Thursday, September 5, 2013

Newsflash: The AMA is Fighting ICD-10 - is my Blog to Blame?

Okay, so it's not really news that the American Medical Association is showing R45.4 (Irritability and anger) and R45.5 (Hostility) when it comes to ICD-10.  But are their R45.82 (worries) really worth all the R45.83 (Excessive crying of child, adolescent, or adult)?

Okay, all kidding aside, I hate to admit that blogs like mine might be partly to blame for the backlash, but are they?  In learning ICD-10-CM, it's just not fun to write blogs and articles about how the ICD-9-CM code for unspecified hypertension will be I10 in ICD-10.  Okay, bad example.  ICD-10 gives us I10 (hypertension).  Oh wait, you've heard that one? 

I'll go out on a limb here and just say it.  Coding is boring.  But I love it anyway and find it fascinating and go out of my way to try to make learning coding fun and enjoyable.  And since in my day job I don't get to spend a lot of time reflecting on the fun and entertaining external cause codes, I have decided to take to my blog to explore some of the more entertaining ICD-10 codes and inject some humor where I can.  And it's hard.  Because, as I mentioned, coding is boring.

But with all of the hype on ICD-10 we've managed to fool a lot of people into thinking that it's not really boring no-nonsense work and that what we do is actually very trivial and unimportant.  In an April interview on Fox News, Congressman Ted Poe (R-TX) gave several arguments against ICD-10-CM implementation in the United States and several examples of why the new coding system is ridiculous and unnecessary, including the various codes for injuries by turkeys and dog bites by specific breeds of dogs (BTW - dog bites by breed codes do not exist). 

Indeed, there are some very silly external cause codes, but in an article by the American Health Information Management Association, which wasn't as well publicized as Congressman Poe's interview, AHIMA states that there is no national mandate to report external cause codes in ICD-10-CM.  In fact, if providers are not reporting E codes in ICD-9-CM, they won't be required to report external cause codes in ICD-10-CM.  And since the 1500 billing form, which is used by physicians to report codes to Medicare, only has space for four diagnosis codes, the external cause codes are not likely to play a large role in pro-fee coding and billing.  And then all that's left is those boring codes in the remaining ICD-10 chapters.

But why isn't anyone pointing that out?  Well, I suppose it's just more fun to talk about a code for being pecked by a chicken.  Or struck by a chicken (is that a live chicken or, say, a frozen chicken from the supermarket?!).  But in reality, we are training coders on the important enhancements that ICD-10 coding brings.  Here are a couple of important "for instances" for you:
  • Somewhat simplified sepsis coding (okay, so they couldn't do it all, but we'll take somewhat simplified over super confusing any day)
  • One diagnosis code for admission for vaccination (the procedure code indicates the specific vaccine given)
  • OB codes that actually make sense - most of them classify conditions by trimester rather than that "delivered with antepartum complication" nonsense
  • New and specific codes for subsequent acute myocardial infarction (AMI) that occurs within the timeframe of an initial AMI
  • Codes for blood alcohol level (here in Colorado we're waiting for the blood marijuana content codes - I'm pretty sure Washington is interested too)
  • Bye-bye to encounter for therapy codes (talk about administrative burden - insurance companies hate those V codes for admission for physical/occupational/speech therapy codes; the new code system has a way of denoting that an injury is in the healing phase)
  • Combination codes for diabetic complications (because half the time coders forget to code the second code anyway)
Now don't get me wrong.  I am not saying that physicians won't be impacted at all because they will.  We will be asking them to document more clearly but in general we want documentation that really should already be there.  It's nice to know whether the left or right femur is broken.  I'm pretty sure that it's not just the coders who are interested.  And even though physicians won't have to code ICD-10-PCS procedure codes, we will be prompting them for more specific documentation within operative reports. 

And while we're at it, let's talk about the volume of codes.  Yes, there are a lot more ICD-10-CM codes than ICD-9-CM codes.  That's to be expected when they create codes for left, right, bilateral, and unspecified where applicable.  And my favorite quote regarding this issue came from Don Asmonga of AHIMA at a conference last spring: "There are a lot of words in the dictionary, but that doesn't mean you use all of them."  Indeed.  There are many codes that we will never use.  And coders aren't supposed to memorize codes anyway.  In the training I've done thus far, coders have actually expressed that having more codes is better - they are able to better drill down to what's really going on with the patient instead of sticking a junky nonspecific code on the case.

So if you come across a physician who is arguing against ICD-10 implementation, I would suggest that you put the kibosh on the fun code talk and get straight to the boring benefits.  Will ICD-10 impact patient care?  Probably not as directly as nurse finding a medication error before meds are administered.  But the data that is collected on the back end will have implications for future quality initiatives; in fact many of the quality initiatives coming up depend on ICD-10 data.  Besides, even the boring ICD-10-CM codes are more exciting than the same old boring ICD-9-CM codes that no other industrialized nation in the WORLD uses anymore.  I mean, I hate to play the peer pressure card, but seriously, we should be leaders in in medicine - and in collecting medical data.  Who else is on board?

How I Spent My Summer, by the Coder Coach (Y93.E6)

I really don't care if I ever see another cardboard box as long as I live.  After a summer of botched real estate closings and not one, but - count them - two moves spaced two weeks apart (complete with my office and two cats), I think I've arrived in my new home with everything except for potentially my sanity. 

I'm not sure which was more foolish - deciding to move the summer before we enter the home stretch of the last year before ICD-10 implementation or deciding to plan a wedding that will occur just a couple of weeks before ICD-10 implementation.  Just for good measure, I decided to do both.  The comforting thing is, ICD-10 is still there waiting for me even after the dust has settled from all of those cardboard boxes and I never did lose sight of my ICD-10 codebooks during the move - er moves.  In fact, my training calendar is booking up fast between now and September of next year!

I was pretty excited to find that there was indeed an ICD-10 code to describe how I spent my summer:

  • Y93.E6, Activity, residential relocation
This code includes packing up and unpacking involved in moving to a new residence.  I wish there was a code for hernia acquired by moving boxes of code books.  I swear those things multiply like rabbits.  And for the record, I have informed my fiancĂ© that we are never moving.  Ever. Again.