleman! The patient knows what was done so there’s little provider temptation to slip in charges for what wasn’t done. And the patient won’t have to pay to support the middlemen he didn’t need. And in truly free market the provider savings from not having to convince the middlemen will be passed along to the patient as well.
I am a professional hospital medical coder. As much as I ABSOLUTELY HATE OCare: The new coding set (ICD-10) has been in the works long before OCare. Actually its implementation has been postponed twice already. A version of ICD-10 has been in use worldwide, except in the US, for quite a while. It was postponed due to the enormous expense to hospitals, doctor’s offices, insurance companies, and the US gov’t (medicare). The main problem now is that setting the start date of 10/1/14 on top of a mandated electronic record and the OCare milehigh stack of regulations,it will financially ruin many healthcare providers. The change from ICD-9-CM to ICD-10 is like changing from English to Russian. The codes, code fields, and root word definitions are changing. At my hospital, we are already spending hours and hours taking on-line courses to learn the new system. It is costing the hospital a lot of money; the IT (info technology) dept is also greatly impacted by this code set change.
So although OCare didn’t dream this up; it will help bankrupt and destroy our healthcare system.
Of course the US version, has many more codes than the international version. I haven’t check to see if there is a specific code for squirrel bite; but there has been codes for injuries caused by animals for years .Just gotta love those statistics. /sarc
BTW, there are codes for getting stabbed by knitting needles, while falling off a chair in an office....
It also represents a concept that has survived past when it is needed. In the early days of computing, databases, and even manual statistics it was important to have a single fully descriptive code number. That code number could be used by simplistic software, or even manual sorting systems, to select a group of patients in the exact same circumstance - i.e. they got bit on the thumb by a squirrel.
But as anyone who has used Google knows, today computer systems can aggregate data from multiple sources, and certainly from multiple fields on one record. So there is no need for a fully descriptive code, and instead partial codes can be used, or even descriptive words.
The theory behind the fully descriptive code is that it serves as a filter, and once coded everyone knows exactly what the data means. But of course that is not true. Coding mistakes get made, and the kid who thought it was a squirrel who bit them might actually have been bitten by a chipmunk, or a weasel, or maybe even the neighbor's cat that they weren't allowed to play with so it was safer to tell mom a squirrel bit them.
ICD-10 is a great example of a bureaucratic mindset imposing costs where they aren't warranted, and imposing a standard on the market that may not be the best solution.
Thanks for your insights.
The tradeoff is benefit vs. cost — how beneficial is it to know whether you were bitten by a squirrel or a rat or breaking down the diagnosis to tiny details — vs the enormous cost of implementation and development of a system to assign different reimbursement values for the different codes, etc.
BTW the article mentions the specific code: “There are codes for injuries caused by squirrels (W53.21)”
It’s a system run amok.
In general principle, I agree. There will be numerous cases however, where that's neither pragmatic nor possible. Namely, I'm thinking of injury claims arising from personal or commercial auto, general liability or anywhere else the injuries were sustained as a result of another party's negligence. If you go to a store that has an improperly maintained staircase which gives way while you're on it and you break your ankle, you're not going to want to, and may not even be able to, pay that bill out of pocket, and it's reasonable for you to expect that store (or by extension their carrier) to cover your medical bills.
I can’t believe it’s taken them this long to finally get to ICD-10. I worked for BC/BS in the 80s and 90s and we used ICD-9 way back then.
Trust me, laughing is the last thing on your mind. Dealing with these folks is not a lot of fun. And usually they want to tell you how it got there. I dont’ care and dont want to know. Trust me.
How much time does it take to look up a code? Wouldn’t “bit by a squirrel” be faster?
i think the billing houses will take a huge hit since they can no longer use only one hand for data entry since every code now has a letter before it not just the V&E codes of today...
http://www.freerepublic.com/focus/f-news/1060580/posts
These new FReepers have no respect for tradition.
It was a squirrel and must have been trying to run across the road when it encountered the car. I really was not going very fast, but there was no time to brake or avoid it -- it was that close! . I hate to run over animals, and I really hate it on a motorcycle; but a squirrel should pose no danger to me.
I barely had time to brace for the impact. Animal lovers, never fear. Squirrels, I discovered, can take care of themselves!
Inches before impact, the squirrel flipped to his feet. He was standing on his hind legs and facing my oncoming Valkyrie with steadfast resolve in his beady little eyes. His mouth opened; and at the last possible second, he screamed and leapt! I am pretty sure the scream was squirrel for, "Bonzai!" or maybe, "Die you gravy-sucking, heathen scum!" The leap was nothing short of spectacular. He shot straight up, flew over my windshield, and impacted me squarely in the chest. Instantly, he set upon me. If I did not know better, I would have sworn he brought 20 of his little buddies along for the attack. Snarling, hissing, and tearing at my clothes, he was a frenzy of activity. As I was dressed only in a light T-shirt, summer riding gloves, and jeans, this was a bit of a cause for concern. This furry little tornado was doing some damage!
