Monday, December 24, 2012

Twelve Codes of Christmas: On the Twelfth Day of the Coder's Christmas (F42)

Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells, Jingle Bells!!!

  • F42, Obsessive-compulsive disorder

Happy Holidays!!!

Sunday, December 23, 2012

Twelve Codes of Christmas:On the Eleventh Day of the Coder's Christmas (F60.2)

Yep. You guessed it.  Another animal picture.  This is the last one, though.  I think.

Pets are better than TV and in since the news is so depressing lately, I highly suggest turning the tube off and tuning in to the closest animal.  It's even better when you have a camera.

This little picture was captured one Christmas when I was snapping pictures of my Christmas decorations - something I often do to either remember how I decorated or to keep a record of Christmases past since I have a tendency to change decor colors every couple of years.  Yes, I'm one of those.  But I think I've already mentioned my affinity for Christmas decorations.

This is a picture of my sweet kitty, Mandy, pondering pouncing on Ginger, the dog.  Ginger was raised by cats and actually liked cats better than dogs.  So the cats pretty much had the rule of the roost and there wasn't a lot Ginger ever did about it.  But this picture looks a little sinister, so here's our carol and code for this eleventh day of the coder's Christmas:
  • Thoughts of Roasting You on an Open Fire (F60.2, Antisocial personality disorder)

Saturday, December 22, 2012

Twelve Codes of Christmas: On the Tenth Day of the Coder's Christmas (Y93.G3)

Today is baking day.  I haven't had a lot of time in the last few years to do any holiday baking, but I decided to take a day to get some goodies baked up for "dessert" on Christmas Day.  We'll see how many of these cookies make it all the way until Tuesday.

There will be my mom's famous cut-out cookies, which are now my famous cut-out cookies - the recipe having been stolen by a homemaker friend with a passion for decorating cookies.  The true secret to the cookies is to roll them out using confectioners sugar instead of flour (diabetics beware!). 

There will be molasses cookies from a family gingersnap recipe.  What makes them molasses cookies instead of gingersnaps, is an airtight container and a slice or two of fresh bread.  The cookies absorb the moisture from the bread leaving a super soft and spicy treat. 

There will be Mexican wedding cookies.  But we never called them that growing up - we called them Grandmother Stanton's horseshoe cookies for their shape and the fact that I had never had this cookie anywhere else before.

And there will be oven mitts.  Lots of oven mitts. I've been a baker since I was a little girl - my mom and I used to bake around Christmas time and by the time I was a teenager, the job was all mine.  And even though I am no stranger to cooking or baking and I know my way around a kitchen pretty well, I burn myself at least once or twice a year while taking something out of the oven.  It's so bad, my boyfriend has quipped that he's going to get me welding gloves for Christmas. 

So today I'm going off script and taking a break from the Christmas Carols for the Psychologically Challenged to bring you this occasion-appropriate activity code:
  • Y93.G3, Activity, cooking and baking
If you are tackling this same task today, be sure to watch out for those hot ovens!

Friday, December 21, 2012

Twelve Codes of Christmas: On the Ninth Day of the Coder's Christmas (F90.0)

Today is my last work day before Christmas.

I have Christmas baking to do.

I have shopping to do for Christmas dinner.

I can't wait to see family - both those from in town and from out of town.

Don't you love this time of year?

Don't you feel like a little kid again as the clock ticks down to 5:00?

Maybe I'll get off early today.

I wonder if it will snow.

Is that a squirrel sitting in a tree and staring in at me?

How do I get myself to focus on work today?!

Today's carol and code?  Maybe you've already guessed:
  • We Wish You... Hey Look!  It's Snowing!! (F90.0, Attention-deficit hyperactivity disorder, predominantly inattentive type)

Thursday, December 20, 2012

Twelve Codes of Christmas: On the Eighth Day of the Coder's Christmas (F40.10)

What is Christmas - or any holiday celebration - like for you?  Is is a small intimate affair or is it a madhouse?  Do you get along with your family, or do you leave the celebration giving thanks for the fact that you didn't choke anyone to death for another year?

I am blessed with a large and happy family.  A very loud and rambunctious group.  Our holiday traditions have undergone some adaptations over the years, but there are a few constants:  there will be lots of food; there will be many goofy white elephant gifts; and there most likely will be a pet or two present.

In case you can't tell, I'm a bit of an animal lover.  And while looking through pictures to match my 12 Days of Codes, I found this gem.  This is Beau, my aunt's cat.  And while I have a cat who is really more like a dog and can be found in the mix during family get togethers (and probably looking for a stationary lap to dominate), Beau has a tendency to do a cursory survey of the situation before retiring elsewhere.

So Beau, this carol and code are for you:
  • Have Yourself a Merry Little Christmas While I Sit Here and Hyperventilate (F40.10, Social phobia, unspecified)

Wednesday, December 19, 2012

Twelve Codes of Christmas: On the Seventh Day of the Coder's Christmas (F40.00)

I have decided to start limiting my daily news intake to no more than 30 minutes per day.  This is mainly because the news has been so depressing lately and although I think it's important to be informed, I think there comes a point when you just have to tune out before you decide to never leave your house again. 

I was looking through some old photos recently  and came across this old one of my dog Ginger.  Ginger is no longer with us, but I still have some great pics of her sweet little face.  This one struck me not only because of her expression, but also because of the bows.  No, I didn't put bows in my dog's ears on a regular basis.  I would take her to the groomer before the holidays and she always came back looking frilly and cute - with bows. It was always a test to see how long those bows would last before she shook her head enough or tried to pull them out with her paws.  Taking Ginger to the groomer was an event.  She was okay as long as we got in the car and headed north, because that meant she was on her way to see my parents and her favorite person - Grandpa.  But if we headed west, there were only two options: the vet and the groomer.  She wasn't a fan of either.

So for the seventh day of Christmas, I dug out this picture of my Christmas pup for our daily carol and code:
  • I Heard the Bells on Christmas Day but Wouldn't Leave my House (F40.00, Agoraphobia, unspecified).
Incidentally, Ginger was always up for leaving the house on Christmas if food was being carted to the car.  She always expected that once the food was packed up, she would be leashed up and we would join the party at a family member's house!

Tuesday, December 18, 2012

Twelve Codes of Christmas: On the Sixth Day of Christmas (G30.9, F02.80)

Christmas only a week away and there is something sorely missing from the scene here in Denver... Snow.

If you don't live here, you may have heard that Colorado is getting snow.  But the truth is, we haven't had much snow down in the city.  Although Denver is a mile high, it sits in a valley - lower than surrounding regions and much lower than the mountainous regions with peaks rising to 14,000 feet.  Snow in the mountains is good news for the ski resorts and our low reservoirs.  But in Denver, we've had weather well into the 60s in December.  And here I am still dreaming of a white Christmas.

I am considering trying to conjure one up by watching endless reruns of White Christmas.  Maybe Bing Crosby and Rosemary Clooney can work some white magic in Colorado in 2012 like they did in the 50s in Pine Tree, Vermont.  Or maybe I should put the Nitty Gritty Dirt Band's "Colorado Christmas" on endless repeat on the iPod. 

