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ICD-10 Flight Delayed, But Keep Your Bags Packed – Breakaway Thinking

Posted on April 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Jennifer Bergeron, Learning and Development Manager at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Jennifer_web

If you’ve ever traveled to a country that doesn’t speak your native tongue, you can appreciate the importance of basic communication. If you learn a second language to the degree that you’re adding nuance and colloquialisms, you’ve experienced how much easier it is to explain a point or to get answers you need. What if you’re expected to actually move to that foreign country under a strict timeline? The pressure is on to get up to speed. The same can be said for learning the detailed coding language of ICD-10.

The healthcare industry has been preparing in earnest to move from ICD-9 coding to the latest version of the international classification of diseases. People have been training, testing and updating information systems, essentially packing their bags to comply with the federal mandate to implement ICD-10 this October — but the trip was postponed. On April 1, President Barrack Obama signed into law a bill that includes an extension for converting to ICD-10 until at least Oct. 1, 2015. What does this mean for your ICD-10 travel plans?

Despite the unexpected delay, you’ll be living in ICD-10 country before you know it. With at least another year until the deadline, the timing is just right to start packing and hitting the books to learn the new codes and to prepare your systems. For those who have a head start, your time and focus has not gone to waste, so don’t throw your suitcases back into the closet. The planning, education and money involved in preparation for the ICD-10 transition doesn’t dissolve with the delay – you’ve collected valuable tools that will be put to use.

Although many people, including myself, are disappointed in the change, we need to continue making progress toward the conversion; learning and using ICD-10 will enable the United States to have more accurate, current and appropriate medical conversations with the rest of the world. Considering that it is almost four decades old, there is only so much communication that ICD-9 can handle; some categories are actually full as the number of new diagnoses continues to grow. ICD-9 uses three to five numeric characters for diagnosis coding, while ICD-10 uses three to seven alphanumeric characters. ICD-10 classifications will provide more specific information about medical conditions and procedures, allowing more depth and accuracy to conversations about a patient’s diagnosis and care.

Making the jump to ICD-10 fluency will be beneficial, albeit challenging. In order to study, understand and use ICD-10, healthcare organizations need to establish a learning system for their teams. The Breakaway Group, A Xerox Company, provides training for caregivers and coders that eases learning challenges, such as the expanded clinical documentation and new code set for ICD-10. Simply put, there are people can help with your entire ICD-10 travel itinerary, from creating a checklist of needs to planning a successful route.

ICD-10 is the international standard, so the journey from ICD-9 codes to ICD-10 codes will happen. Do not throw away your ICD-10 coding manuals and education materials just yet. All of these items will come in handy to reach the final destination: ICD-10.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Why Do People Find ICD-10 So Amusing?

Posted on April 2, 2014 I Written By

In case you missed the news, ICD-10 has been delayed a year. It’s likely that we’ll be taking a break from talking about ICD-10 for the next 6-10 months. However, before we put ICD-10 on the shelf, you might want to read two opposing arguments for and against ICD-10: The Forgotten Argument For ICD-10 and Why ICD-10? Plus, below is a guest blog post by Heidi Kollmorgen, Founder of HD Medical Solutions, putting some perspective on where we’re at with coding. She has some good insights I hadn’t heard before. I’ll probably wrap up this series on ICD-10 with a look at what organizations should do now that ICD-10’s been delayed.
Heidi Kollmorgen
Many people who don’t understand the value of ICD-10 go straight to the “humorous codes” as a reason to justify delaying its implementation or even not adopting it at all. Does anyone realize those codes only make up 67 of the 1583 pages of the 2014 Draft Set?

Those seemingly “useless” codes are stated in the ICD-10 Chapter 21 Guidelines as having “no national requirement for mandatory ICD-10-CM external cause code reporting”. External Causes of Morbidity codes “are intended to provide data for injury research and evaluation of injury prevention strategies” only.

