Slim Year for ICD-10 Coding Updates

Just like the past couple of years, we've been waiting rather impatiently over the last couple of months for the release of the fiscal year (FY) 2019 ICD-10-CM and ICD-10-PCS code updates.  While the PCS code sets have been out for a month or two, the CM updates were released just last week, sans coding guidelines, which we are still eagerly awaiting.  FY 2019 codes will be implemented on October 1, 2018 (the federal fiscal year runs from October 1 through September 30).  In case you're wondering how the code changes stack up to previous years, what the process is for updating the code sets, or why they aren't released at the same time, this post is for you!

In comparison to past years, it's a slim year for code updates.  When the code sets were unfrozen for FY 2017 after ICD-10 implementation, we saw a whopping 2,710 CM and 4,330 PCS code changes.  Last year, for the FY 2018 release, there were 731 CM and 6,029 PCS code changes.  FY 2019 has a pretty sharp drop for both code sets with 473 CM and 616 PCS code changes. 

If you've been playing along at home and waiting for the code releases, perhaps you've been wondering why the CM and PCS updates are not released at the same time.  Even though both code sets are presented to the Coordination and Maintenance Committee for review and discussion before the Cooperating Parties and general public, each code set is maintained by a separate government agency. 

ICD-10-CM is maintained by the National Center of Health Statistics (NCHS), a component of the Centers for Disease Control and Prevention (CDC).  ICD-10-PCS is maintained by the Centers for Medicare and Medicaid Services (CMS).  Twice a year (every March and April), both agencies present proposed code changes at the Coordination and Maintenance meetings in Baltimore and then each agency works to finalize the code sets. 

Over the past couple of years, we've noticed that PCS changes happen more quickly and are released earlier than their CM counterparts.  CMS presented code proposals for FY 2019 as late as the March 2018 meeting.  On the other hand, most of the code proposals that NCHS presented for CM in March were for consideration for FY 2020.

The other trend we've been noticing since converting to ICD-10 is the last thing to be released is generally the ICD-10-CM Official Guidelines for Coding and Reporting.  We are still waiting for the FY 2019 coding guidelines to be released.  It's been common for NCHS to release the code sets first and the guidelines at a different time, whereas CMS has been pretty consistent with releasing the PCS code sets along with the ICD-10-PCS Official Guidelines for Coding and Reporting.

If you read this post hoping I would give some spoiler alerts, you'll have to wait for the webinars I'm presenting in August for Haugen Consulting Group.  I hope you'll click the links to the marketplace and register for one or both (CM and PCS) updates webinars where I will outline the changes with some background information and a healthy dose of Haugen fun.  Well, fun is relative - we're still talking about coding, but who said that has to be boring!

Here are the links to help keep you updated for FY 2019!

• 2019 ICD-10-CM Updates: Diagnosing What You Need to Know
• 2019 ICD-10-PCS Updates #FirstToKnow

Reflections of a Coder Coach: Ready to Get Back to Normal

A few weeks ago, it occurred to me that my job hasn't been "normal" for the last six years.  Right around this time six years ago is when I first went to AHIMA's ICD-10 Academy and earned my status as a trainer.  Creating and presenting ICD-10 training materials came soon after that and it wasn't until recently I realized that my job hasn't been normal for the last six years.  And since I've only known my husband for four years, one could argue that he's never known me when I'm normal... er.. at least when my job is normal!

As I look around the articles and social media related to coding, a lot has changed in this industry in the six or seven years that I've put myself out there as the Coder Coach.  When I first started blogging and meeting once a month with coding students and wanna-be's, there weren't a lot of people out there looking to mentor coders.  Now, my voice is one of many as people who never heard of coding before ICD-10 jump on the bandwagon to get a piece of the action.  There have been questions about certifications - which ones to get and how to make sure ICD-10 certification requirements are met.  There have been questions about how to code things we never had to think about before - initial vs. subsequent encounters for injuries and poisonings and root operations based on procedure intent.