So in an attempt to help things along a bit and get me one step closer to walking in a winter wonderland this Christmas, on the sixth day of Christmas, here's our carol:
  • Walking in a Winter Wonderland Miles from my House in my Slippers and Robe (G30.9, Alzheimer's disease, unspecified and F02.80, Dementia in other diseases classified elsewhere without behavioral disturbances)

Monday, December 17, 2012

Twelve Codes of Christmas: On the Fifth Day of the Coder's Christmas (F22)

When I was a kid, the idea of Santa Claus coming on Christmas Eve and dropping off presents was both exciting and perplexing.  We didn't have a chimney and being the inquisitive type, I remember never getting a satisfactory answer as to how Santa got in the house.  I believe the word "magic" was thrown around a lot and I guess I figured if he knew everything, then he also knew how to get into the house.

And even though I begged to go see Santa at the mall when I was little, I don't think I have a single picture of a happy me sitting on Santa's lap.  The closer we got in line to the big jolly fellow, the more uneasy I felt and  when they perched me on his lap, I don't think I ever felt like this was someone who knew me well, he was just a stranger.  As an adult, I finally get it.  Santa is creepy.

I mean seriously.  This is a grown man who knows where you live, if you've been good or bad, and he sneaks into your house while you're sleeping.  There's a word for that: stalker.

So if you've ever felt a little uneasy about the oversized jolly old elf, this carol on the fifth day of the coder's Christmas is for you:

  • Santa Claus is Coming to Get Us (F22, Delusional disorders [includes paranoia])

Twelve Codes of Christmas: On the Fourth Day of Christmas...

As I type this, it's all about Vanessa Williams' Christmas album again. This time she's singing "Hark the Herald Angels Sing," which is another good rendition of a classic song. And of course, this leads me to our fourth carol and code:

Hark, the Herald Angels Sing About Me (F60.81, Narcissistic personality disorder)



Friday, December 14, 2012

Twelve Codes of Christmas: On the Third Day of the Coder's Christmas (F31.9)


Do you live next door to Clark Griswold? 

I love Christmas lights.  And I love Christmas decorations in general.  I do decorate my house to the extent where you can find something Christmasy in every room of the house.  Yes, every room.  I have a birthday around Christmas, so that combined with my love of holiday decor has led to my mom nicknaming me her Christmas kid.

But there comes a time when enough is enough.  Less is more. 

Last year I had a new neighbor and when they started hanging Christmas lights outside, I got a little excited.  I love it when all the neighbors get into the action and brighten up the neighborhood!  But there was a point when it reached Clark Griswold proportions and it just become too much.

So on the third day of the coder's Christmas, today'd carol choice is for all those with Clark Griswold tendencies:
  • "Deck the Halls and Walls and House and Lawn and Streets and Stores and Office and Town and Cars and Buses and Trucks and Trees and Fire Hydrants and..." (F31.9, Bipolar disorder, unspecified)
Please note that this code includes bipolar disorder with a current manic episode, which would explain the incessant need to decorate it all.  And I suppose I could be accused of some of this, even though I've significantly reduced my decorating footprint over the last couple of years.  Nonetheless, you are sure to find a reindeer or snowflake in at least one of my bathrooms!

Thursday, December 13, 2012

Twelve Codes of Christmas: On the Second Day of the Coder's Christmas... (F20.9)

I am still not 100% after almost 3 weeks of a really bad upper respiratory infection.  But last night I did hit an improvement milestone.  I was able to sing my favorite Christmas carols at top volume in the car on my way to dinner.  Yes, I am a car concert giver.  A legend in my own mind.

I have lots of favorites, but one last night was worth a repeat performance:  Do you Hear What I Hear by Vanessa Williams.  It's my favorite version of the song but I don't like the shortened version they play on the radio - the long version from the CD I've had for years is really the only way to listen to the song.

So this leads us to our carol and code for the second day of Christmas:
  • Do You Hear What I Hear, the Voices, the Voices (F20.9, Schizophrenia, unspecified)
The mental disorders chapter of ICD-10-CM has undergone a lot of changes from its ICD-9-CM counterpart.  Schizophrenia is part of the psychoses section in ICD-9-CM, but ICD-10-CM eliminated the neurosis vs. psychosis terminology and moved to terminology more in line with DSM-IV.  The code above it now listed in the Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders section in ICD-10-CM.

Wait... do you hear it what I hear?  Thankfully it's not voices.  Bells!  An angel must have just gotten its wings.  Either that or one of the cats is scratching its ears and jingling the bells on its collar.


Wednesday, December 12, 2012

Twelve Codes of Christmas: On the First Day of the Coder's Christmas... (R41.3)

I remember the Christmas of 2006 vividly.  I can tell you which small town in the Eastern time zone I was in and the name of the hospital where I did my training the week before Christmas.  I can tell you how I suggested to the client weeks before that training a week before Christmas was probably not a good idea.  I can tell you how the people I was training plugged in a Christmas tree behind me and snacked on holiday pot luck fair while I was presenting.  And most of all, I can tell you that I was training ICD-9-CM, Chapter 5 on Mental Disorders.

Stellar memory you say?  That's absolutely amazing you say?  I certainly can't remember that many details about my other trainings.  It's what happened after that which makes the trip memorable.  Or maybe I should say during.  Christmas was on a Monday that year and on the Wednesday before - you know, when I was training - it started snowing in my home town of Denver.  A lot.  The airport was closed by Wednesday evening and it wasn't looking good for my flight home on Thursday. 

Sure enough, I was up bright and early Thursday morning and all flights in and out of Denver were canceled.  A massive blizzard had dumped nearly 2 feet of white stuff all over the city.  Once my Central-time zone based travel agent made it into the office, she was able to tell me I could fly home on the 26th.  Holiday travel combined with catch-up from Wednesday put me low on the priority list. 

To try to shorten this story up a bit, after crying to my travel agent and placing a very early morning and tearful call to my brother in Phoenix, I had a very expensive nonstop flight booked that would get me into Phoenix at midnight.  My wonderfully accommodating brother picked me up at the airport and his hospitality-driven wife had the guest room and Friday manis and pedis all set up. On Saturday, the three of us set out for Denver along with a small U-Haul trailer and two large dogs: one with a urinary tract infection (many potty stops) and the other with amazingly terrible gas.  Good times.

Oh right.  The point.

Recently, I was perusing the internet and came across a list of Christmas Carols for the Psychologically Challenged and remembered that fateful trip.  In order to infuse a little Christmas spirit into that mental health training, I had written these Christmas carols in the margins of my trainer's manual and we all had a good giggle any time one came up.

So in honor of that memorable Christmas - I've decided to do a special subseries on the code for the day.  Here is the first of my Twelve Codes of Christmas series:
  • I Don't Remember if I'll Be Home for Christmas (R41.3, Other amnesia)
Tune in tomorrow for another installment!

Monday, December 10, 2012

Code for the Day: Awakening from a Tryptophan-Induced Coma (T50.3X2D)

I knew it had been awhile since I penned a blog post, but I didn't realize quite how long.  And how does one come back?  Which excuse should I use?  Well, now that we are two weeks post Thanksgiving, I choose tryptophan as my excuse - you know, that supposed chemical in turkey that makes us so sleepy after Thanksgiving dinner?  Did you know there is a code for overdosing on tryptophan?!
  • T50.3X2D, Poisoning by electrolytic, caloric and water-balance agents, intentional self-harm, subsequent encounter
This code cracks me up.  I'm sure there is a real reason for this code to exist - I mean, besides blog fodder. But this one is just too good to be true.  I found this code by looking up tryptophan in the Table of Drugs and Chemicals and decided to use the column for intentional self-harm rather than accidental.  Because really, we do this turkey stuffing thing to ourselves.  And, of course, I chose the subsequent encounter because this isn't my first rodeo!