The *real* ICD-10 codes are more specific and allow greater accuracy for clinical data purposes. Many would agree that patient safety and effective and timely patient-centered care are the goal of most healthcare providers. Clinical data gathered and analyzed is what allows this to be achieved and ICD-10 codes are critical for more accurate analysis (1).

ICD-9 was adopted and went “live” in 1979 – how many advances has medicine made since that time? The ICD-9 code set does not allow doctors to accurately identify how they are treating patients any longer, nor does it allow accurate reporting of the services they provide to their patients. In 2003 the NCVHS recommended the adoption of ICD-10 and fourteen years later providers still claim they haven’t had time to prepare (2).

Doctors and other healthcare professionals who choose to take advantage of the daily barrage of free ICD-10 training and education from CMS and countless other sources for themselves and their staff will not go out of business. Providers who recognize that hiring an educated and/or certified medical biller/coder is an investment with huge ROI potential.

Those individuals have the training and ability to prevent and decrease denials and rejected claims from the onset when the claims are initially prepared. They also understand the intricacies of carrier guidelines so providers who hire them will never go out of business or suffer from decreased cash flow, rather their reimbursement would improve and they would also be compliant.

The days of hiring your neighbors daughter or friend because they need a job, or because they like working with numbers are over. It shouldn’t be impossible to understand how saving money in overhead and payroll only costs you infinitely more in lost reimbursement. Is the irony lost in correlating the profession of Health Information Management to Nursing? In the history of medicine it was only in the last one hundred or so years that licensing of nurses went into law. http://www.nursingworld.org/history Would any doctor today work with an unlicensed or inexperienced person who claimed to be a nurse? Would any hospital or facility hire someone who applied for a nursing position only because they liked working with people? That’s basically how the profession of nursing began.

In regards to the opinion held by many how ICD-10 codes are outlandish I would agree in some cases. I have a wicked sense of humor and because I know the codes I could create funnier cartoons than any you have come across. The difference is that coders understand how that argument holds no merit and only proves how providers don’t even understand ICD-9-CM. Unfortunately, most are probably using it incorrectly as well and it may be one of the causes of low reimbursement.

Just in case you see a patient today who is a water skier and has an accident while jumping from a burning ship use ICD-9-CM E8304. Have a patient who was knocked down by an animal-drawn vehicle while riding a bike? There’s a code for that too – ICD-9-CM E827.

The good news is how the Guidelines for ICD-9-CM patient encounters are similar to ICD-10-CM for these types of codes. If you don’t typically use them now you won’t when ICD-10 goes into effect either. Providers who document what they did, why they did it and what they plan to do do about it will have no problem switching to ICD-10. Aren’t we lucky nothing has changed about that?

Heidi Kollmorgen is the founder of HD Medical Solutions which offers practice management services for solo and multi-physician groups. She holds AHIMA certifications and is dedicated to optimizing reimbursement by following compliant measures. She can be found at http://hdmedicalcoding.com/ or follow her on Twitter @HDMed4u.

Making the Case for Dual Coding

Posted on December 19, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at AHIMA, Healthcare Scene sat down with Kim Carr, Director of Clinical Documentation at HRS. In the following video, I ask Kim Carr to make the case for dual coding. I even assert that many look at dual coding as dual work, but Kim Carr offers a number of important reasons that organizations should be doing dual coding ICD-9 and ICD-10 today.

While dual coding is great for your ICD-10 preparations, it turns out that your organization can benefit from dual coding even under ICD-9. Kim Carr talks about a specific example of benefits you can gain for your organization even before ICD-10 becomes a requirement.

Certainly some organizations struggle with how to do dual coding while still maintaining their day-to-day coding production. This is where an organization may want to look to an outside company to help them through the process.

Considering New Years is just around the corner, maybe dual coding would be a great New Years resolution for your organization.

Check out all of our ICD-10 Tuesdays posts for other related content.

Should ICD-10 Go Through Rigorous Outside Testing? Definitely. – ICD-10 Tuesdays

Posted on November 26, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Sometimes it’s fun to critique my health IT editor colleagues in this space, but this time, I can do nothing but agree with a column written by FierceHealthIT editor Dan Bowman.