I have to be honest and say that in my abnormal day-to-day life as a coder over the last few years, I've had trouble finding my voice and giving advice as a coding mentor.  I no longer feel qualified to tell a coder how to break into the industry because things are so different than they were 20 years ago when I got my start and coding is something that many people are now aware of - not something that people kind of fall into anymore.  Since I fill my days adding to my own intellectual bank by researching procedures and learning how to explain them - and how to code them - I wonder what it is that new coders need right now.  And for everyone who is trying to learn coding, I just want to reach out and give them all a virtual hug because this is, in my humble opinion, about the hardest time to learn this industry.

This week I am working on something I haven't done in years.  I'm reading the Final Rule for the 2016 MS-DRG changes.  That is something I used to read and summarize every year for my clients.  And even though the codes are different and there are some new sections to read in this super long file, I had a moment of realization, a sigh of relief if you will, that this... this is normal!  After we flip the switch on October 1 and everyone starts using ICD-10 (because I have pretty much zero faith in our congressmen to accomplish any earth shattering legislation in two weeks when they're so focused on Donald Trump's run for president), I'm sure there will be a few things that don't go as planned.  But for coders, it's a time for us to return to "normal."  I miss having a general confidence in assigning codes (although this has gotten better as I train more coders!).  I miss code updates!  Oh, how I miss those code updates!  We've had frozen ICD code sets for four years!  I've been following the recommendations made to the Coordination and Maintenance Committee and I can't wait to see which changes they decide to adopt on October 1, 2016.

And maybe when the dust settles a bit and we see how many people really want to stick with coding in ICD-10, I will find my voice again as the Coder Coach.  I sincerely hope so, because I miss meeting people with a passion to learn about my passion and giving them little nuggets of wisdom to help them make a difference in this industry.

I don't want to live in a world where Ebola is sold out at the Giant Microbe store - and there's no code for it

There is a super cute little toy shop in Coeur d'Alene, ID called Shenanigan's Toy Emporium that sells vintage toys and other unique items.  When traveling there on business, we usually make a stop in to shop from their wall of amazing salt water taffy and check out their selection of toys that don't come with a power button.  You know, the kind of toys we had prior to the Atari and Game Boy era!

Shenanigan's also has a great display of giant microbes - small plush renderings of everything from the common cold to diarrhea.  I am still marveling at how they could create a plush toy out of liquid stool!  I'm sure it's just the geeky coder in me (and my colleagues), but we decided to buy a few and put them out during our training sessions along with our baskets of Play Dough, pipe cleaners, and candy (we like to have FUN in our training sessions!).  Needless to say, they were a big hit with our clients and we noticed on one of the tags that there was a website where we could order more.  By now your interest is surely piqued, so be sure to check out the online Giant Microbes store.

You're probably thinking what I'm thinking right about now, which is, wouldn't these giant microbes make great white elephant gifts for Christmas?  My thoughts immediately went to what would be appropriate for my family's white elephant gift exchange.  Don't worry, my family has a great sense of humor - there's still a copy of Pamela Anderson's novel (yes, she wrote one) complete with the "naughty" pages clipped together courtesy of my grandmother who was sheltering her daughter from the filthy parts.  And what better gift for someone in 2014 than the Ebola virus?  There's just one problem.

Sold out.

Apparently I am not the only person who thinks that Ebola would make a great Christmas gift.  It's a sign of recent headlines that this virus, which is actually kind of cute in plush form, is unavailable.  What's even more worrisome given that this was the year Ebola came to the US, is that we don't have an ICD-9-CM code to report it.  Here's the best we can do in ICD-9:

• 065.8, Other specified arthropod-borne hemorrhagic fever
• 078.89, Other specified diseases due to virus

What about ICD-10-CM?  How about this?

• A98.4, Ebola virus disease

YESSSSSS!  Way more specific!