Just for good measure, let's also throw in this little gem for overeating:
  • R63.2 Polyphagia

So now you're saying, well, Kristi, that was over two weeks ago, where the heck have you been?  This is where the coma part comes in and luckily, we have codes to capture the Glasgow coma scale too.  This is how I would rate my Thanksgiving experience:
  • R40.2131, Coma scale, eyes open to sound, in the field [EMT or ambulance]
  • R40.2221, Coma scale, best verbal response, incomprehensible words, in the field [EMT or ambulance]
  • R40.2361, Coma scale, best motor response, obeys commands, in the field [EMT or ambulance]
Okay, not really.  In all honesty, since Thanksgiving, I've been trying to kick a nasty virus while continuing to meet work deadlines and other commitments.  The code for upper respiratory infection just isn't as much fun as the ones listed here. I hope you are having a healthier holiday season than me!

Thursday, November 1, 2012

Code for the Day: Nuclear Radiation Exposure Leads to Cannibalism? (F50.8 and W88.1xxS)



I list a lot of movie references in my blogs.  There was a time when my movie collection rivaled the local video stores.  That was a long time and a lot of VHS tapes ago (and during the era of video stores!).  These days, my schedule prevents me from seeing the latest movie every couple of weeks and in fact, most of the time when I do take the time to unwind and watch a movie, I inevitably miss most of it when I fall asleep.  But I still love movies – usually funny movies, and of course, the quintessential chick flick.  But lately, at this time of year, I am in the mood for a scary movie or two.  And last weekend’s couch surfing adventure yielded two movies: Chernobyl Diaries and The Hills Have Eyes. Both of these movies bring to mind one word: “ew.”

Me, zombified.
I didn’t realize going into the double feature that the evening would have a distinct theme beyond the horror genre.  First we watched Chernobyl Diaries, where a group of young tourists take a forbidden tour into the town of Pripyat, near the Chernobyl Nuclear Power Plant.  Their van breaks down and one by one, they are attacked by an unseen force.  In the Hills Have Eyes, a nuclear bombing testing ground in New Mexico is home to miners who refused to leave during the testing.  After disabling a family’s truck and motor home, the deformed miners take revenge on the unsuspecting tourists.  After watching both movies, I came to a very troubling conclusion: exposure to excessive radiation turns people into cannibals.  So here are your somewhat belated codes for the day with a Halloween twist:

  • F50.8, Other eating disorders
  • W88.1xxS, Exposure to radioactive isotopes, sequela

I know what you’re thinking.  Cannibalism?  An eating disorder?  I usually come up with my codes for the day myself, but having done a little research and realizing that cannibalism is not classified by the Diagnostic Statistical Manual (DSM-IV) and therefore not by ICD-10-CM, I consulted a colleague.  We had a rather sordid discussion on how best to classify these radiation victims.  And this is what we came up with: Merriam-Webster defines pica as “an abnormal desire to eat substances (as chalk or ashes) not normally eaten.”  We found a reference that stated that a person who chews his own fingernails and then swallows them could be classified as having pica.  And this type of self-pica is considered a type of cannibalism. I know we’re taking liberties here, but I’m coding characters from a movie.  I really don’t know what I will do should I ever have to code a real case for a cannibal.  Let’s hope it never comes to that.  

The exposure code was the easy one.  Notice the 7th character extension of “S” for sequela.  The Chernobyl disaster occurred in 1986.  The nuclear testing in The Hills Have Eyes appears to have occurred in the 1950s, so these particular radiation-infused cannibals were all suffering long term effects, or sequelae, from their radiation injuries.

As for the horror movies, I’m ready to trade them in for the warm and fuzzy holiday movies!

Saturday, October 20, 2012

Code for the Day: Getting Through the Operative Report without Crying Part 2 (R45.83)

Every once in awhile I get a complimentary email or message about a blog posting from a couple of years ago, "Getting Through an Operative Report - Without Crying."  It's always great to hear that people are reading my blog.  It's even better when people cite a particular posting and tell me how very helpful it was for them. This posting has been speaking to me lately too as I move beyond the shallow end of the ICD-10 coding pool and immerse myself neck deep in this new and strange coding world.  I'm not sure if this will make people feel better or if I risk losing part of my audience with this admission, but I've been crying a lot lately when it comes to ICD-10-PCS coding.

And thus, the code for the day:
  • R45.83, Excessive crying of child, adolescent or adult
To say that ICD-10-PCS coding is foreign is an understatement.  My favorite statement about it - which I'm sure I've already blogged about before - is that ICD-10-PCS is like CPT on steroids.  Even the most experienced coders struggle with it and I've had my share of debates with colleagues about how to code something. And yes, there have been tears.

But the tears have not overshadowed the sheer excitement of learning this new coding system.  I find that I'm learning more about how procedures are performed and it's honing my coding skills further.  But there are a few things I really have a hard time with.
  • The concept of root operation is a tough one.  Trying to determine the intent of a procedure is harder than it seems.  So many things we take for granted in ICD-9-CM will be so different in ICD-10-PCS.  Case in point: when you replace a device in ICD-9-CM, you will likely find that procedure indexed under the main term "Replacement."  In ICD-10-PCS, the root operation Replacement is only used to describe replacing a body part with a device.  When a device is replaced, it's usually two separate root operations: Removal and Insertion.
  • Determining the approach is not something to take for granted.  How a physician approaches a procedure is easy, right?   We know laparoscopic versus open.  We understand that that there are certain body parts you can get to through an orifice while others can be access percutaneously by puncture.  But approach is more complex than you think.  For a transbronchial biopsy, the scope is placed through a natural orifice, but once inside the bronchus, a percutaneous puncture is made to obtain the biopsy, so the approach is percutaneous endoscopic.  The really unfortunate thing here is that many coders don't realize they are making mistakes with approach because it seems so darn easy!
  • There's no such thing as unbundling in PCS.  Having coded both ICD-9-CM and CPT procedures, I strongly believe that CPT coding is a great prep for learning PCS.  The level of detail needed to code CPT is much greater than that needed for ICD-9-CM procedural coding.  But there are times when I initially miss PCS codes because I am applying CPT bundling rules to PCS.  In short, you can't do that.  We have specific PCS coding guidelines - if you have procedures that have more than one approach, root operation, or body part as defined in the PCS table, you code multiple codes.  And for a CPT coder, that's sometimes hard.  A specific example - we have a PCS guideline that says if they biopsy a structure and then remove it, you code two procedures since it is two root operations: Excision and Resection.  Weird, huh?!
  • Where is the class on procedures?  We've been hearing for years that coders need to bone up on the biomedical sciences including medical terminology and anatomy and physiology, but I'm finding that many coders can't figure out the root operation because they don't understand the procedures themselves.  And while the training I've been working on does go into detail about how procedures are performed, I find there isn't really a college course you can take on procedures.  But YouTube has some great videos if you want to self study.
Okay, so that's the bad news.  PCS is hard.  Really hard.  The good news is this.  It's fun.  Super fun!  And it's opened up dialogue with other coders I haven't had the chance to have in a long time and I miss that.  So if you're starting to learn PCS and you're struggling -maybe even crying - you aren't alone.  And the best news of all is that they make some really cute tissue boxes these days!

