ICD 10 finally recognizes the dangers inherent in diving !!!!

[boulderjohn]

Several years ago, I needed a surgery, and it was an expensive one. It was not an emergency, so I carefully scheduled it for late in a year in which I had had a number of medical issues, also with big bills. I did that because I had by then met my out of pocket maximum for my health insurance, meaning I would not have to pay a dime for it. The hospital got it all pre-approved, and I was ready to go. Everything went as planned. I went into the hospital in the morning, had the surgery, spent the night, and was released the next morning, exactly as it is always done for that surgery.

My insurance refused to pay anything, and I was sent a bill for the entire amount--about $145,000. (That is not a typo.) When I checked, I found out that the hospital employee who had gotten it pre-approved had entered the wrong code; she had entered it as an outpatient procedure, meaning I was not gong to spend the night. It was an obvious coding error, since patients getting this surgery always spend the night. Because the surgery was not what was pre-approved, the insurance refused to pay, even though they would have approved it had the correct code been entered. The hospital told me not to worry about it--it would all be negotiated.

Almost two years later the negotiations ended, and the insurance agreed to pay. When they did so, it was treated as if it were a new procedure. It was the beginning of the year. I had to pay thousands of dollars for my deductible, even though I would not have had to pay a cent if there had been no coding error.

So I guess coding errors do matter.

 

[doctormike]

It's actually not such a big deal at all. I have been doing my own coding without any trouble. It's actually easier now, from my experience...

Here, you can try it yourself: The Web's Free ICD-10-CM/PCS Medical Coding Reference

For extra fun, type "spacecraft" into the search box!

Sent from my iPhone using Tapatalk

 

[Craig66]

I would just like to meet the person who actually uses code: T63.512D (Toxic effect of contact with a stingray, INTENTIONAL self harm, SUBSEQUENT encounter - This is an individual that should get the Darwin award.

I agree that in practice attaching the correct code has not been as much as an issue but we are already starting to see denials for clearly appropriate care that is not matched to the code. Proponents of ICD 10 will tell you it is used the world over and that is true except that the rest of the world uses it as a epidemiological tool and not as a reimbursement tool.

 

[uncfnp]

I would just like to meet the person who actually uses code: T63.512D (Toxic effect of contact with a stingray, INTENTIONAL self harm, SUBSEQUENT encounter - This is an individual that should get the Darwin award.

I agree that in practice attaching the correct code has not been as much as an issue but we are already starting to see denials for clearly appropriate care that is not matched to the code. Proponents of ICD 10 will tell you it is used the world over and that is true except that the rest of the world uses it as a epidemiological tool and not as a reimbursement tool.

We haven't had our quarterly meeting yet so I have no idea what our success rate for collections has been.

 

[DocVikingo]

I would just like to meet the person who actually uses code: T63.512D (Toxic effect of contact with a stingray, INTENTIONAL self harm, SUBSEQUENT encounter.

Had Steve Irwin survived, he may eventually have qualified for that code.

Cheers,

DocVikingo

 

[tracydr]

It's actually not such a big deal at all. I have been doing my own coding without any trouble. It's actually easier now, from my experience...

Here, you can try it yourself: The Web's Free ICD-10-CM/PCS Medical Coding Reference

For extra fun, type "spacecraft" into the search box!

Sent from my iPhone using Tapatalk

I just started at the VA. The computer system is not very good and I've been finding it very difficult to search for codes. I'll give this a try next time I have an issue. The worst part is that with my complex,old patient population, recoding the old problem list into the new is taking a lot of extra time per chart. Many of these patients have 20+ issues on their problem list that I have to update.

 

[doctormike]

The reason why this isn't much use as a research tool is GIGO (garbage in, garbage out). If you are assembling a clinical database about a population for research purposes, you have a big incentive to accurately and thoroughly include any medical conditions that your study group has. But if you are required to code for insurance purposes, you are going to quickly figure out which codes work in general terms for reimbursement, and then just use those codes.

It doesn't change your actual medical care, and any busy clinician is going to figure out how to streamline this as soon as possible. You find codes that work, you put them on your coding form, and then you check them on and get on with things.

If you aren't being paid to be incredibly accurate with coding, and if you aren't trying to get good research results, and if it doesn't change the patient's care, why spend a lot of time obsessing over the fine differences between two codes which will both work?

Now I have a subspecialty surgical practice and I tend to see a fairly narrow range of conditions. Maybe it's different for primary care docs. But I think that this principal applies generally. Especially as more and more practices go to EMRs where this can be built in to some degree (I don't have that yet).

 

[uncfnp]

Here, you can try it yourself: The Web's Free ICD-10-CM/PCS Medical Coding Reference

For extra fun, type "spacecraft" into the search box!

Sent from my iPhone using Tapatalk

That is hilarious!

tracydr I have had fair success with this one. Dr Gily's ICD 10 CM and PCS Codes Lookup, ICD 10 Training and ICD 9-10 Crosswalk. Smartphone / tablet compatible.

---------- Post added November 21st, 2015 at 05:12 PM ----------

The reason why this isn't much use as a research tool is GIGO (garbage in, garbage out). If you are assembling a clinical database about a population for research purposes, you have a big incentive to accurately and thoroughly include any medical conditions that your study group has. But if you are required to code for insurance purposes, you are going to quickly figure out which codes work in general terms for reimbursement, and then just use those codes.

It doesn't change your actual medical care, and any busy clinician is going to figure out how to streamline this as soon as possible. You find codes that work, you put them on your coding form, and then you check them on and get on with things.

If you aren't being paid to be incredibly accurate with coding, and if you aren't trying to get good research results, and if it doesn't change the patient's care, why spend a lot of time obsessing over the fine differences between two codes which will both work?

Now I have a subspecialty surgical practice and I tend to see a fairly narrow range of conditions. Maybe it's different for primary care docs. But I think that this principal applies generally. Especially as more and more practices go to EMRs where this can be built in to some degree (I don't have that yet).

I work at an Urgent Care so probably a little broader range of codes but your theory is sound and sums of the process pretty well.

 

[DocVikingo]

It doesn't change your actual medical care, and any busy clinician is going to figure out how to streamline this as soon as possible. You find codes that work, you put them on your coding form, and then you check them on and get on with things.

If you aren't being paid to be incredibly accurate with coding, and if you aren't trying to get good research results, and if it doesn't change the patient's care, why spend a lot of time obsessing over the fine differences between two codes which will both work?

Amen, Brother Mike.

Cheers,

DocV

 

[doctormike]

That is hilarious!

tracydr I have had fair success with this one. Dr Gily's ICD 10 CM and PCS Codes Lookup, ICD 10 Training and ICD 9-10 Crosswalk. Smartphone / tablet compatible.

---------- Post added November 21st, 2015 at 05:12 PM ----------

I work at an Urgent Care so probably a little broader range of codes but your theory is sound and sums of the process pretty well.

The funny thing is that I'm a metadata freak for my genealogy research, my photography, my dive logs, etc... I spend a HUGE amount of time organizing and labeling things.

And maybe I'm just being cynical, perhaps some sort of conclusions actually can be drawn from the aggregate data that we are generating with this process. I figure that in 10 years when all clinical systems (labs, micro, radiology, path, etc..) are on a common backbone, and we are all using some sort of standard EMR, much of the coding that we deal with will sort of fade into the background. There will be some google style analytics that can read trends and patterns in the data, etc...

I remember being a resident when we were first told that we had to start coding procedures - it seemed so completely alien to all of our training...

I pride myself on not knowing any codes, though. I find doctors who do know a lot of codes to be kind of obsessed with billing, and that's usually not a good thing.