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ICD-10 Day . . . Will the World End as Predicted?


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We have been "practicing" on ICD10 for the past few weeks and not using 9 at all.

Our EMR is not terribly smart, though. 

If you are entering a Problem List and search - you get 100% different results than if you search for a Dx while writing an Rx.

The sections of the EMR do not match or search the same database. Unbelievably frustrating.

One area of EMR knows "fibroids" while the other area ONLY knows Leiomyoma.

 

I have always correlated ICD10 to the boardgame Clue.

It was Colonel Mustard in the Kitchen with the Stove.............

On a Tuesday, in an even numbered month, during a full moon with his right hand not wearing a glove.....

 

For the Love of All that is Holy - he has a head lac on his left temple from hitting the stove!

 

Pretty soon - the government will decide Stoves are dangerous and outlaw them or black label them for consumer use only after a training course.

 

Yep, it is that kind of day around here.......................

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Yet another hoop to jump through...and yet another distraction for clinicians (cause we don't have enough administrative mandates already!)

Seems like the perfect day to share some of the most  bizarre codes ICD-10.

It's entertaining reading until you think about the fact that this is reality for us.

http://www.poweryourpractice.com/revenue-cycle-management/the-most-bizarre-icd-10-code-awards/http://www.poweryourpractice.com/revenue-cycle-management/the-most-bizarre-icd-10-code-awards/

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A follow up question.  Healthcare is on an unsustainable path right now . . . how will this end? I just worked one month, (50+ hours per week) for free, didn't pay myself one cent. I just laid off, yesterday two full time employees.  Our schedule has always been 90-110% full.  We wrote off 67% of our billings last year.  My billing, before I started to farm it out, was taking two people working 40 hour per week each just to fight with insurance companies over my billing alone.  I am for a single payor system.  I dream of a cash only and am moving in that direction.

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A follow up question.  Healthcare is on an unsustainable path right now . . . how will this end? I just worked one month, (50+ hours per week) for free, didn't pay myself one cent. I just laid off, yesterday two full time employees.  Our schedule has always been 90-110% full.  We wrote off 67% of our billings last year.  My billing, before I started to farm it out, was taking two people working 40 hour per week each just to fight with insurance companies over my billing alone.  I am for a single payor system.  I dream of a cash only and am moving in that direction.

 

 

I don't see how you wrote off 67% of your billing and still have your doors open.  

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We were billing with ICD10 codes for at least this last month of my fellowship and I had no issues with it.  Then again I don't have to worry about much being in a big hospital system.  The folks in the hospital doing chart reviews will message me with any clarifications that are needed in the notes, i.e. sepsis vs. severe sepsis.  The billers will change the coding if needed.

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I don't see how you wrote off 67% of your billing and still have your doors open.  

Understand that this is first insurance part only and the 67% write off is 67% off our (previously) published prices.  If we charged $1,000,000 for visits, we would have a 99% write off. We had made our prices reasonable and the insurance companies, including all the denials, equaled last year to 43% payment. It is very hard to keep our doors open like this. People who don't run a medical practice assumes that we are doing something wrong. We are not and this is the new reality. I have been through four billers and the last one was great. The game now is that 90% of all errors are done by the insurance companies. But when they make an error, they don't pay you and that is not one damn thing you can do about it . . . unless we band together and do a class action law suit.  No other business, I know of, is rewarded for the mistakes they make.

 

Our cash paying patients (20% of the practice) have paid 70% of their balances.  We are pushing towards 100% with immediate cash at time of service and keeping a back up credit card number, if the first one they gave us was eventually declined and sent back.  The cash paying patients have kept us afloat and we are moving in that direction but it is really hard to do in a rural area.  We are trying to move more aggressively into the Seattle and Vancouver, BC markets.

 

If a typical practice converts to cash only, they will immediately loose 80% + of their patient panel.  People in the US have traditionally had "free" (insuranced covered) healthcare and it is hard for most to think outside of that box.

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I was also baffled by the instance of folks being hit by space debris and the ever present problem of clothing on fire. That is all taken care of now…. Man, will I sleep better…...

 

How will you code patients struck by a meteorite? Does "space debris" cover both natural and man-made debris?

 

http://news.nationalgeographic.com/news/2013/02/130220-russia-meteorite-ann-hodges-science-space-hit/

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also hard to code for a bee sting, but not "toxic effect, cobra venom", the first thing that populates in our emr when you type "sting". also "walking corpse syndrome" no longer a problem to code for.....seriously....