In his column, he notes that physician practices and hospitals have been quite worried about the transition from ICD-9 to ICD-10, something which is inevitable given the complexity of the switchover. And with the switch set to go into effect Oct. 1, 2014, the time available to prepare is flying by.

So, he says, it’s definitely a Good Thing that CMS may be amenable to do external ICD-10 testing, despite previously asserting that it wouldn’t do so. Now, bear in mind that CMS hasn’t promised to do external testing — it’s just said that it would consider the  idea — but that’s encouraging news.

After the mind-blowing failure of HealthCare.gov, CMS hardly needs another disastrous failure of systems or operations in one of its key responsibility areas. What’s more, if ICD-10 coding doesn’t work right, we’re talking about tying up millions (or even billions) of dollars in reimbursement to providers. That could prove to be a disaster which makes the HealthCare.gov debacle look like a minor blip.

Given that a failure of testing was instrumental in the HealthCare.gov debacle, I can’t imagine why CMS wouldn’t have become super-cautious in its wake. The last thing CMS needs is mass confusion, delayed payments, undercoding, upcoding, fraud….need I go on?

As things stand, CMS’s IT operation is already in turmoil, with the agency’s CIO having resigned and other heads still likely to roll. And Congress, for once understandably, isn’t going to have a lot of patience with anything resembling another IT failure.

CMS, don’t tell the public you don’t have the resources to do more extensive ICD-10 testing. Find them. Your future as an agency may depend on it.

Meanwhile, readers, if you want to keep up with ICD-10 twists and turns, don’t miss John Lynn’s ICD-10 Tuesdays. He’ll have plenty of insights to offer as the big day approaches.

For Providers, Revenue Assurance through the ICD-10 Transition is Key

Posted on July 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Vik Anantha, Vice President – Financial Management Solutions, Edifecs, Inc.
Anantha Vik - Edifecs
We all know ICD-10 is a complex and costly initiative. One of the promises of ICD-10 is the potential for enhanced granularity, laterality and overall reporting accuracy. This is particularly important to providers because health plans use the ICD code set to determine reimbursements based on the medical condition of the patient and procedure(s) used for treatment.

With promise comes risk. ICD-10 not only exponentially increases the number of diagnostic and procedure codes, it changes the structure of the coding scheme and introduces new clinical concepts, terminology and granularity. These widespread changes will force business process and policy changes in areas such as benefits, medical management, and payer contracting. In other words, ICD-10 will affect almost every operational, clinical and financial process.

On the business side of ICD-10, revenue neutrality is a big concern for healthcare CFOs and revenue cycle management leaders. While it’s unrealistic to expect revenue neutrality at a claim level (there will always be some variation), it’s entirely possible to achieve revenue neutrality in aggregate. And this should be the goal.

It won’t be easy. Improper and incomplete coding can increase denial rates, causing significant revenue loss. Even error-free claims hold financial risk, particularly for healthcare organizations that depend on DRG (diagnosis-related group) methodology for reimbursement. The process of mapping ICD-9 codes to their counterparts in ICD-10 can be very complex, and there is often no single, one-to-one relationship.

The DRG for a certain claim is selected based on the ICD code(s) present on the patient claim. Therefore, the reimbursement on every claim depends on the assignment of diagnosis codes and inpatient procedure codes to specific DRGs.: As a result, migration to ICD-10 could result in significant over- or underpayment when using DRG-based reimbursement if providers use the wrong code.

