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Medical Billing Codes For Injury Via Turtle Among Thousands Created by New Law
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."
The obvious temptation is to run, but that would be a mistake. NEVER show a turtle your fear.
SJW: Someone who has run out of real oppression, and has to fake it.
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.
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?
I need to know in case a henchman falls into the tank...
ICD-9 had codes for masturbation.
Go ahead and think about why I might know that. Scar yourselves.
sig not found
I assume "Struck by turtle" is an indicator of being hit by a turtle shell thrown by a fat Italian man named Mario
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.
Flexible bare-metal recovery for Linux/UNIX
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
Ceci n'est pas une signature.
You're magnetic ink
For justice, we must go to Don Corleone
"Bureaucracy expands to meet the needs of the expanding bureaucracy. "
"I bless every day that I continue to live, for every day is pure profit."
Does it cover death from a blogging accident?
I eat only the real part of complex carbohydrates.
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.
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.
Now does this cover all turtle attacks, or only specific kinds of turtles? Are there subcodes for teenage turtles or mutant turtles or, heaven help us, ninja turtles?
What if you are attacked at the opera by a trumpet-playing turtle hitting you with a lamp post? What about that shit, huh?
To start with, the ICD-10 codes were not developed by any federal agency, ICD codes are developed by the World Health Organization, part of the UN. The federal government has finally mandated that ICD-10 be used in the United States. The US is the only country still using ICD-9, everyone else has already moved to ICD-10 which was released 12 years ago. The release date of ICD-11 was announced earlier this year, so by forcing the change at least we'll maintain our status of only being one version behind the rest of the world.
Complete nonsense. Rather than mod you down, I'd just like to point out that natural circumstance can and frequently does circumvent any level of planning or recklessness engaged in by people. You CAN be severely injured by a lightning strike from a clear sky. Not every injury can be blamed on a lack of responsibility,
Moreover, the importance of classifying injuries goes beyond insurance, and doctors can use these codes to help identify specialties that are applicable to a patient.
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.
If a pig walks by Castle Dracula on a Tuesday playing a banjo, what code is used if you get killed because Dracula bit you?
I put my books on Amazon, Smashwords, Demonoid, ISOHunt and Pirate Bay. Search for 'Michael Cargill'
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 will prevail in this thread. Being able to say "Other contact with turtle, initial encounter" versus "Other contact with turtle, subsequent encounter" may seem unnecessary, but to medical coders, it's not.
Planning to be moderated ± 1: Bad Pun.
We're talking about bureaucrats here. They never think about details like that.
I've dealt with similar nonsense when buliding systems before. Seven pages of codes to classify a file, most of which never get used because it was far too complicated for the users to figure out... and they don't think it's specific enough.
And I say that as a government employee. This type of nonsense goes on all the time.
-- "So they told me that using the download page to download something was not something they anticipated." - Bill Gates
And in other news, all accidents are caused by code 1 - Unknown Accident.
I had cancer, which of your two tags covers that?
It will be interesting to see whether the codes are used. They're intended to provide useful data granularity, but even the current codes are underused. The psychologists I have worked with all used a diagnosis of something like "non-specific mood disorder" to protect patient privacy rather than giving the insurance company a more specific code with details that might possibly leak back to the patient's boss in some way.
"Who controls the past controls the future. Who controls the present controls the past." -- George Orwell
There are people who believe that, if something bad happens to someone, then that person did something to deserve it. The action to "earn" punishment might be reckless behavior, or the punishment could be divine retribution, but either way bad things only happen to bad people.
For that type of people, it's a justification for their belief that no one ever deserves a safety net in case all else fails. You might find that this drives certain political views.
It doesn't hurt to be nice.
