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."

Comments

Some turtle attack advice

[elrous0]

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

Re:Some turtle attack advice

[GameboyRMH]

Am I the only one who was immediately reminded of the hospital's "front desk control panel" in Idiocracy?

Re:Some turtle attack advice

[GameboyRMH]

Yeah you know they're going to have to add more codes anyways. They're not thinking ahead. Let me contribute some more:

Injured by industrial robot
Injured by robotic pet
Injured by sex robot
Amputation due to portal failure
Broken bones due to faulty fall impact absorbers
Jetpack crash
Flying car crash
Electric rollerblade crash

Good for insurance

[Spunkee]

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.

Re:Good for insurance

[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'?

Re:Good for insurance

[royallthefourth]

Doctor: "You wear skateboard pads to church?"

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

Re:Good for insurance

[limbodog]

The 25 or so other countries who use these codes already have not yet imploded.

Re:Good for insurance

[avandesande]

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.

Re:Good for insurance

[SleazyRidr]

This isn't Twitter, there's plenty of room to post the full URL here. Unless you're just trying to hide a Goatse link...

Re:Good for insurance

[chiguy]

Neither the government (Medicaid, Medicare) nor private insurance companies currently base payment on injury codes, so I'm not sure why you think they will begin to now.

Because the current ICD-9 codes do not have detailed causation. Here's what a billing looks like:

Fracture of lower limb (820–829)

        (820) Fracture of neck of femur
        (821) Fracture of other and unspecified parts of femur
        (822) Fracture of patella
        (823) Fracture of tibia and fibula
        (824) Fracture of ankle
        (825) Fracture of one or more tarsal and metatarsal bones
        (826) Fracture of one or more phalanges of foot
        (827) Other, multiple, and ill-defined fractures of lower limb
        (828) Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum
        (829) Fracture of unspecified bones

The injury is indicated. The cause is not.

But if you give insurance companies more information about the circumstances of injury, as you do in ICD-10, then you allow insurance companies the information to more finely deny coverage. So your insurance policies now state they will cover injuries except for those that occur on a list of dangerous activities.

And in case you think they wouldn't micromanage like that, a friend of mine was able to get insurance coverage but ANY injury to his left knee, which had an ACL repair done 20 years ago, would not be covered.

In an era where both public and private insurance is trying to save money, more reasons to deny coverage is sure to come out of this.

Re:Good for insurance

[jahudabudy]

ICD-9 DOES have detailed causation, although not nearly as detailed as ICD-10, it looks like. ICD-9 has "Coded Cause of Injury Codes", AKA "E Codes" (they all start with E). These are distinct from the Injury Diagnosis Codes, which you provided examples of above. For instance -> E029.2 - Rough Housing and Horseplay. Or E885.4 - Accidental fall from Snowboard. These seem to fit your criteria of plausibly deniable causes of injury, are currently available, yet aren't being used by insurance companies.

Re:Good for insurance

[Unkyjar]

Actually, this completely incorrect. Aetna, Blue Cross Blue Shield, Cigna, Humana, United Healthcare, and Unicare all base denials around injury codes.

Re:Good for insurance

[OldeTimeGeek]

In my experience, doctors don't look up anything. They write down what they did or what is needed for a referral and leave it up to their secretaries/receptionists to figure how to map it to the codes that the insurance companies use.

Re:Good for insurance

[bk2204]

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.

tag based system

[FunkyELF]

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?

Re:tag based system

[ColdWetDog]

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 is the code for burns via shark?

[clonan]

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

Re:What is the code for burns via shark?

[blueg3]

W5649XA
W902XXA

Re:What is the code for burns via shark?

[stubob]

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

Re:What is the code for burns via shark?

[ColdWetDog]

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 struck by the animal (W56.42XA initial, W56.42DX subsequent). If lasers were involved, please additionally code W90.2XXA (Exposure to laser radiation, initial encounter) or W90.2XXD (subsequent) as appropriate.