Wednesday, October 10, 2012

Code for the Day: Lack of Awareness (R41.9)

Some day I intend to write a book about airline travel.  Not the usual fun and informative here-are-my-best-tips-and-tricks type of book, but a real, this-is-what-it's-really-like-and-can-you-believe-people type of book.  You see, for an avid people watcher, airports are the mother lode.  And what strikes me most about airline travel is how completely clueless people can be when they're using airplanes to get from point A to point B.

If you've traveled a lot, you've seen it too.  The woman with 5 bags (how did she get them all through security?!) who can't manage them all, so she stops in the middle of a busy airport concourse to reorganize herself but fails to see the traffic accident she caused behind her.  The young, able bodied person who takes a seat on the rental car shuttle while a elderly woman with obvious difficulty balancing stands and hangs onto the roof strap for dear life.  The person in the middle seat sitting next to you on the plane, who decided taking the armrest wasn't enough and now has his elbow in your side.  Or how about the guy who took my carry-on and walked off the plane and was at the parking garage before he realized he had the wrong bag? 

I just finished a couple months of more travel than I've done for quite some time.  I used to travel every week and I think you become immune to it after awhile, but after my brief return to airline flight, upon my arrival home, I happily posted on Facebook that I was glad to be done with my weekly dose of invasion of personal space (AKA airline travel). 

And while I don't think people are purposefully annoying, I do think it boils down to one thing: lack of awareness.  I've talked before about addiction to smart phones, but seriously - people are so dialed in that they've lost touch with reality.  It reminds me of the movie WALL-E, where the humans have left earth and spent countless years floating around on hovercraft and talking to their friends on little computer screens. And of course, the friends they are talking to are sitting right next to them!  One day the little robot WALL-E knocks a couple of them out of their little machines and they not only discover each other, but that the spaceship has a pool!

I know I am guilty of being ultra-plugged in, so I try to make an extra effort to unplug when I'm in a busy airport.  Unless of course, I am waiting at my gate and need something to pass the time.  The payoff is immense - watching other people can be quite entertaining!  One of my favorite people watching stories happened at baggage claim.  It was a late Monday evening and I was at an airport that I traveled to weekly and I knew it took about 30 minutes for bags to start arriving.  I also knew that the airport was terrible about marking which carousel would have your flight's bags.  On this Monday evening, I sat on the edge of an empty baggage carousel and watched the madness unfold.  It wasn't long before my attention locked on a short, balding, middle-aged man who bore a striking resemblance to the lead character from that cartoon, The Critic.  He bounced around from carousel to carousel looking for his bag.  When he saw one that was red (this appeared to be his only criteria - not size or other appearance), he pulled it off, looked at the tag, and heaved the suitcase back on the carousel with a heavy sigh.  I was momentarily put off when he grabbed my bag, but as I watched him struggle with my huge bag, which was more than half his height (and full of code books!), I suppressed a giggle.  Karma!

So this week as I am now happily grounded and working on some education material, I ran across this little gem of a code.  It's not the code description that captured my interest, but the index entry.  I found the code for the day under the main term "Lack of" and the subterm "awareness"
  • R41.9, Unspecified symptoms and signs involving cognitive functions and awareness
 And just for good measure, let's add this one too:
  • Y92.520, Airport as the place of occurrence of the external cause
If you're heading to the airport any time soon, happy aware travels!

Wednesday, October 3, 2012

Presidential Debate = Total Coronary Occlusion (I25.82)

Topping news headlines in Denver this morning is tonight's presidential debate.  I know what you're thinking - it's a big topic everywhere.  But here the focus is not on the candidates or their platforms - yet.  The focus is on what it will do to Denver traffic for the evening commute as our own University of Denver (DU) plays host to the candidates. 

If you're not familiar with the geography of Denver - besides the whole mile-high thing - we have one major interstate that runs north and south, connecting the northern community of Fort Collins to the southern city of Colorado Springs.  That is Interstate 25.  And right smack dab in the middle is Denver.  I think Denver is quite unique in that the downtown area is not the only major business area.  Just a little to the south is the Denver Technological Center (DTC) - the Silicone Valley of Colorado, if you will - which is filled with office parks.  To say that I-25 is a busy thoroughfare during rush hour is an understatement.  It's the heart of the city's traffic structure.  And DU is situated right in the middle of downtown Denver and the DTC - just off the I-25 corridor.  And for this evening's presidential debate, a significant portion of I-25 near DU will be closed off.  And this leads me to today's code for the day:
  • I25.82, Chronic total occlusion of coronary artery
Of course, I suppose this closure would be more of an acute total occlusion, but I just loved the wording so much, I took a liberty or two with my blog today.  I think it's hysterical that coronary artery disease codes to category I25.  It tickles my twisted coder funny bone to realize that the code for clogged heart arteries is the namesake of the frequently clogged interstate that runs through my home town.  I believe I even snickered out loud in class when I made this discovery.  To add to my joy, arteriosclerosis of the peripheral arteries is classified to category I70, which happens to be our major east/west artery through Colorado and the gateway to the mountains.  On a Sunday afternoon, eastbound I-70 traffic coming into Denver is more backed up than I-25's morning rush hour as people erase their peaceful mountain weekend bliss and cuss at each other on their way down the mountain.  But I digress!

Category I25 is filled with all kinds of codes covering the gamut of coronary artery disease, including CAD of the native arteries as well as CAD of the bypass grafts or vessels of a transplanted heart.  It also has codes for chronic total occlusion of the coronary artery (as already mentioned), old MI, and coronary atherosclerosis due to lipid rich plaque, which always brings to mind a quote from a movie I can't quite place right now: "Your cholesterol is so high, you're practically a solid!"

So to all my blog followers who live in the Denver area, best of luck with your evening commute.  Hopefully you have a nice boss who either let you work from home today or will let you leave early!


Tuesday, October 2, 2012

Code for the Day: I Saved the Article on Procrastination for Last (Z73.89 )

Whew, it's over!  That's really all I can say about September - it's over!  It  was a very busy month both professionally and on a personal level and as I organize my to do list this week, I realize just how much I put off.  Busy people understand that you can't get it all done, so it's all about prioritizing and since I am a very ambitious person, my to do list is usually pretty huge and I know going into it that something is going to get cut.  The opposite of this process, in my mind, is doing absolutely nothing!

One of my to do stacks.  I'll get to it one of these days...
The other day during a little down time (I do have some!), I decided to start in on a series of articles my mom clipped for me.  I usually don't have time to read the articles she sends me, but as I flipped through the pages, with topics ranging from saving for retirement to time management, I thought perhaps I should take the time.  I read the article on why you should break certain time management rules first.  Then I moved onto the icky articles on retirement planning - good information, but not my favorite topic.  I saved the article on procrastination for last.

Oh, procrastination, you are my friend!  I am a master procrastinator, although it has backfired on me in the past.  I don't enjoy the last minute scramble to get a project done, it's just that I often so tightly manage my time (not a good thing according to the first article), that it's all about priorities.  And ever since high school, I have done some of my best work at the eleventh hour.  The tricky part is making sure you're not extending that into the twelfth hour!