In previous years as we've prepped for ICD-10 implementation, the opponents have given a laundry list of extensive and admittedly ridiculous (yet fun!) ICD-10 codes that begged the question, why do we really need this?  And this year, Ebola was delivered to our health system and we have nonspecific codes to report it.  But in ICD-10, we have a very specific code.  Hmm.  Perhaps this ICD-10 thing really could help with reporting and impact patient care.  Just a thought.

So Santa, if I can't have Ebola for Christmas this year, could I please have ICD-10 so that I can code it for those people who did get it?

Author's Note: I am not affiliated with Shenanigan's Toy Emporium or giantmicrobes.com in any way. I am just a really big fan!

From the Trainer: ICD-10 FAQ #1 - If the US is the last to implement, why are there so many unknowns?

For the last year, I've traveled across the country providing ICD-10-CM and ICD-10-PCS education to coders and clinical documentation specialists.  Our company's model provides three separate training sessions for our clients: basic, intermediate, and advanced.  This means lots of repeat visits to each client, lots of really hard questions, and tons of professional growth for me.  I thought it was time to start a new series here on my Coder Coach blog: ICD-10 FAQs.  This is a question I've been asked a lot lately as we get into advanced trainings and more controversial topics:

If the United States is the last country to implement ICD-10, why are there so many unanswered coding questions and why do we have to wait for Coding Clinic advice?

While it seems logical that someone would have figured out all of this ICD-10 stuff within the last 20 years as we've been "messing around" here in the US (please note the sarcasm, because I don't really think we've been messing around; we've actually been quite busy), the reality of the situation is that the US version of ICD-10 is different from everyone else's.  The core ICD-10 code set was developed by the World Health Organization (WHO) and classifies causes of morbidity (i.e., diagnoses) and every country has the ability to adapt it further (e.g., ICD-10-CA in Canada, ICD-10-AM in Australia, ICD-10-CM in the US).  Two things should have jumped out at you based on this statement:

1. ICD-10 diagnosis codes may be different in Canada, Australia, and the US
2. The international code set does not  include procedures

Let's tackle #1 first.  The US version of the ICD-10 diagnosis codes, ICD-10-CM, is a clinical modification (BTW - that's what the "CM" stands for; it's not "coding manual" like some people seem to think).  It is based on the WHO version, but has been adapted for use here in the good ole United States of America.  I haven't had a ton of time to compare it to the original, but what I do know about the CM version is this:

• The Excludes1/Excludes2 convention, which solves a lot of problems from ICD-9 (and creates a few new ones) is not part of the WHO version
• The use of 7th character extensions for injuries and poisonings is not part of the WHO version
• The expansion of the external cause codes, which are not required for reporting, are not nearly as extensive in the WHO version
• While we have adapted diabetes terminology in the US to Type 1 and Type 2 diabetes, the WHO version still uses the insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) terminology that we've worked so hard to banish from our medical record documentation here in the States

Most of the really hard diagnosis questions I get about coding ICD-10 diagnoses revolve around the changes that are unique to the CM version.

As for the procedural component, ICD-10-PCS (which stands for procedure coding system), that was developed in the US by CMS under contract with 3M.  Although I've heard that other countries have plans to adopt PCS, right now the US is the only country using it.  Although other countries have procedural coding systems, it's important to remember that we are the only ones using coding for reimbursement.  For that reason, we will likely place more weight on those procedure codes than other countries and when it comes to PCS, it's uncharted territory.

Hopefully that answers a couple of questions about the ambiguity of ICD-10.  And may I also just point out that this is nothing new.  Coding has always undergone an evolutionary process.  We have seen it with ICD-9-CM and CPT.  It's the reason we have official publications like the Coding Clinic and CPT Assistant.  If you are not familiar with these publications, you need to be.  They are official resources that answer a lot of questions.  And as of second quarter of this year, the American Hospital Association has stopped publishing Coding Clinic for ICD-9-CM and is only publishing Coding Clinic for ICD-10-CM/PCS.  My colleagues and I have been monitoring the publication very carefully each quarter because their advice does change some previous assumptions many have made based on what we know about these new coding systems.

