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Government Medicine Idle

Medical Billing Codes For Injury Via Turtle Among Thousands Created by New Law 380

Posted by samzenpus
from the there's-a-code-for-that dept.
A new government law has created an unusually precise list of injury codes for billing purposes. Currently there are 18,000 standard billing codes; the new law would expand that list to around 140,000. If you've been injured at the Opera, walked into a lamppost, pulled something while playing a trumpet, or have been attacked by a turtle, there's now a code for that. From the article: "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."
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Medical Billing Codes For Injury Via Turtle Among Thousands Created by New Law

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  • by elrous0 (869638) * on Wednesday September 14, 2011 @10:51AM (#37398800)

    The obvious temptation is to run, but that would be a mistake. NEVER show a turtle your fear.

  • Good for insurance (Score:2, Insightful)

    by Spunkee (183938)

    This is designed to make it easier for insurance companies to deny payment in more situations. The overhead created will increase costs for everyone and that's good for the people at the top.

    Hopefully the system implodes on itself.

    • This is designed to make it easier for insurance companies to deny payment in more situations. The overhead created will increase costs for everyone and that's good for the people at the top.

      Hopefully the system implodes on itself.

      We can't wait around for it to implode. If this occurs, there will be no healthcare at all for a while until a new system is created. What needs to be done is to create the new system now so that we have a much shorter window of pain.

      Also, there's no evidence that it will hit some critical value where its internal contradictions would be the sole force to cause it to implode. More likely it'll just get worse and worse until it hits a point where it is pushed to collapse from the outside, facilitated by its

      • by limbodog (2461424) on Wednesday September 14, 2011 @11:43AM (#37399550)
        The 25 or so other countries who use these codes already have not yet imploded.
        • I'm not really talking about the codes in the article but about the almost completely broken insurance-health complex in the United States. Maybe you meant to address someone else...?

        • Think about it, "who will be impacted by increasing by an order of magnitude of ways folks are Diagnosed?" The short answer is Medical Biller's for Medicare, and Medicaid. Biller's typically get 8% to 5% of the gross; it looks like they'll be staying up late working on their "billing skills". And not to be ignored are the various tasks doctors need to do given the diagnoses, they bill for that also. The other group of people are the ones who write Medical Billing Software. For us software types, that m
    • Re: (Score:2, Insightful)

      by Anonymous Coward

      Other than plain old tin-foil hat paranoia and idiotic 'the only reason anyone does anything is to fuck me' thinking, what exactly do you base this on? And what idiot marked it 'informative'? Where is the information? Are the rantings of every loony now considered 'information'?

    • by Marillion (33728)
      Furthermore, it may lead to patients lying to their physicians. When you have codes that suggest "hazardous" activities, if patients worry about rise in premiums due to risky behavior then they may lie about the cause of an injury. Patient: "I broke my arm bone while going to church." Doctor: "You wear skateboard pads to church?" Patient: "Um ... sure, doesn't everyone?"
      • Doctor: "You wear skateboard pads to church?"

        Those damn evangelicals are always trying new gimmicks to increase attendance. Xtreme 4 Jesus &c.

    • by avandesande (143899) on Wednesday September 14, 2011 @11:53AM (#37399702) Journal

      Statements like this make it clear that people don't understand the nature of the insurance industry.
      They don't want to deny anything, as long as the other companies are forced to cover the same issue. That's why they want everything classified, so there is parity of coverage.
      I know it sounds counter intuitive but insurance companies make their money by skimming a percentage off of every transaction. That's why lobbyists pushed through the HMO model, which gave them a 'vig' from small transactions that people could just pay for out of pocket. The higher healthcare costs are, the more money they make.

      The important thing is that other insurers are forced to cover everything so they won't have an advantage by being able to deny things. Insurance companies want costs to be high so they can justify their exorbitant fees.

    • by gandhi_2 (1108023)

      I'm sure there will be a rush to file injuries incurred while using "burning water-skis".