And, of course, I had to see if there was a code for procrastination, and I do believe I found one:
  • Z73.89, Other problems related to life management difficulty
I suppose you would only really consider this code if you thought procrastination was a bad thing.  Category Z73 also includes codes for type A behavior (Z73.1), lack of relaxation and leisure (Z73.2), and stress, not otherwise classified (Z73.3).  So I suppose if you aren't careful, a Z73.1 lifestyle along with Z73.89 can lead to Z73.2 and ultimately, Z73.3.  But I still think there is such a thing as a healthy amount of procrastination.

Now, to get back to that to do list.  I can check one thing off for today, but I'm sure there's something else I can put off until tomorrow...

Thursday, September 20, 2012

Code for the Day: A Day at the Spa 8E0KX1Z

The last few weeks have been more than the usual crazy.  I knew going into September that I was going to have to take every rare opportunity I found for a little relaxation.  Since August, I have spent more weekend nights away than at home and while most of my trips have been for fun and not work, I am a person who relishes a routine schedule and values downtime - probably like a lot of coders out there.

My September travels began with a trip to North Carolina for a wedding followed closely by a work trip to Kansas City for training.  The whole time I had my eyes open, considering ideas for my blog and looking for inspiration in the normally mundane daily grind.  I have a few ideas that will take more thought before putting to paper - er, PC - so stay tuned.  But it was something quite literal that inspired today's code for the day: a heavenly day spent at the spa with coworkers.

I know what you're thinking. A relaxing day at the spa with coworkers is an oxymoron.  Well, you haven't met my coworkers!  We spent a nice Sunday morning at the spa and I do believe the topic of work came up only once and very briefly before we moved on to more important topics, such as, admiring each others' nail color and inquiring about the various facials, wraps, and massages we all received.

Oh, the massage.  Actually, after a busy week of lugging heavy suitcases and flying across the country and back and then back to the midwest and back again had left my feet as sore as my shoulders.  I was pretty much a goner after the pedicure, but I subjected myself to a hot stone massage anyway and I remember wondering afterward if there was a code for feeling like jello, because it's been awhile since I've felt that complete relaxation.  In fact, I did something I pretty much never get to do that afternoon: I took a nap!

My attempts at locating a jello code were not fruitful, so I went with the more obvious and here it is - the code for the day:
  • 8E0KX1Z, Therapeutic massage
This code is found in ICD-10-PCS in one of the sections we trainers like to call the "stuff in the back of the book."  Most of the stuff in the back of the book includes codes we aren't likely to code and provide evidence that at one time, there were plans for PCS to replace CPT (this is not happening - I repeat, CPT is not going away!).  But I like this code and it was so appropriate for my weekend.

On a side note, I am not crazy about advertising on my blog, but I have to give mention to this amazing spa.  If you ever find yourself in Denver and need a little pampering, the folks at Woodhouse Day Spa will take great care of you.  This particular location at 17th and Ogden is located in the historic Merritt House.  There's just something about relaxing in this Victorian setting that makes it seem extra special!

Thursday, September 6, 2012

Solution to Yesterday's Word Search

  
 
+ S + + + + + S Y R O T A R I P S E R U T C A R F + + + + + + + + + + + + + + + 
+ U + + + + + I G C + D G E V I T A R T S I N I M D A + + + + + + + + + + + + + 
+ B + + S + + S O H + + P C + + L Z + + + + + + + + + + + + + + + + + + + + + + 
L A T N E M P O L E V E D O R U E N + + + + + + + + + + + + + + + + + + + + + + 
O C + + Q + + R O M + + G N C + + E + + + + + + + + + + + + + + + + + + + + + + 
+ U + + U + + E I O + + L S D D H U + + + + I + + + + + + + + + + + + + + + + + 
+ T T U E + + L S T S T A T U S G L + + + N + + + + + + + + + + + + + + + + + + 
+ E + P L + + C Y H + V U R M + N F + + P + + + + + + + + + + + + + + + + + + + 
+ + H + A C M S H E O + C U + O I N + A V R + + + + + + + + + + + + + + + + + + 
+ + + Y E T E O P R + + O C I + N I T A + E + + + + + + + + + + + + + + + + + + 
+ + + T P + I R B A T + M T G + E I P + + M + + + C + + + + + + + + + + + + + + 
+ + + I + E + E + P + H A I E G E P T + + I + + O + + + + + + + + + + + + + + + 
+ + + D + Y R H N Y + C R V S N R + + O + S + E + + + + + + + + + + + + + + + + 
M A N I F E S T A T I O N E T O C D A + R S X + + + + + + + + + + + + + + + + + 
+ + + B C + + A E L B A E G A T S N U E + I + + + + + + + + + + + + + + + + + + 
+ + + R + + + + P N + G + C T T A + S I S O N G A I D + + + + + + + + + + + + + 
+ + A O + + + M O + S N H O I T E I E T Y N + G + + + + + + + + + + + + + + + + 
+ + F M + N O I T A N I B M O C S N T + M + + + + B + + + + + + + + + + + + + + 
+ + T O + C T + + + + S V M N T + + E + P + + + Y + + + + + + + + + + + + + + + 
+ + E C + A S + + P E O Y E A + + + B D T L + P + + + + + + + + + + + + + + + + 
+ + R + U D U + + R + D + N L M + + A + O + A + + + + + + + + + + + + + + + + + 
+ + C L + D O + V I + R C C P + B + I + M S H C N + + + + + + + + + + + + + + + 
+ + A + + I I A + N + E + O H + + U D I S E A S E + + + + + + + + + + + + + + + 
+ V R + + T T + H C + D + U A + + + L + + + + U + + + + + + + + + + + + + + + + 
E S E P T I C E M I A N + N B C + + + A + + + R + + + + + + + + + + + + + + + + 
+ + + I O O E + + P M U + T E + T + + + T + + G + + + + + + + + + + + + + + + + 
+ + + N + N F + + A + A + E T W + I + + + O + E + + + + + + + + + + + + + + + + 
+ + + T N A N G I L A M + R I + B + V + + + R R + + + + + + + + + + + + + + + + 
+ + + E + L I + + + + + + + C H R O N I C + + Y + + + + + + + + + + + + + + + + 
+ + + G + + L + + + + + + + + + + + R + T + + + + + + + + + + + + + + + + + + + 
+ + + R + + U + + + + + + + + + + + U N + Y + + + + + + + + + + + + + + + + + + 
+ + + A + + S + + + + + + + + + + + B + + + + + + + + + + + + + + + + + + + + + 
+ + + L + + N + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 
+ + + U + + I + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 
+ + + B + + A + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 
+ + + A + + P + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 
+ + + T + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + 

Wednesday, September 5, 2012

Code for the Day: Is Now a Good Time for a Z56.1 (Change of job)?

In case you haven't been paying attention lately, there are a few things happening in the health care industry.  We have Obamacare, the insurgence of accountable health organizations, implementation of electronic health records (EHRs), and a firm date for ICD-10.  If you google "fastest growing industries" you will find many of the top 50 jobs are within health care.  And according to the US Bureau of Labor Statistics, the job outlook for a medical records/health information technician (including coding) is projected to grow faster than average at 21% by the year 2020.

For a lot of people pondering a change in careers, these statistics might seem like a no brainer, yet the transition to ICD-10 has a lot of people wondering:  is now a good time for a Z56.1 (Change of job)?