Walking corpse syndrome is for those who watch Night of the Living Dead and then become addicted to the movie and corpse programs. 

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I found this awesome collection of nonsense. 

I am still struggling to find the code for Social Anxiety as opposed to the 48 other absurd descriptions of anxiety including anxiety induced by inhaled hallucinogen. 

 

Enjoy!

 

16. V97.33XD: Sucked into jet engine, subsequent encounter. 

Sucked into a jet engine, survived, then sucked in again? First of all, that really, really sucks. Second of all, this patient is obviously Wolverine, and should be detained for imaging and posterity. 

(Technically, this means "subsequent encounter with a physician" not "subsequent encounter with a jet engine," but that's less dramatic.)

15. W51.XXXA: Accidental striking against or bumped into by another person, sequela. 

The "sequela" here implies the kind of human bumper cars that can only happen at a music festival, the subway or possibly an active combat zone. Potentially fatal for agoraphobics. Recommend handling with care. 

14. V00.01XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter.

First, are roller skates even still a thing anymore? I mean, other than how one knows spring has sprung in Central Park? Second, can you call a person on roller skates a pedestrian? Thirdly, if the answers to one and two are "yes," then these things should be outlawed, because they are obviously dangerous. 

13. Y93.D: Activities involved arts and handcrafts. 

Camp is a dangerous thing. Hot glue guns and knitting needles definitely wouldn't be allowed on a plane, yet we habitually allow 7-year-olds to play with them. This is a public health crisis that needs to be addressed. 

12.Z99.89: Dependence on enabling machines and devices, not elsewhere classified.

There's a reason they call it the Crackberry. This is an obsolete joke, but there just isn't an iPhone pun that can compete with "crackberry."

11. Y92.146: Swimming-pool of prison as the place of occurrence of the external cause.

There is also a code for "day spa of prison as the place of occurrence."

10. S10.87XA: Other superficial bite of other specified part of neck, initial encounter.

Alright, people. Let's call a spade a spade. "Other superficial bite of other specified part of the neck?" This is a hickey. Admit it. Although why anyone would be admitted for that remains a mystery. 

8. W61.62XD: Struck by duck, subsequent encounter.

tweet this quotetwitter_mini.png 9. W55.41XA: Bitten by pig, initial encounter​.

First, be sure that the patient is restrained from doing whatever he or she may have done to provoke the pig in the first place. Security should be placed on alert. Also, what was this person doing in a farm setting in the first place? Pigs are not pets. 

8. W61.62XD: Struck by duck, subsequent encounter.

Maladies that rhyme should be given immediately priority in the ER. Ducks, like most water fowl, are mean-spirited animals and this case should be treated with the utmost urgency as it is likely to be a serious injury. 

7. Z63.1: Problems in relationship with in-laws. 

Who doesn't? 

​​6. W220.2XD: Walked into lamppost, subsequent encounter. 

No. No. People. You only get to do this once. ONCE. If a patient is going around whacking into lampposts regularly, there is a deeper problem here, and he should be referred to psych immediately. 

5. Y93.D: V91.07XD: Burn due to water-skis on fire, subsequent encounter​.

How does this happen? Are water skis even flammable? 

4. W55.29XA: Other contact with cow, subsequent encounter.

"Other contact with cow." OTHER CONTACT WITH COW? There are codes for "bitten by cow" and "kicked by cow." What else is there?! What, precisely, is the contact with the cow that has necessitated a hospital visit?!

3. W22.02XD: V95.43XS: Spacecraft collision injuring occupant, sequela

The existence of this type of code does not engender trust in the National Aeronautics and Space Administration. Shouldn't they have more control over their spacecraft than that? Or are they just careening around in the ether, pinging into one another and injuring occupants/astronauts? 

2. W61.12XA: Struck by macaw, initial encounter.  ​

Macaws are endangeredsome are extinct in the wildso if a patient has been struck by a macaw, chances are, it was the patient's fault. Consider calling the SPCA and/or the police. The macaw needs to be found and treated immediately. 

​1. R46.1: Bizarre personal appearance. 

LADY GAGA, IS THAT YOU? WE LOVE YOUR MEAT SUIT. 

But seriously, who gets to decide what constitutes "bizarre personal appearance"? Let the people do what they want! 

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