Here are a few real-world examples:

  • ICD-9 procedure code 38.12 (extirpations of upper arteries with an open approach) is grouped to DRG 039. The same procedure in ICD-10 has 31 mapping options. Thirteen of these map to the same DRG and will generate the same reimbursement. However, the remaining 18 ICD-10 codes group to DRG 027, which generates a higher reimbursement. Selecting one ICD-10 code over another could result in nearly a 100% payment increase ($5,927.14 for DRG 039 vs. $12,409.74 for DRG 027.)
  • ICD-9 procedure code 2754 (repair of cleft lip) groups to DRG 134. This procedure has six potential ICD-10 codes, all of which group to a lower-weighted DRG 138, which represents a more generic procedure. This could reduce reimbursement by approximately $1,000 ($5,269.34 for DRG 134 vs. $4,203.28 for DRG 138.)
  • ICD-9 diagnosis code 86.01 (traumatic pneumothorax with open wound into thorax) is grouped to DRG 201. In ICD-10, this claim maps to a combination of two ICD-10 codes. Together, the two codes group to DRG 199, which increases reimbursement by 276% ($3,910.60 for DRG 201 vs. $10,816.98 for DRG 199.)

These examples show that payment variation under ICD-10 can cut both ways. If a provider organization can’t quantify its risks, it may end up dealing with unfavorable payer contracts, longer collection cycles and uncertain financials.

Of course, this type of analysis can be very time- and labor-intensive. Providers and payers should work together to identify and prioritize areas of risk, based on actual historical data. Analyzing a provider’s own data based on reality-based ICD-9 to ICD-10 mapping scenarios delivers the “street-level view” of the real operational and financial risks posed by ICD-10 to the organization, rather than just a list of every possible risk.

Many providers already have clinical documentation improvement (CDI) initiatives underway, and coding improvements made by these teams can be a key part of the financial analysis as well. The CDI process will narrow the number of ICD-10 codes to those the provider will actually use, which can then be used to build financial modeling maps specific to that provider, rather than using generic maps such as GEMs.

Providers looking to ensure consistent revenue cycle management through the ICD-10 transition should take the following steps:

  • Identify high-level risks at the outset, using historical data
  • Integrate with physician/clinical/coding training and CDI efforts
  • Refine analysis and prioritize risk with refined, “reality-based” mapping
  • Iterate, validate and improve to allocate resources based on real risk
  • Test and transition with highest possible degree of confidence

ICD-10 does hold promise for the healthcare industry. The transition period is likely to be bumpy and somewhat painful. But with some foresight and commitment to working with each other, providers and payers can assure themselves of financial neutrality in both directions.

Are You Ready for ICD-10?

Posted on May 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’ve been writing about ICD-10 for a long time now including the delay of ICD-10. Based on the CMS comments at HIMSS, there will be no more delays in the implementation of ICD-10. Barring something crazy, ICD-10 will go into effect on October 1, 2014. The question is, are you ready?

If you’re not ready or you’re not sure if you’re ready, check out this ICD-10 whitepaper. It’s a nice straightforward look at ICD-10 and provides 6 steps you can use to make sure you’re ready for ICD-10. Plus, it has some good background on ICD-10 and the basics of the ICD-10 code structure.

Of course, many of you might be wondering why I’m posting about ICD-10 if it’s still over a year away. If you’re asking this, then you must not have looked into ICD-10 very much. It’s not that I think the switch over from ICD-9 to ICD-10 is really that hard, but it takes some time to ensure that all of your systems are ready for the switch over and that your staff are trained.

As is discussed in the ICD-10 whitepaper I mentioned, the first step is to do an impact analysis so you know how you’re doing on your path to ICD-10. Maybe you won’t need a year to get there, but you’ll want to do that impact analysis now so you know either way.

I won’t be surprised if some EMR vendors aren’t ready for ICD-10. It’s kind of insane to consider, but I can see a few scenarios where this happens. Plus, you want to make sure your EMR is able to send proper ICD-10 codes to your billing systems. In some cases you may need to “ride” your EMR vendor to make sure they’re ready. This may take time.

The reality is that the provider is responsible for ICD-10 whether their various software and billing companies are ready or not. So each practice should be proactive in their approach to ICD-10.

ICD-10 Fact: We’ve been using ICD-9 since 1979 and ICD-10 was first brought to the US in 1994.