A selection of my codebooks - note the ancient green SNODO book!
I do get email from people asking me this very question.  Is now the right time to become a coder, or should I wait?  The job of a medical coder is very attractive because most coders work from home and many work on a flexible schedule.  I've had Facebook friends from high school and other walks of life telling me that they are passing my blog information onto their friends and family because they are interested in coding.  But I continue to hear the question - is now a good time?

In typical coder fashion, there is no short answer!

First things first, though.  Now is a great time to become a coder.  But it's not going to be easy if you decide to start now.  We do have ICD-10 coming up on October 1, 2014.  But most coding programs will have you graduating before then, which means you will learn both ICD-9 and ICD-10 (oh, and CPT too!  But CPT isn't changing).  You could wait a couple of years so you don't have to learn both systems, but here are 10 compelling reasons I think you shouldn't wait:
  1. Coding is 25% the codes themselves, 25% the coding guidelines, and 50% knowing how to navigate the massive word search that is a medical record (or operative report) and only abstract and code the right stuff.  This last 50% is the hardest part about being a coder and it takes equal parts natural skill and practice (lots of practice!).  Start practicing now.
  2. The industry is abuzz with talk about what current coders will do when ICD-10 is implemented.  Some have already said they intend to move on.  You will want to be trained and ready to go when their positions are vacated.
  3. You'll be "closer to the books" when it comes to ICD-10 and will probably get more intensive training than coders in facilities (except the coders I intend to train, that is!).
  4. Training to become a coder takes time.  You can't finish a class on September 30, 2014 and expect to land a job on October 1, 2014.  You won't be ready.
  5. Employers are about to freak out.  They have to implement ICD-10 in 2 years with limited resources and lots of moving parts.  They need to train their existing coders and my guess is, in about a year, they will not be as willing to take on a newbie as they are now.  If you wait, you may find it hard to get a job in 2014.
  6. When it comes to ICD-10, all coders are on a level playing field - except for that 50% abstracting thing - which means you will have the opportunity to roundtable and network with experienced coders who will be just as clueless about ICD-10 as you are.  But you will have an advantage - they will be pulling up lots of old ICD-9 references and you will be asking them "why" a lot (e.g., "why can/can't I code X with Y?").  While you might think you are naive, this is critical to everyone learning ICD-10 - you will give the experienced coders something to think about and you may find you know more than you think.
  7. Experience, experience, experience.  In coding, nothing is more of an asset than experience.  You could have all the coding credentials in the world, but without experience, they mean nothing to your future employer.  The more experience you have before October 1, 2014, the better.
  8. There are lots of great cost-effective and maybe even free opportunities to network and learn.  All coders are looking for ways to come together and learn ICD-10 right now.  In Colorado, our ICD-10 Task Force has created ICD-10 Coffee Chat Meetups every other month.  We come together with cases and discuss ICD-10 coding in a roundtable format.  And it's free.  Your local AAPC chapter or AHIMA component state association may also have something available, so check it out. 
  9. Attitude is everything.  If you tell a potential employer, fellow coder, or educator that you plan to wait because it doesn't make sense to learn ICD-9 and ICD-10 too, it's a huge red flag.  What it tells me is you don't want it badly enough.  Will it take extra work to learn ICD-9 and ICD-10?  Absolutely.  Will learning both pay off?  In spades - and it's not just about knowledge, it's your attitude to tackle the unknown.  I will take a positive attitude and willingness to learn over a stubborn attitude with experience any day.
  10. ICD-9 will not be used on claims after September 30, 2014, but it will still be needed and we will still need people who know how to use it.  Many auditing entities, including Medicare's recovery audit contractors (RACs) are several years behind in their auditing and someone will need to double check audit findings and verify their validity.  Likewise, various groups and agencies who use coded data (e.g., Health Grades) are looking at old data as well.  If you can code both ICD-9 and ICD-10 and better yet, compare data between the two, you will be an asset.
So what are you waiting for?  Get going!

Do You Have the Skill to be a Coder?

Perhaps you got stuck on the word "skill" above.  If you did, you're very astute.  Try as they might, not everyone has the skill to be a coder.  It takes a lot of knowledge in the medical sciences, detective abilities, and knowledge of coding guidelines.  Do you have what it takes?

I usually ask people who want to be coders if they like word searches.  A prompt "no" makes me a little wary.  Because medical records are word searches - you won't truly read an entire medical record because there simply isn't time.  And, as I am fond of telling some of the newer coders who find their way into my classes, just because there's a code for it, doesn't mean you assign it.

Here's a little word search for you to test out your skill.  The words are some that we see often in coding and are found forwards, backwards, up, down, and diagonally.  Yes, it's hard - but so is coding!  I will publish the solution tomorrow.

C S R G N V T S Y R O T A R I P S E R U T C A R F T A L S V I D B Q O U I N E I 
S U P K K H N I G C Y D G E V I T A R T S I N I M D A I H K V D Q G U Z X G R W 
E B V Y S L Q S O H I X P C C Y L Z P V P E G G K U P W T C O L W T B X B P I X 
L A T N E M P O L E V E D O R U E N S S X O Y V M G U V H Y R N M R X X B B V I 
O C S M Q O E R O M F E G N C V N E Z S G M P Q L I C M C B C Z H L H O H V J V 
G U R U U V O E I O A H L S D D H U B I F X I T P K M T R E M I V N I H O S V S 
S T T U E C Q L S T S T A T U S G L V U W N L B N T Y M R C M M G X P P Q U D S 
H E D P L J J C Y H O V U R M V N F J O P R T X J H A E K T E G Y G Q G S P Q I 
U W H Y A C M S H E O L C U O O I N P A V R M N K B P D B X W Z Q V F Z W X B J 
F Q X Y E T E O P R F U O C I U N I T A B E D C Y S F E Y B E C T C Z M O A I L 
C N S T P S I R B A T E M T G Z E I P S B M N X F C Y Y U J H O B K V K L U H H 
I W D I U E R E I P N H A I E G E P T T Y I I F O Q K R H P Q E L G H L E K B X 
U E C D S Y R H N Y S C R V S N R H I O Q S I E T K J R L O R R N Y R Q M E Z P 
M A N I F E S T A T I O N E T O C D A X R S X C V O B T P I L P K E L E F H P S 
W R U B C I S A E L B A E G A T S N U E K I Y B C X V O P R Z V V D H D L T I M 
F M K R V O I M P N E G G C T T A I S I S O N G A I D M I J P C H K X H U W Z R 
X Y A O U Q H M O I S N H O I T E I E T Y N I G A G O J V J N S O H X J E P L Q 
C F F M Y N O I T A N I B M O C S N T J M O X T T B E X N F V E D J P L X P J V 
A S T O Z C T P G Q O S V M N T D Y E S P C I D Y C H X C I P J Z F N W U C I P 
P A E C R A S F Y P E O Y E A Q X P B D T L S P W F A T E H E K X C X W Y C V S 
Q I R K U D U E V R H D G N L M B K A K O O A G T N W Q W W F T G U H D N R W X 
X V C L U D O E V I E R C C P Y B V I G M S H C N V Q Y R M G X V J Y X L K C V 
V G A U E I I A U N T E R O H E L U D I S E A S E Z V T Q A D W K O E X B U G N 
S V R J H T T P H C G D Q U A V Y M L L K R J U S W O X S K V V F I Y V F M C Y 
E S E P T I C E M I A N T N B C R I C A X M L R F D H Z E X L H E M Z Z O C C V 
N D N I O O E L J P M U T T E L T R W T T F C G V T C L C E F W Q H X Z Y R E I 
R K M N D N F M M A S A E E T W I I H N C O Q E M W T D A O Y P M Q M D U G E L 
W N N T N A N G I L A M N R I S B Z V E N X R R X C Z B H S B O Q E I X N K O S 
P S Z E P L I C H L T A L J C H R O N I C F F Y J J C D D O D H X W R Q H R O K 
E U M G D N L K U W S U Z T A O B R R C T W Q M E K T A D W M V B M C V R Z M G 
T T O R E W U E F R D H J X T T G X U N D Y U A A V W P H H A T G J Z J A J G C 
N E L A D W S S X J L U V O M W A C B V I P S Z Y O P G P O T L G F N K Z I J J 
R R D L U P N V F G I H D Z B W L A X J W I V M I O H X Z L T R O F X X X M O Q 
W G L U Y H I Z L L N K D U Q B K O T K K P Q C V F K K I U T C C X F L B H T K 
W D O B E M A A D Y T O R A N P R X S S N Y V S X D Q N X Y D N Q T T R E H V K 
M N H A F U P K N E F K S A P Y H W M D N G O S N Z D O N X C X E E V H K K R P 
H Q L T D H W G K R P Q P F U V V E Z J J N O X Y I R I V N V A Q U F M Q W A E 
I W E O C D A K I A S N R G L I M H D E Q B H M O X F N K U I A T U V J C Q R Y 
F W N T B A I Z O W V M H J O T K N X S A N M K S H X F F D O C N S S E A H A O 
F A C L G Y M L E P P E Z L J A H I R H Y B K N H L M Z C L G R L R E E D C T G 
 