      WTF?

      http://graphicsweb.wsj.com/documents/MEDICALCODES0911/#term=Water-skis [wsj.com]

    • by bk2204 (310841)

      Actually, the ICD-10 is created by the World Health Organization. The goal is to have a code for pretty much any medical-related concept not to increase overhead but to have a language-independent way of discussing and improving health. Determining the existence and spreading of public health issues is a lot easier when you can simply search medical records with a code.

  • by FunkyELF (609131) on Wednesday September 14, 2011 @10:55AM (#37398848)

    Wouldn't a tag based system be more effective than trying to exhaustively list 140,000 things?
    Or can each of these 140,000 be used in a combination?

    What if you walked into a lamp post, fell and hit your head on a turtle, it got angry and bit your ear?

    • Wouldn't a tag based system be more effective than trying to exhaustively list 140,000 things?
      Or can each of these 140,000 be used in a combination?

      What if you walked into a lamp post, fell and hit your head on a turtle, it got angry and bit your ear?

      Yes, you can use them in combination.

      You CAN be injured by a turtle, struck by lightening and suffer traumatic brain injury and a hernia. On a plane. On an experimental plane. On the runway.

      This would engender a number of codes and would be indicative of very, very bad karma. Or perhaps God really does have a sense of humor.

    • What if you walked into a lamp post, fell and hit your head on a turtle, it got angry and bit your ear?

      You are right, we are not precise enough. We should reevaluate the whole lot and add such obvious mishaps.

    • You're right - a faceted system would be much more powerful (think the guided navigation at your favorite ecommerce store with choices to narrow search by brand, price range, star rating, and type of gear - each of those is a facet).

      It's just math - a system with five facets with 10 choices in each facet gives 100,000 unique descriptions vs. having to write out hundreds of thousands of possibilities.

      For these healthcare codes, looking at facets like type of injury, location of injury, the activity involved

    • by gilleain (1310105)

      Wouldn't a tag based system be more effective than trying to exhaustively list 140,000 things? Or can each of these 140,000 be used in a combination?

      What if you walked into a lamp post, fell and hit your head on a turtle, it got angry and bit your ear?

      In fact, if you are a trumpeter at the opera, and a turtle bites you so that you walk into the scenery, which happens to be a lamppost...

  • by clonan (64380) on Wednesday September 14, 2011 @10:56AM (#37398870)

    I need to know in case a henchman falls into the tank...

    • by blueg3 (192743) on Wednesday September 14, 2011 @11:26AM (#37399294)

      W5649XA
      W902XXA

    • Re: (Score:3, Informative)

      by stubob (204064)

      W56.49 "Other encounter with shark" + W90.2 "Exposure to laser radiation" is all I've got.

    • I need to know in case a henchman falls into the tank...

      Dear Dr. Evil:

      Your recent Workman's Compensation claim has been returned to your office for further processing. We need additional information before we can later reject it out of hand. The description of a coworker falling into the shark tank needs to be clarified.

      Please describe whether the shark came in contact with coworker (ICD 10 CM code W56.42XA for initial contact, W56.49XD for any subsequent encounters), was actually bitten by the shark (W56.42XA initial bite, W56.41XD subsequent bites) or merely

      • Can anybody tell who's been to a recent ICD-10 coding seminar?

        • by Anomalyst (742352)
          What is the ICD-10 code for Seminar induced narcolepsy?
          • WICD10.01X for the initial nap, WICD10.01XA for subsequent, and since this seminar obviously included sharks, W56.42EXA for inability to find sharks exciting. In case of further symptoms related to W56.42EXA and related codings, consult the PDR to determine if the conditional is pathological, psychological, meteorological, or meta-logical.

            Cases where meta-logical stress induced psychological pathology is indicated should be admitted to trauma care within one hour to prevent further loss of cognitive faculti

            • by Anomalyst (742352)
              I assume taco bell bean burrito induced flatulence (whatever the code is for that) is cause for considering a posterior to be sinister?
  • by mat catastrophe (105256) on Wednesday September 14, 2011 @10:58AM (#37398892) Homepage

    ICD-9 had codes for masturbation.