Clinical Documentation Upgrade Critical Before ICD-10 Conversion

Posted on April 4, 2012 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For most providers organizations, the news that ICD-10 implementation is likely to be delayed is, at minimum, a big relief.  But don’t let that lull you into a false sense of relief, suggests Priya Patel of tech consulting firm Perficient.  Even if the ICD-10 rollout is delayed — as many hope — until October 2013, it’s still going to happen.

So what can organizations due to reduce that weak feeling in the knees associated with ICD-10?  Well, generally speaking, Patel notes, your organization is already overdue for doing an ICD-10 impact assessment to figure out how to move ahead.

While the whole assessment is important, perhaps the most important element of the ICD-10 preparation process is clinical documentation assessment, Patel says. In fact, “if you choose not to assess your clinical documentation, you will certainly lose!” Patel asserts. Lose what?  Well, clinical and business effectiveness, sure, but also a great deal of money.

Right now, few doctors document efficiently enough to support coders, who are forced to do their work based on their assumptions and often, make mistakes and end up doing things over again.  As things move to ICD-10, these problems are only likely to get worse, as consistency in coding will become even more important.

Unfortunately, that’s not going to happen on its own. In fact, According to Patel, a recent study of 3,000-odd medical records across the country found that only 37 percent of physician documentation in existence would meet standards set by ICD-10.  Most organizations, in other words, will find that the documentation they have on hand is nowhere near as specific as it should be to support ICD-10 coding.

To figure out just how much your physicians need to improve before you transition to ICD-10, it’s critical to assess what clinical documentation gaps your organization faces, Patel says.

Anyone who reads Patel’s article and doesn’t see it as a red-hot wakeup call (deadline move-up or not) they’re crazy. It’s hard to argue that it will take a lot of time and physician training of doctors, coders and hospital staff.   If your clinicians don’t drill down to codes that have the clinical impact for them, and medical coders get much more training on documentation, anatomy and physiology and disases processes, things could get ugly, Patel notes.

ICD-10 Benefits – Where are they?

Posted on March 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the interesting topics of discussion at HIMSS was around the delay of ICD-10. However, I have yet to find an answer to what I think is probably the most important question around ICD-10. I posted the question and some other thoughts related to the question on the EHR Guy’s passionate post about ICD-10. Here’s my question and comments:

“What are the true benefits to using ICD-10?”

I’ve read story after story about ICD-10 (including this post) and so far I’ve only seen people giving general lip service to the basic idea that more specifically quantified data will somehow have a benefit to the healthcare system. Darren in the comment above says, “The fact that ICD-10 helps so many electronic and quality initiatives right now, or as pointed out above, are, in fact, required to achieve them”

What are the electronic and quality initiatives to which he speaks? What are the true benefits that we’ll get if we go to ICD-10? I haven’t seen enough of these examples.

We could also look at this same question another way. The rest of the world has been using ICD-10 for a lot longer than us. What have been the benefits that the rest of the world has seen from their use of ICD-10 that we haven’t seen in the US since we’re still on ICD-9?

I’m not trying to say that there aren’t benefits. I’m just saying if there are, then why aren’t we hearing more stories with concrete examples of the benefits? If there are, I’d love to see them and make them more widely known.

The EHR Guy offered this reply:

What you are asking for is reasonable and fair.

I will post, in a future blog, examples of why migrating to ICD-10 has beneficial clinical quality outcomes other than the intended reimbursement aspect of it which has been the main purpose of implementing it here in the United States.

But in essence a deep specificity would eliminate the erroneous coding accompanied by bulk documentation to justify the claim to be reimbursed.

Achieving semantic interoperability with erroneous coding is impossible. I’ve been in aggregation projects where abstracting information from HL7 messages was futile because no one in the healthcare organization seemed to understand what was contained in them.

This will be a very lively topic for months to come. I look forward to your participation in the discussions.

I look forward to the EHR Guy offering some more concrete examples in future blog posts. Although, I think this question deserves much more attention. I’ll admit to not being an expert on ICD-10. I know enough to be dangerous. So, I’d love to hear some of the real life benefits that ICD-10 has provided other countries and/or the benefits the US will get from ICD-10 implementation.