Picture a large man on a huge black and chrome cruiser, dressed in jeans, a T-shirt, and leather gloves, puttering at maybe 25 mph down a quiet residential street, and in the fight of his life with a squirrel.
And losing...
I grabbed for him with my left hand. After a few misses, I finally managed to snag his tail. With all my strength, I flung the evil rodent off to the left of the bike, almost running into the right curb as I recoiled from the throw. That should have done it. The matter should have ended right there.
It really should have. The squirrel could have sailed into one of the pristinely kept yards and gone on about his business, and I could have headed home. No one would have been the wiser. But this was no ordinary squirrel. This was not even an ordinary angry squirrel. This was an EVIL MUTANT ATTACK SQUIRREL OF DEATH!
Somehow he caught my gloved finger with one of his little hands; and, with the force of the throw, swung around and with a resounding thump and an amazing impact, he landed squarely on my BACK and resumed his rather antisocial and extremely distracting activities. He also managed to take my left glove with him! The situation was not improved. Not improved at all. His attacks were continuing, and now I could not reach him. I was startled, to say the least. The combination of the force of the throw, only having one hand (the throttle hand) on the handlebars, and my jerking back unfortunately put a healthy twist through my right hand and into the throttle. A healthy twist on the throttle of! a Valkyrie can only have one result.
Torque.
This is what the Valkyrie is made for; and she is very, very good at it. The engine roared, and the front wheel left the pavement. The squirrel screamed in anger. The Valkyrie screamed in ecstasy. I screamed in - well, I just plain screamed.
Now picture a large man on a huge black and chrome cruiser, dressed in jeans, a slightly squirrel-torn t-shirt, wearing only one leather glove, and roaring at maybe 50 mph and rapidly accelerating down a quiet residential street on one wheel, with a demonic squirrel of death on his back.
The man and the squirrel are both screaming bloody murder.
With the sudden acceleration, I was forced to put my other hand back on the handlebars and try to get control of the bike.
This was leaving the mutant squirrel to his own devices; but I really did not want to crash into somebody's tree, house, or parked car. Also, I had not yet figured out how to release the throttle. My brain was just simply overloaded. I did manage to mash the back brake, but it had little effect against the massive power of the big cruiser.
About this time, the squirrel decided that I was not paying sufficient attention to this very serious battle (maybe he was an evil mutant NAZI attack squirrel of death); and he came around my neck and got INSIDE my full-face helmet with me. As the faceplate closed part way, he began hissing in my face. I am quite sure my screaming changed intensity. It had little effect on the squirrel, however. The RPMs on the Dragon maxed out (since I was not bothering with shifting at the moment); so her front end started to drop.
Now, picture a large man on a huge black and chrome cruiser, dressed in jeans, a very raggedly torn T-shirt, wearing only one leather glove, roaring at probably 80 mph, still on one wheel, with a large puffy squirrel's tail sticking out of the mostly closed full-face helmet. By now, the screams are probably getting a little hoarse.
Finally, I got the upper hand. I managed to grab his tail again, pulled him out of my helmet, and slung him to the left as hard as I could. This time it worked - sort of.
Spectacularly sort of ...so to speak.
Picture a new scene. You are a cop. You and your partner have pulled off on a quiet residential street and parked with your windows down to do some paperwork. Suddenly, a large man on a huge black and chrome cruiser, dressed in jeans, a torn T-shirt flapping in the breeze, and wearing only one leather glove, moving at probably 80 mph on one wheel, and screaming bloody murder roars by, and with all his strength throw! was a live squirrel grenade directly into your police car.
I heard screams.
They weren't mine.
I managed to get the big motorcycle under control and dropped the front wheel to the ground. I then used maximum braking and skidded to a stop in a cloud of tire smoke at the stop sign of a busy cross street. I would have returned to 'fess up (and to get my glove back). I really would have. Really. Except for two things.
First, the cops did not seem interested or the slightest bit concerned about me at the moment. When I looked back, the doors on both sides of the patrol car were flung wide open. The cop from the passenger side was on his back, doing a crab walk into somebody's front yard, quickly moving away from the car. The cop who had been in the driver's seat was standing in the street, aiming a riot shotgun at his own police car.
So, the cops were not interested in me. They often insist to "let the professionals handle it" anyway.
That was one thing. The other?
Well, I could clearly see shredded and flying pieces of foam and upholstery from the back seat. But I could also swear I saw the squirrel in the back window, shaking his little fist at me. That is one dangerous squirrel. And now he has a patrol car. A somewhat shredded patrol car, but it was all his.
I took a deep breath, turned on my turn-signal, made a gentle right turn off of Brice Street, and sedately left the neighborhood. I decided it was best to just buy myself a new pair of gloves. And awhole lot of Band-Aids.
true. Very true. We have data entry people freaking out over the code changes. They don’t even choose the code; just enter it. They’ll just have to pay more attention.
I deal with InPatient stays. Many codes for each stay!!!. It really doesn’t make much difference to me which code set we use. The general coding guidelines aren’t changing.
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