The law is not creating any codes. ICD-10 codes were created back in the early 90s and have been in use by countries other than the USA since the late 90s. But Medicare hasn't been eager to adopt anything that would require they change their software, so the USA sat on it's butt with the ICD-9 codes for the duration. ICD-10 does indeed give lots more detail. And while some of it is ridiculous sounding, the vast majority provides levels of detail that the insurers have been wanting, but the health care providers have had no mechanism to send. (bear in mind that the HIPAA law requires almost all providers use EDI electronic commerce for sending health care claims, so they've been on a standardized format for years) ICD-9 isn't up to the task. ICD-10 goes above and beyond. There will definitely be some issues (I'm seeing them already on some of my projects at an insurance company) as we figure out how to process claims when we receive a lamp-post-injury code etc. But we'll get there. As for costs. Will it increase costs? Yeah, in the short term. But it's got to happen. We're paying more now for not having it, we'll have to pay a bit more to adopt it, and then it is to be hoped that having it (ICD-10, that is) will eventually reduce some costs. How? Because the claims that get denied because the person shouldn't have been covered that is successfully communicated by the ICD-10 codes means that everyone else doesn't have to pick up the tab for that person who is setting his skiis on fire while being attacked by a bird with a lamp post. Trust me, you want payments to be as accurate as possible.
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.
I have developed a truly marvelous proof of this comment, which this signature is too narrow to contain.
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, the object involved (turtle or otherwise) etc. would give far better coverage with less complexity.
cz
People don't understand how fast a snapping turtle can move, how far it can stretch out or the biting force.
They assume all turtles are harmless, that is until they are bit by one. Just some stats, they can whip their head around quickly, extend it approximately 75% the length of their body and can snap a broom stick in half with their bite.
=================
Unix is very user friendly, it's just picky about who its friends are.
I'll be the ridiculous poster who has an actual encounter with a turtle. Getting tossed about by the waves two weekends ago in Maryland, I feel sharp pain and scratching at my shins. There were no trees or branches anywhere on the beach, so I think maybe it's a crab (it is Maryland after all). As I kick to get away from the object, I feel more nipping at my ankles. My crab theory is shot to hell as I see the brown shell about 16" in diameter surface a few feet in front of me. I feel ridiculous as I tell the story when my friends ask me about the blood streaming from my shins and ankle. Had this "attack" been any worse. I may have needed this code after all. (I duck and take cover as I see clumps of vitriol and ridicule coming my way already...)
"Now, I doubt any of you would prefer a rolled up newspaper as a weapon against a dictator or a criminal intruder."
It depends on who was smoking the cigarettes.
Insurance agents?
Was it an accident?
Then you got cancer on purpose! No coverage for you!
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.
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
T124.1.17.ZZ.Plural-Z.Alpha: Intentional self-harm injury sustained to left head in booth 24 at Eccentrica Gallumbits Spa and Saunas, hit in the head with a gold brick wrapped in a slice of lemon.
ID 10 T injury.
Hello year 2011!! This is 1990 calling, we want our news back!
ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990. Who would have thought that Americans were going to take soo long to get with the program.
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 optional parameter (which, if not passed, defaulted to blunt force trauma) for damage type. Then there was a list of defined constants for the damage type. It started out a short list
(Around the time we added werewolves, I realized I should have used an enum.) But people kept adding new things. Now that list of constant is up to 140000 entries. You can't ever really fix the problem, so please give our federal agencies some slack.
"Believe me!" -- Donald Trump
Not all cancer comes from cigarette exposure. So tags 1 and 2 still don't apply.
I'm sure there is a code for that.
Faster! Faster! Faster would be better!
Exactly how to you talk to the government? Are you talking with policy experts? Politicians? Government healthcare researchers? Government funded healthcare workers? In what capacity? What jurisdiction? What department?
I know that for most people, government is government is government. That's cool - government is at its best when it just takes care of things so well you don't notice it (rare but possible).
But if you're going to make a claim that the government intentionally plans for a 2-3 year period where hospital care is nearly impossible to get (and as a result thousands of people die) then you need to have a little more specificity than "I've heard from the government".
Something you may have heard from the health policy side: With the demographic curve of aging boomers, Western healthcare systems will have to become incredibly efficient in the next couple decades to keep the same level of care (older people need more care, we have more older people...). If we don't get those efficiencies, then we will likely see a period where hospital care is more difficult to get because of those increased pressures on the system.