If we don’t have more stories and example of these benefits, then instead the stories related to the cost and inconvenience of ICD-10 (which are easy to find) will dominate the conversation. If that’s the case, then we can be sure that ICD-10 will be delayed.

Top Five ICD-10 Pitfalls – “Top 10” Health IT List Series

Posted on December 30, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today is going to be the last day looking at other people’s “Top Health IT Lists” since tomorrow I think I’ll create my own Top 10 Health IT 2011 List and then for the New Years I’ll see about doing a Top 10 Health IT in 2012 list. However, today let’s look at something that will likely make the Top 10 2012 Health IT issues: ICD-10. Government Health IT recently wrote an article what they call the Top 5 ICD-10 Pitfalls.

1. Reporting: I’m sure that many think that ICD-10 is just going to happen and be fine. They’ll assume that their reports are just going to work with ICD-10 since they worked with ICD-9. Don’t be so sure. Test the reports so you know one way or another. Diving a little deeper beforehand is a lot better than learning about the problems after.

2. Overlooking impacted areas: Much like an EHR implementation, don’t forget the other people that are affected by ICD-10. Involve everyone in the process so that they can share their concerns so they can be addressed. Plus, by having them involved you’ll get much better buy in from the staff.

3. Teaching old dogs new tricks: ICD-10 is a different beast and will require significant training even if you have an expert ICD-9 coder with years of experience. Don’t underestimate the cost to train your coders on ICD-10.

4. Preparing for impact on productivity: The article mentions Canada’s loss of productivity during their implementation of ICD-10. Do we think we’re going to be any different? Remember also that productivity loss can come in a lot of different places (which is kind of a repeat of number 2 above).

5. Communicating with IT vendors: It’s one thing to trust that your EHR and other health IT vendors are prepared to deal with ICD-10. It’s another to blindly follow whatever you’re being told. Remember at the end of the day it’s your organization that will suffer if your health IT vendor is not ready. I like to use the phrase, trust but verify.

Be sure to read the rest of my Health IT Top 10 as they’re posted.

Crazy and Funny ICD-10 Codes

Posted on September 23, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Wall Street Journal put out an interesting article about the switch from ICD-9 coding to ICD-10. The title mocks the ICD-10 codes, Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way”, and the subtitle is funny as well, “New Medical-Billing System Provides Precision; Nine Codes for Macaw Mishaps”

I must admit that I’m not very well steeped in the history of ICD-9 and ICD-10. Nor am I that familiar with the process that was used for creating the voluminous ICD-10 coding system. I’m more of a practical person and so I’ve been more interested in EHR’s ICD-10 preparedness and the timeline for ICD-10 implementation. Seems like we won’t have much choice.

I guess I should have known that going from 18,000 codes (which doctors can’t even stay up with as is) to 140,000 codes would offer some crazy and hilarious codes. Here’s some examples from the article linked above:

There are codes for injuries in opera houses, art galleries, squash courts and nine locations in and around a mobile home, from the bathroom to the bedroom.

And the appropriate follow up question from a family physician, “Really? Bathroom versus bedroom? What difference does it make?”

Some other interesting codes mentioned in the article:
R46.1 is “bizarre personal appearance”
R46.0 is “very low level of personal hygiene”
W22.02XA, “walked into lamppost, initial encounter
W22.02XD, “walked into lamppost, subsequent encounter”
V91.07XA, “burn due to water-skis on fire”

There are codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting—but not while shopping. There are codes for injuries from birds such as: a duck, macaw, parrot, goose, turkey or chicken. I’d hate for my doctor to choose the “bitten by turtle” versus “struck by turtle” code. My insurance company might not reimburse the second.

Do people know of any other off the wall ICD-10 codes?

While this has me a little concerned to see ICD-10 in action, hopefully it will give all of you a good laugh going into the weekend. I can’t say I saw a code for any sort of Friday inefficiency, but there probably should be.