Word List: 
ACTIVITY
ACUTE
ADDITIONAL
ADMINISTRATIVE
AFTERCARE
AHA
AHIMA
ALPHABETIC
AMBULATORY
AMI
ANATOMY
APPROACH
ATHEROSCLEROSIS
BURN
BYPASS
CAD
CEREBROVASCULAR
CHEMOTHERAPY
CHRONIC
CMS
COEXIST
COMBINATION
COMORBIDITY
COMPLICATION
COPD
DIABETES
DIAGNOSIS
DISEASE
DRG
EGD
ENCOUNTER
EVALUATION
EYE
FRACTURE
GESTATIONAL
GLAUCOMA
HYPERTENSIVE
INFECTIOUS
INFLUENZA
INPATIENT
INSULIN
INTEGRAL
MALIGNANT
MANIFESTATION
MONITORING
MORBIDITY
NCHS
NEURODEVELOPMENTAL
NEWBORN
OBSERVATION
OUTPATIENT
PAIN
PHYSIOLOGY
PLACE
PRINCIPAL
RECONSTRUCTIVE
REMISSION
RESISTANCE
RESPIRATORY
SCREENING
SEPTICEMIA
SEQUELAE
STATUS
SUBACUTE
SURGERY
SYMPTOMS
TABULAR
THREATENED
UHDDS
ULCER
UNDERDOSING
UNSTAGEABLE
VAP
 
Word search created using http://puzzlemaker.discoveryeducation.com/.   

Tuesday, September 4, 2012

Code for the Day: Pillow Fights in the Dark Are a Bad Idea - Y93.83

I am that geek who asks for copies of my operative reports.  My doctors usually look at me a little weird and tell me how boring they are, but nonetheless, I collect operative reports.  I have certain friends, family, and coworkers who have joined the cause and will ask for copies of the report for whatever procedure they had done recently.  In fact, I recently acquired a tonsillectomy.

While this may seem to be a rather strange collection, for me it's purely educational.  I like to teach from real operative reports, so I collect them and use them in training materials.  A couple of weeks ago, I dusted off one of my previous procedure reports in preparation for ICD-10-PCS training.  It was for a septoplasty and turbinate reduction after what one of my doctor's not-so-lovingly referred to my as my "100-day cold."  When I finally saw a specialist, she determined that I had trouble due to a deviated septum, which was caused by an old fracture - probably during childhood.

When I told my mother that I had a deviated septum, probably due to an old nasal fracture from childhood, she could see where I was going.  We both knew how my nose got broken and who did it. 

My brother and I were pretty close growing up.  Only three years apart in age, we spent a lot of weekends and cold snowy days playing together.  On the fateful night in question, I remember we were in his room having a pillow fight.  Mom and Dad were watching TV in the living room.  We had been smacking each other around with pillows for a bit when we decided to add a degree of difficulty.  Let's turn out the lights!  It's all fun and games until someone gets smashed in the nose with a fist.  Unfortunately, it was my nose, which immediately began gushing blood.

I remember thinking one thing and one thing only: if I holler loud enough, my parents will come down the hall to see what's up and my brother will get in a lot of trouble for decking his little sister in the nose.  It didn't work.  I had a lot of nosebleeds as a child and my brother had watched my Mom stop the bleeding many times before.  Within seconds, he had me lying on the bathroom floor with one of the nosebleed-approved washcloths and he was mopping up the blood, making sure I was pinching the bridge of my nose, and telling me shut up before Mom came down the hall.  Duh.  That was the point!

The bleeding stopped.  Several minutes later, Mom came down the hall, asked what happened, saw that my brother had the situation under control, and returned to the living room.  Well, that plan kind of backfired.  It seems the fact it actually was an accident and his nurturing nature prevented him from getting in trouble. 

At any rate, about 25 years later I found myself sitting in the office of an ENT who wanted to straighten out my septum.  And then I realized that there's a code for this after-the-fact injury and I was very excited! 
  • S02.2xxA, Fracture of nasal bones, initial encounter
  • Y93.83, Activity, rough housing and horseplay
  • Y92.013, Bedroom of single-family (private) house as the place of occurrence of the external cause
The codes here refer to the initial injury, had I received medical treatment. I love that there is a specific code for horseplay as the activity.  And check out that place of occurrence code - it's pretty darn specific, down to the bedroom of a single-family home.

Of note, had my doctor documented in my record at the time of surgery that this was due to an old nasal fracture, I could have used this code:
  • S02.2xxS, Fracture of nasal bones, sequela
As for my brother, he loves this story.  I remember relaying the saga to him one evening when we both happened to be in the same state during a business trip.  When his wife phoned soon after that, he proudly declared to her that he had broken his sister's nose.  "Just now?!," she exclaimed and then he had to tell her the story.  It's funny now - especially years after the surgery.  But if you have kids, just warn them.  Pillow fights in the dark are a bad, bad idea.

Tuesday, August 28, 2012

Code for the Day: Will Insurance Cover T75.01xxA while Y93.11?

It hardly seems possible, but Labor Day weekend is upon us and September is only a few days away.  As the unofficial end of summer, that means one thing in Colorado - all of the pools will be closing this weekend.  It's my last chance to get to the pool before they abruptly drain it and cover it over.  The only time it will be appealing until next Memorial Day weekend is when it snows enough to partially coat the pool cover and make it look like a picturesque iced-over pond. 

So this weekend I'm hoping the super hot weather we're having this week carries over through Monday without any thunder storms. You see, I'm old school when it comes to swimming. 

All those rules that seemed so ludicrous when I was a kid now make perfect sense.  Don't run around the pool because it's slick and having suffered my share of skinned knees from falling pool side, I get it.  Don't eat right before you swim because you might get a cramp and drown.  And finally, the second you hear thunder, get out of the pool.