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 / Draft Revisions were finished on ICD-10-CM in 2003 - http://en.wikipedia.org/wiki/ICD-CM ) 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. Its just a flying shame it has taken this long to get around to being mandated - it was originally slated to be implemented by October 1, 2010 - but the healthcare lobby didn't want to spend all the money up-front to adapt, and so they delayed it.
For those implementing it, it is a major PITA - but in the end it will result in better, more efficient medical billing and information exchange. This is a Good Thing (TM) - It should go a long way to help avoid things like this: http://science.slashdot.org/story/09/08/26/2316210/VA-Mistakenly-Tells-Vets-They-Have-Fatal-Illness
For clarification, ICD-10 proper has been in use in the US already for some time, since 1999, but only for mortality reporting, not billing/procedure detail, etc.
Full Disclosure: I work for a major regional health carrier on adopting full HIPAA 5010 and ICD-10/ICD-10-CM support.
It would be more accurate to say:
Bad things can happen to anyone. The probability of a bad thing happening is proportional to the risky behavior exhibited by the subject. For example there have been cases of people being struck by lightning 10 miles away from a thunderstorm in this case the victim perceived that there was clear sky above. However the probability of that happening is significantly lower than the probability of a groin injury happening to a person who likes to skateboard on hand rails.
So you are both right.
These comments are my own and do not necessarily reflect the views or opinions of my employer or colleagues...
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
Tag 3: God was being stupid and/or reckless.
Now The Shredder gets a code for all the work related turtle injuries he's had to endure!
"Quote me as saying I was mis-quoted." -Groucho Marx
It's your own fault for being born in Hinkley.
I just learned about this kind of injury recently. Apparently sea turtle rape of scuba divers is a not-as-uncommon-as-you-might-think issue, with drowning, compression/decompression sickness, and trauma being common effects, as sea turtles will force divers to the bottom of the ocean and hold them their for as much as an hour. Without being an expert myself, I'd wager cardio-respritory care would be needed in addition to trauma treatment.
This post is not intended to be humorous, this is an actual, serious issue I learned about with loggerhead turtles recently.
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.
So what's the code indicating "nipple bitten off by a beaver?"
Specialization is for insects. - R.A.H.
The medical billing people have this obsession with "codes", because they're designing for paper-based systems. This sort of info ought to be collected with something where someone clicks on a body outline to show where the injuries are, and then there's additional info for "how serious" and "source of injury". For the last part, it's probably only worth collecting info for the top 20 or so causes (autos, guns, falls, etc.) Allow for a narrative description for unusual cases, and send those to a call center for detailed coding.
This is all time that could have been spent making a healthcare system that doesn't suck
Spacecraft: http://graphicsweb.wsj.com/documents/MEDICALCODES0911/#term=spacecraft
Nuclear Weapons: http://graphicsweb.wsj.com/documents/MEDICALCODES0911/#term=nuclear+weapon
3 pages of alcohol: http://graphicsweb.wsj.com/documents/MEDICALCODES0911/#term=alcohol including "Blood alcohol level of 240 mg/100 ml or more"
Primary Thunderclap Headache??? : http://graphicsweb.wsj.com/documents/MEDICALCODES0911/#term=clap
Contact with hot toaster (as opposed to being hit over the head with a cold toaster, I aasume): http://graphicsweb.wsj.com/documents/MEDICALCODES0911/#term=toast
"War operations involving destruction of aircraft due to accidental detonation of onboard munitions and explosives, civilian, subsequent encounter"
"Sexual harassment on the job"
The mind boggles...
Tiller's Rule: Never use a word in written form that you've only heard and never read. You will end up looking foolish.
Does anyone know if it is just a flat list? Or is it an OWL-DL ontology? Or something else?
I believe you start with the most general, such as
C Malignant Neoplasms
and add details
C71 Malignant neoplasm of brain
C71.4 Malignant neoplasm of brain, Occipital lobe
that the undoubtedly overworked, underpaid staffers tasked to 'fill in the blanks' have the time to look up such minutiae.