    Go ahead and think about why I might know that. Scar yourselves.

    • No thanks, I'm not into self mutilation.

    • by wisty (1335733)

      Did you realize before or after you took the pen from the "lost and found" box?

  • by bigredradio (631970) on Wednesday September 14, 2011 @11:02AM (#37398926) Homepage Journal
    Why stop at 140,000? There are an infinite number of ways you can get hurt. I think that the most common injuries could be classified within the 18,000 codes. All other injuries should be labeled 'misc'. The additional cost and confusion out weighs the benefit. Once you open the door to classifying EVERY injury, you will get a lot of duplicates because of mistakes and misspellings. Code 999 = Hit by potato gun. Code 1256 = Injured shooting a potatoe gun.
  • Flaming Skis (Score:4, Interesting)

    by Jodka (520060) on Wednesday September 14, 2011 @11:04AM (#37398948)

    My favorites:

    V9107XA Burn due to water-skis on fire, initial encounter
    V9107XD Burn due to water-skis on fire, subsequent encounter
    V9107XS Burn due to water-skis on fire, sequela

  • by lobiusmoop (305328) on Wednesday September 14, 2011 @11:05AM (#37398968) Homepage

    "Bureaucracy expands to meet the needs of the expanding bureaucracy. "

  • Does it cover death from a blogging accident [xkcd.com]?
    • by Exitar (809068)

      It should, google gives 13,100 results for that, so I assume it is a quite common way of dying.

  • So would "Fell off balcony at opera" go under the same code as "Strained vocal chords at the opera"? Good grief. Your government in action.
    • by bws111 (1216812)

      Opera house is a place, not an injury or cause of injury. In both of your examples, the code for opera house would be used for the place of injury. There is nothing wrong with that. One of the injuries would also have 'broken left tibia' as the injury, and 'fall' as the reason for the injury. The other one of course would have different codes.

      The codes are just a language used to describe things so that computers can easily search, categorize, etc. Once computers that can understand 'fell off balcony a

  • by iggymanz (596061) on Wednesday September 14, 2011 @11:08AM (#37399014)

    Just to clarify, ICD-10 is maintained by the WHO. The clinical modifications to the ICD-10 in the USA are known as "US ICD-10 CM".
     
    Yes, they are very stupid

    I'm cranky about it because for one of my clients I design insurance adjudication and practice management systems.

    • by Registered Coward v2 (447531) on Wednesday September 14, 2011 @11:41AM (#37399520)

      Just to clarify, ICD-10 is maintained by the WHO. The clinical modifications to the ICD-10 in the USA are known as "US ICD-10 CM". Yes, they are very stupid

      However, from an epidemiological standpoint, having better information about the causes of health problems will allow better study of cause and effect relationships between wellness and disease, for example. Even if it is a pain to implement (there must be a code for that).

  • What if you are attacked at the opera by a trumpet-playing turtle hitting you with a lamp post? What about that shit, huh?

  • NPR did a segment on this yesterday. The best code was "Burned: skis on fire while water-skiing."

    If you've ever seen what a snapping turtle can do to a broomstick handle, the code for a turtle attack wouldn't surprise you in the least.

    • I don't know about you, but I for one am glad that someone is finally going to be holding those Macaws to account. Those bastards have had it too easy for too long.
  • One of my favorites is T63.192A: "Toxic effect of venom of other reptiles, intentional self-harm, initial encounter"

    But, as silly as these seem, there are already codes to cover the category in ICD-9. The turtle attack correlates to "Other specified injury caused by animal" excluding dogs, rats, snakes and lizards, etc. Similarly, "Accidents occurring in music hall" comes from the existing code "Accidents occurring in public building". So calm down with the government overreaching attitude that I'm sure wil

    • I know a medical coder and she thinks this is dumb. Most of her co-workers make enough mistakes trying to code to ICD-9. Trying to create a category for everything just means that coding will be slower with more mistakes. Never mind that the doctors and nurses frequently don't include all of the information that ICD-10 expects.