In reviewing previous similar claims, it appears that your employees have had similar issues with Sea Bass. Since a Sea Bass has a different code than a Shark, you would use W56.51XA (Bitten by fish, initial encounter) or W56.51DX (subsequent bites) or if the Sea Bass just hit the employee code as Other Contact with Fish (W56.59XA or XD as appropriate).

Of course, these codes exclude any poisonous Shark or Sea Bass. If this was noted, please contact the World Health Organization for further guidance.

We hope we may be of continued service to you.

Sincerely,

EvilOverlord Insurance Company
"More Evil than you could ever be"

Re:What is the code for burns via shark?

[ColdWetDog]

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

Re:What is the code for burns via shark?

[Anomalyst]

What is the ICD-10 code for Seminar induced narcolepsy?

Re:What is the code for burns via shark?

[SleazyRidr]

Wait, there's a genuine code for "Other encounter with shark"?

Re:What is the code for burns via shark?

[Lemmeoutada Collecti]

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 faculties and potential decrease in billable coding according to EMCR401-36 subsection ii(a).

If unable to determine the exact morphology of the shark, repeated cranial impact stimulation using a arboreal mesh imprinted with all potential ICD codes is required. Avoid stimulation of the frontal and prefrontal cortices unless patient displays negative reactions to application on the posterior sinister epidural surfaces.

If in doubt of final diagnosis, select all available codes and notify the patient's HMO, secondary insurance provider, preferred mortician, and nearest organ donor collection facility. Ensure that the patients organ donor card is completed properly to ensure prompt and accurate payment for donated organs.

Re:What is the code for burns via shark?

[Anomalyst]

I assume taco bell bean burrito induced flatulence (whatever the code is for that) is cause for considering a posterior to be sinister?

Re:What is the code for burns via shark?

[Alsee]

Just to expand on that, I looked up the full titles for those codes:
W5649xA Other contact with shark, initial encounter
W902xxA Exposure to laser radiation, initial encounter

-

Re:What is the code for burns via shark?

[tivoKlr]

There'll always be "other" no matter how many codes the ICD contains.

This isn't really interesting

[mat catastrophe]

ICD-9 had codes for masturbation.

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

Why stop at 140,000?

[bigredradio]

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

[Jodka]

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

Re:Flaming Skis

[icebraining]

Yet countries with real government health systems like those here in Europe have often less restrictions on such things (where I live consuming drugs - any drugs - is not a crime, for example).

So, how does this fit in that view?

Oblig. Oscar Wilde

[lobiusmoop]

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

U.S. ICD-10 CM not the ICD-10

[iggymanz]

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.

Re:U.S. ICD-10 CM not the ICD-10

[Registered Coward v2]

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).

Relevant

[stubob]

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.

Re:How does it actually work?

[Tridus]

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.

Re:Make it simple

[SydShamino]

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.

Re:Make it simple

[tepples]

It depends on who was smoking the cigarettes.

This is actually a good thing...

[damn_registrars]

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.

Re:This is actually a good thing...

[tazan]

The first issue is they've gone to a level of detail where there are an infinite number of possible reasons, but they only have 140,000 different code. Sometimes there will be a code that fits exactly. It seems more likely though that there will be several that are close but nothing exactly right. Secondly the chances of finding the exactly correct code out of 140,000 codes in a reasonable length of time seems pretty small. And finally the person entering the data most likely does not care how accurate it is, they just want to get something entered and move on. They aren't going to spend 5 minutes looking for a code. In theory the resulting data would be very useful for someone I'm sure. In practice I suspect it will be the opposite.

Re:This is actually a good thing...

[Tony Isaac]

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 increased precision does not necessarily lead to better--or more useful--data.

"From the government"??

[count0]

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.

ICD-10 is not "New"

[DiabolicallyRandom]

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.

Re:Make it simple

[i kan reed]

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.

Re:How does it actually work?

[Jeremy Erwin]

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

Re:Make it simple

[kenj0418]

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.

Re:Make it simple

[skids]

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.
.

Re:Make it simple

[Xacid]

Well I'll be... http://www.seaturtle.org/mtn/archives/mtn117/mtn117p10.shtml