Y92146
Swimming-pool of prison as the place of occurrence of the external cause
how many swimming pools in prisons anyway?
every day http://en.wikipedia.org/wiki/Special:Random
Years ago I read an account by a British Army officer of his days leading a band of native guerrillas in attacks on the Japanese in Burma. They got all their supplies by airdrop, and had to grab the stuff and beat feet in a hurry because the airdrop would alert the enemy. Once in a while a man would be injured trying to catch a package, and one man was killed by a crate of canned pineapples.
He invented a new cause code for deaths and injuries in his logs: DFF, for Death by Flying Fruit.
rj
What he wanted to say was this: Was sailing SSW at position 33 degrees N 72 degrees W. First mate, who you may recall was appointed in New Guinea against my wishes and is probably a head-hunter, indicated by signs that something was amiss. It appears that quite a vast expanse of seabed has risen up in the night. It contains a large number of buildings, many of which appear pyramid-like in structure. We are aground in the courtyard of one of these. There are some rather unpleasant statues. Amiable old men in long robes and diving helmets have come aboard the ship and are mingling happily with the passengers, who think we organized this. Please advise.
His questing finger moved slowly down the page, and stopped. Good old International Maritime Codes. They'd been devised eighty years before, but the men in those days had really thought hard about the kind of perils that might possibly be encountered on the deep. He picked up his pen and wrote down: "XXXV QVVX." Translated, it meant: "Have found Lost Continent of Atlantis. High Priest just won quoits contest."
in Good Omens, by Neil Gaiman & Terry Pratchett.
Might be interesting reading. Particularly the object X lodged in orifice Y subgroup. Or RSI injuries.
Have gnu, will travel.
Are we really getting our tax dollars worth with this new upgrade? There seems to be nothing related to hamsters there.
Wow, I wonder how health care got to expensive in this country. Oh wait, that's how. Every penny spent on this was a waste.
1.5: Invest the premiums in various financial vehicles
For example, Cigna had a net income of 1.3 billion last year, helped out by a net investment income of 1.1 billion.
You CAN be severely injured by a lightning strike from a clear sky.
Hmm, let me check my list:
S444.11 Smote - Fire, Pillar from sky
S444.12 Smote - Fire, Spontaneous Combustion
S444.2 Smote - Salt, Transformation into pillar
S444.3 Smote - Lightning
Ahh, there it is.
Citation needed.... can't find it in the list
The Wikipedia code tables are rather incomplete. icd10madeeasy.com appears to have complete listings.
Under the old ICD9 system:
V692 High-risk sexual behavr
Under the new ICD10 system:
Z725 High risk sexual behavior
Z7251 High risk heterosexual behavior
Z7252 High risk homosexual behavior
Z7253 High risk bisexual behavior
-
- - You can't take something off the Internet! That's like trying to take pee out of a swimming pool.
It all makes sense once one understands the coding scheme:
V91.07XS
The first three characters are the type of water transport accident that caused the injury:
V90 Drowning and submersion due to accident to watercraft
V91 Other injury due to accident to watercraft
V92 Drowning and submersion due to accident on board watercraft, without accident to watercraft
V93 Other injury due to accident on board watercraft, without accident to watercraft
V94 Other and unspecified water transport accidents
Next there is a sub-code that further categorizes the incident:
V91.0 - Burn due to watercraft on fire ...
V91.1 - Crushed between watercraft and other watercraft or other object due to collision
V91.2 - Fall due to collision between watercraft and other watercraft or other object
After that is a code that identifies the type of water craft:
0 - Merchant ship
1 - Passenger ship
2 - Fishing boat
3 - Other powered watercraft
4 - Sailboat
5 - Canoe or kayak
6 - Inflatable craft (nonpowered)
7 - Water-skis
8 - Other unpowered watercraft
9 - Unspecified watercraft
And then the following 2 character code:
XA - Initial Encounter
XD - Subsequent Encounter
XS - Sequela
One can then combine what is needed in a systematic way. The confusion comes when they are blindly enumerated to generate every possible combination. Some combinations will not make sense but that is just a side affect of not specifying the water craft and encounter type individually for every sub-code. For instance 'water-skis' is perfectly reasonable for other sub-codes such as:
V91.2 - Fall due to collision between watercraft and other watercraft or other object
The probability of a bad thing happening is proportional to the risky behavior exhibited by the subject.