  • My EMS agency uses EMSCharts, and it's the same deal. Since they don't allow you to type in a MOI (mechanism of injury), they need to have pretty much anything you can imagine - including several due to injury by spacecraft, depending on whether it was on the launch pad, falling from the sky, exploding, or being worked on.

    Not surprising, it's just what happens when you try to pigeonhole every possible way that people injure themselves. They're too damn creative.

  • by damn_registrars (1103043) <damn.registrars@gmail.com> on Wednesday September 14, 2011 @11:39AM (#37399472) Homepage Journal
    While people are beating themselves silly to denounce this as "nanny state" or "government take-over of your life", they are missing how this is useful.

    This actually makes health care data more usable. They are setting in a standard ontology for records. It improves comparability across different parts of the country or parts of the population.

    To take the turtle example, previously if you were interested in turtle accidents, you may have needed to look under "reptile" "turtle" "tortoise" or maybe even just "animal". For that matter some people call snapping turtles just "snappers", which of course is also a kind of fish. Now with standard coding it is easier to find quickly who is being hurt by turtles, how often, when, and where.
    • The usefulness of the data depends on its accuracy.

      Part of my job is to write software that assists medical coders in selecting ICD-9 codes. Even with ICD-9, medical coders constantly use incorrect codes because nobody can absorb or know all of the possible distinctions. ICD-10 may be more precise, but that doesn't mean coders will KNOW about the new, more precise codes. They already often turn to a more generic code, rather than a more precise one, because they know the generic version already. So i
  • When I rewrote everything, I was delighted that my ICD1 code list (since it was a totally new instance, I got to restart all internal version number sequences) contained only one entry:

    1. living->hit() got called

    and hit() just took a hit_points argument. I felt pretty clever.

    I was surprised that everyone hated it. It turned out they wanted different damage types, so that magic missiles could bypass armor, some kinds of monsters could be resistant to fireballs, and so on. So I added a second option

  • Try it yourself. Think of something really dangerous, like skydiving... nope. Parachute? Nope. Cougar? Nada. Macaw? You bet!

  • ICD-10 has existed since the 80's - it is not "new", and it was not created by the laws, however it was modified heavily for the version (CM being implemented) ( Work on ICD-10 began in 1983 and was completed in 1992. - http://en.wikipedia.org/wiki/ICD-10 [wikipedia.org] / Draft Revisions were finished on ICD-10-CM in 2003 - http://en.wikipedia.org/wiki/ICD-CM [wikipedia.org] ) The laws have, however, mandated its implementation in the US by October 1, 2013 (preceded by HIPAA5010 no later than 01/01/2012), and with good reason I might add
  • Code W5929XA, W5929XD, W5929XS are for other contact with a turtle...

    Does that include STD's?

  • Laceration without foreign body of left cheek and temporomandibular area, initial encounter; Laceration without foreign body of left eyelid and periocular area, initial encounter; Laceration without foreign body of left hand, initial encounter;... I mean, *face palm*.
  • Probably
    W34: Discharge from other and unspecified firearms
    or
    X95: Assault by other and unspecified firearm discharge

    • Oops. Those are codes associated with potato guns.

      "Burn due to water skis on fire" is a natural consequence of the fact that
      a. Boats sometimes collide with each other, causing accidents.
      b. Marine fires can be very dangerous.
      c. Waterskis are a type of watercraft.

      Codes can be combined to give an epidemiologist some idea of what happened, and as with most codes, unlikely combinations can occur.

      It's no different than observing that English words are made up individual letters, so theoretically, "Xyzzy" could me

  • Now The Shredder gets a code for all the work related turtle injuries he's had to endure!
  • an enumeration has got to be the stupidiest, least usable, most 1950's card-deck kind of approach imaginable.

    not that other people (say, librarians or linguists) do a better job. but isn't this really the case where people with no computer experience are effectively designing programs? people with computer/applied-math backgrounds could make this work right.

FORTRAN is for pipe stress freaks and crystallography weenies.

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