When squirrels attack! There’s a medical code for that. (New ICD-10 coding system)

Washington Post ^ | Feb 14, 2014 | Sarah Kliff

[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).

[Mrs. B.S. Roberts]

In a hospital setting the MD would dictate a discharge summary that says, “bite injury on left pick-a-body-part by a squirrel and sutured the bite...” The coding analyst must take the words and turn them into codes. My experience in the hospital that I work for....the doctors have better things to do than worry about codes. The problem is that reimbursement by insurance companies and medicare or medicaid are based on the specific codes and RULES governing how they are used! You wouldn’t believe the number of RULES and MORE RULES we have to follow. And you guessed it, the rules are always changing from year to year. Good thing I like my job...most days

[Innovative]

LOL!!!

Make a movie of it, bet you would get a lot of hits. :)

[Chode]

10/1/2014 is gonna be an ugly day all the way around...

[Chode]

better hope PETA never reads that... 8^)

[ShadowAce]

IT wasn’t a regular squirrel! it was an EVIL MUTANT ATTACK SQUIRREL OF DEATH!!!!!!

[Chode]

if it's not, it'll sure do till a real one comes along!

[St_Thomas_Aquinas]

—— Have you heard of a scenario in which the attending physician/health care specialist is deliberately vague about a diagnosis because to be more specific (and accurate) in coding would require a new protocol and more troublesome paperwork? ——

Or a doctor prescribing drugs for off- label use?

Inconceivable!

[St_Thomas_Aquinas]

Thanks for that hilarious story! The whole family enjoyed it.

[Mom MD]

While I do t have to supply the code I have to know the exact wording. For example but by squirrel and attacked by squirrel may be 2 different codes with dramatically different remuneration. One word may literally be thousands of dollars difference in how a hospital is reimbursed. And coders cannot supply the word or infer it if I have not stated it that way. Treating the same patient can literally be reimbursed multiple ways with thousands of dollars difference. The hospital I work for would like to be paid enough to keep the doors open and is looking to me to get the coding right. It’s a ridiculous game, and once docs and hospitals figure it out, Medicare and Medicaid change the rules sometimes literally with 2 weeks notice...

[dfwgator]

[JohnBovenmyer]

Good exceptions. I figured there would be some, hence my ‘most.’ I hadn’t thought about your scenarios. There is potential for things to get unavoidably messy when there is a potentially adversarial relationship between ‘patients,’ ‘doctors’ and payors. I’d like to believe that in the majority of health care interactions patients and doctors are trying to be on the same side. My ‘general principle,’ where applicable, would save everyone, except the third party parasites, a lot of money.