More like "the probability of a bad thing happening contains a term which is proportional to risk behavior exhibited by the subject." No amount of risky behavior is going to affect your chances of being hit by an uncharted meteor.
.
Someone had to do it.
How long do you think its going to take the insurance companies to start raising rates for "stupid" people? At which point people will start lying to their doctors to avoid increased premiums (or just the embarrassment), thus reducing the effectiveness of care, increasing the duration of care, and probably increasing costs.
I don't think Insurance companies need to know how people are injured or become sick.
We do this, specifically I program and design PACS (Radiology) and EMR systems that use various coded sets. What's really interesting about the "water skis" thing people caught on NPR is that in reality there are 61 specific codes involving 'skis' alone, and that's just in English. Within the full subset of the Metathesaurus we use, there are in excess of 4M interacting concepts, and with the entire set there are over 400M interacting concepts. To make things even more complex, CPT, ICD-10, SNOMED-CT, and others all have to be made relational such that an injury related to "water skis on fire" has subrelational codes for the skis (material), what the patient was doing (observational), and what a role (doctor) does about it (procedural) before it can be billed to insurance, a process that (even electronically) takes up to 30 days and 20 revised submissions. This is PER BILLING STATEMENT. You have to be a special kind of warped to get into this (I, for instance, started as a DBA...). All this said, the whole of the codesets actually can describe pretty much anything in reality, starting with the semantics of the subject and trickling down to the price of each material and service consumed. It's pretty complex, but it's truly challenging, and beats the hell out of coding drudgery based projects by a long shot.
Imagination is the silver lining of Intelligence.
Supposedly the ancient Greek poet Aeschylus was killed by a tortoise dropped from a great height, so maybe that one's not so far-fetched. NB: the summary says "attacked BY a turtle", however the actual article includes the codes for "attacked WITH a turtle" - quite a difference - especially to a certain ancient Greek poet . . . the creepy ones are for "Other contact with a turtle". I dare not even speculate on what that "Other contact" might be . . .
Do they have a code for Nerd Rage?
Statistically, some percentage of people who try something "risky" will fail. Is it the fault of those people that they fail? Sometimes, maybe, but not every time.
And sometimes bad things happen to people who did nothing risky, or at least riskier than living and breathing within the means afforded them by their parentage and intelligence.
This is why I believe in a social safety net.
It doesn't hurt to be nice.
My opinion was concurring, not dissenting. I did agree with him.
It doesn't hurt to be nice.
You've run out of coffee! T43616A Underdosing of caffeine, initial encounter T43616D Underdosing of caffeine, subsequent encounter T43616S Underdosing of caffeine, sequela
For example, if someone breaks their leg, why does it matter if the leg was broken by a fall from a ladder, someone beating them up and stealing their wallet, a turtle bite, stepping on a land mine or whatever else?
A broken leg is a broken leg and the only thing that should matter is which leg is broken, how badly broken it is and what the correct treatment for that particular broken leg is.
Well I'll be... http://www.seaturtle.org/mtn/archives/mtn117/mtn117p10.shtml
Wow, can you imagine if a loved one was raped to death by a sea turtle. I mean, I don't care how somber you are, if someone looks at you all serious and they're like, "My Dad was raped to death by a sea turtle," you're not going to be able to stop yourself before at least a little giggle escapes.
The world you experience is only a close approximation of reality.
Okay. I was agreeing with you both. I was just clarifying your point. Sometimes intent is hard to express using forums.
These comments are my own and do not necessarily reflect the views or opinions of my employer or colleagues...
So do I. A certain political party preaches pulling one's self up by the boot strap. This would imply that they are encouraging people to assume risk for a potential payoff. It seems illogical that they would encourage people to be entrepreneurs or investors while removing these social safety nets. It's as if they are just catering to the ones who already took the risk and succeeded or are descendants of robber-barons at the expense of future new wealth.
These comments are my own and do not necessarily reflect the views or opinions of my employer or colleagues...