Apparently these rules no longer apply, though.  There is a swimming pool within clear view of my office window and one of my favorite summer pastimes is watching people hang out in the pool during  thunderstorms.  Actually, most of the time, they move to the hot tub instead.  Maybe hot water is safer than cold in an electrical storm.  One day I watched as it poured rain with crazy thunder and lightning and there were 3 or 4 people in the hot tub.  With umbrellas.  I suppose they didn't want to get their hair wet as they sat in a tub of water.  I wondered, though, if they had given any consideration to the lightning rods in their hands.

So it got me pondering.  With these new ICD-10-CM codes, the insurance company will be able to tell just exactly what you were doing when you were struck by lightning.  Since it's a well-known fact that water is an excellent conductor of electricity, will insurance companies punish their customers by refusing to pay for accidents incurred while they were doing something that was, shall we say, not the smartest thing in the world?  More specifically, will insurance cover T75.01xxA (Shock due to being struck by lightning, initial encounter) while Y93.11 (Activity, swimming)?  

I'm not the first to wonder.  About a year ago, the Wall Street Journal published an article questioning the need for thousands of new codes in ICD-10-CM.  And while it may seem ridiculous to have some of the codes, I've seen more than one code that made me exclaim, "Finally!" - because it is something I've seen documented before.  The people at the Wall Street Journal may not understand, but the codes are used for more than payment - a lot of statistics you hear reported on the evening news ("x number of people died in car accidents last year") comes from coded data.

It will be interesting to see, though, what insurance companies do with this information.  It actually gives me another idea - I've never been able to watch Jackass the Movie all the way through.  But it might be fun to code in ICD-10-CM!

Friday, August 24, 2012

Code for the Day: Hip-Hip-Hooray! We Have a Final Rule! Y93.45

I've been hanging out in a room with other coders most of the week with piles of cases and lots of discussions about how to code them in ICD-10.  I wanted to get at least one post out this week with a code for the day, but there was really not much I felt inspired to write about.  While many of our discussions did revolve around coder humor, nothing really jumped out at me.

I was about to let it go. It is Friday, after all.  Perhaps something inspiring would happen over the weekend.  Or perhaps the Final Rule for ICD-10 would be published on Friday morning.

Wait... What? The Final Rule?

We've been through a roller coaster with this whole ICD-10 thing.  When I started as a coder in the 90s, there were rumors that ICD-10 was coming any day.  It was already overdue at that time - it should have been implemented in 1989.  And we waited.  And waited.  We went to countless presentations once the draft code sets were underway and in January 2009, just before President Obama took office, we were told it was official - we would be implementing in 2013!  But wait... once President Obama took office, he put everything the Bush administration tried to push through in his last weeks in office on hold.  That hold was temporary, though, and it didn't take long before ICD-10 was back on track. 

And everything was just great and hunky-dory until April of this year.  After spending countless hours, days, and months preparing not only myself, but clients and our state association as well, I was completely deflated.  And even though everyone said not to stop preparing for ICD-10 implementation - even if we had a one-year delay, there was a definite slowdown in the health care community.  I heard rumors of some organizations postponing their ICD-10 budgets.  Some people I've talked to from other organizations who were so anxious to be a part of Colorado's ICD-10 Task Force suddenly stopped coming to meetings.  This was exactly what I was afraid of when the delay was announced.  I didn't want to lose the great momentum I'd seen build up over the last year.

Then this morning, I saw it.  The Final Rule!  And our new date - October 1, 2014.  It's official.  And while I haven't had time to read it yet, it is printed out and ready to be perused over the weekend. My first reaction was to cheer - to tell everyone I could think of that ICD-10 is a go.  So I spread the word to my coworkers, our state association, and Colorado's ICD-10 Task Force.  And then I broke out the purple pom pons because it's coming.  For real this time (we hope)!

So here it is, for everyone who has been preparing for ICD-10 - the code for the day:
  • Y93.45, Activity, cheerleading
Cheer on!  Hip-hip-hooray!  It's the end of the questionable delay!

If you would like to peruse the final rule, you can find it here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2012-21238.pdf.

Thursday, August 16, 2012

Code for the Day: The Goonie Code - Z60.4

As I mentioned in my last blog posting, I recently returned from Oregon.  The trip was conceived while catching a repeat of a favorite movie from the 80s - The Goonies.

The Goonies house with its signs & the jail with getaway Jeep
If you haven't seen the movie, I highly recommend it.  In short, it's about a group of misfit kids living in Astoria, Oregon, who are in danger of losing their homes to the rich set, who plan to tear down their houses in exchange for a golf course.  The kids find a treasure map in the attic that leads them on an adventure complete with the bumbling Fratelli gang of crooks, pirates, scary caves, and - of course - hidden treasure obscured by Oregon's natural landscape and pirate booby ("that's what I said, booby") traps.  And if they can find the treasure, they can save their homes, which they lovingly refer to as the Goondocks.  The movie was written by Chris Columbus, produced by Steven Spielberg, and directed by Superman's Richard Donner and starred Sean Astin, Corey Feldman, Josh Brolin, and a cast of familiar faces.  Do you need a better reason to see this film?!

So while watching the movie and all its extras one night, we decided it was a must see.  Besides, there are other things to check out in Astoria- other movies, like Kindergarten Cop and Short Circuit were also filmed there.  Oh, and then there is Astoria's natural beauty as well!  So we set off to what I now like to call Goonie Town and began our adventure.  Immediately upon checking into the hotel, we noticed the Goonies house sitting atop a hill overlooking the town.  Cool!  First stop: the old jail where the opening jail break scene was filmed.  Parked out front - complete with bullet holes in the tailgate - was the Fratelli's getaway Jeep!  The jail now houses the Oregon Film Museum with a special nod to the cell where Jake Fratelli was imprisoned.  Very cool!  Then we headed across the street to the Flavel House, which is the museum where characters Mikey and Brand's father worked.  It turns out it's also an amazing Victorian mansion that you can tour.  Historically cool!  We then parked and walked up the hill to the Goonies house where a sign at the base of the driveway welcomed us (Goonies) and where, at the top of the hill, a small group of fans took turns snapping pictures of the house that meant so much teenagers in 80s.  You could almost see Chunk out there doing the Truffle Shuffle! We even made it down the coast to Ecola State Park and Cannon Beach where the majestic Haystack Rock formation is found.  Naturally cool!


Anyway, it was a great time and we proudly proclaimed ourselves Goonies.  What's interesting is that the Goonies were misfits - they didn't fit in anywhere else, so they created their own little club.  But I always related to the Goonies - perhaps because I was a misfit myself.  At any rate, they had an amazing adventure and I couldn't help feeling an enormous amount of nostalgia just being in Astoria.

And so today, still with part of my brain stuck on the west coast, I decided to look for a Goonie code.  Here it is (with instructional notes):
  • Z60.4, Social exclusion and rejection
Exclusion and rejection on the basis of personal characteristics, such as unusual physical appearance, illness or behavior.
This is an interesting code.  I think a lot of people could argue that this code fits them, which perhaps means we all fit in just by the fact that none of us fit in.  I never considered the Goonies to be misfits, but I suppose Mikey's fragile asthmatic state, Brand's inability to get a driver's license, Chunk's weight, Data's outrageous gadgets, and Mouth's sharp tongue do make them stand out.  But I always liked their motto: Goonies never say die!