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 fiancé that we are never moving.  Ever. Again.

Code for the Day: It's All About Heart (I21.-& I22.-)

I am not a fan of Valentines Day.  And please don't mistake this for bitterness, I just find it ridiculous that we have a holiday dedicated to telling the ones we love that we love them when there are 364 other perfectly good days in the year to confirm the sentiment.  So I really just see Valentines Day as an excuse for my grocery store to mark up the cost of roses for 2 weeks in February.  And let's be real here: I hate the combination of pink and red hearts.  I don't know what it is, but it makes me queasy.  Pink hearts alone are fine.  Red hearts alone are dandy.  But together, ick.  And it get even worse when they throw in those purple hearts for good measure.

As I sit here with my pink heart necklace - after all, I am a festive person and there are no red hearts in sight - I do like Valentines Day as a reminder of something more important: February is American Heart month.  Maybe you "go red" on Fridays or wear a red ribbon.  Maybe you take the month to become more educated on heart disease and the warning signs of a heart attack.  Today, I think we should definitely focus on ICD-10 coding for myocardial infarction!  So consider this my valentine to you: a short tutorial on what to expect in ICD-10 for coding myocardial infarction.

The first thing you need to know is that the definition of an acute myocardial infarction (AMI) has changed.  It is no longer one that has occurred within the past 8 weeks, the period is now reduced to 4.  You also no longer need to know if the AMI episode is the initial or a subsequent encounter for treatment.  In fact, forget everything you know about coding AMI in ICD-9-CM because it will just confuse you in ICD-10-CM.  Here are the highlights:

• The new period for an AMI is 4 weeks
• The terms ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) are now part of the code titles, not just inclusion terms for the codes
• AMI codes to two categories: 
• I21, ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
• I22, Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction
• Additional characters report the specific site of the AMI (heart wall or vessel)
• Sequencing depends on the circumstances of admission

The key to knowing when to use a code from category I21 versus one from category I22 is not when the patient receives treatment, but for which AMI he is receiving treatment for.  

Let's take an example.  Bob comes in February 14 with a heart attack.  This is so tragic for Bob's wife, who did not get her roses.  For this Valentines Day visit, we assign a code from category I21 for an initial AMI.  This is the first heart attack Bob has had in the last 4 weeks.  

Let's say Bob comes back on his anniversary, February 28 with a second heart attack. I'm really starting to feel sorry for Bob's wife.  Oh, and Bob too. For this second visit, we would assign a code from category I22 to show that this is a subsequent heart attack that occurred within the 4 week period of his initial heart attack.  You would assign a code from category I21 as a secondary diagnosis to report that first heart attack on Valentines Day.

As for sequencing, notice in Bob's case, I22 was put first on the second visit since it was the reason for his admission (after study, yada yada).  But what if Bob had been admitted for that first heart attack on the 14th and experienced his second while he was an inpatient?  In this case, the I21 would be sequenced first with I22 as a secondary.  Again, sequencing depends on the circumstances of admission.

I'll just let that sink in a bit.

Have a healthy and happy Valentines Day and enjoy the ones you love.  And if you must indulge, might I recommend some antioxidant chocolates and heart-healthy red wine?  Stay away from those overpriced roses!

Code for the Day: Let's Hope Steamboat Springs' Lighted Man Never Sees This on a Claim Form

I just spent a very fun weekend in Steamboat Springs with my boyfriend visiting his family.  For the second year in a row, we decided that the prime weekend for a visit was during Winter Carnival, which is pretty spectacular if you ever have the chance to witness it.  During the day, they load up Main Street with snow for events such as the donkey jump, where local cowboys saddle up their horses so they can drag kids on skis over ski jumps (something my boyfriend has experienced and survived) or the shovel race, where the cowboys drag "grown" men sitting on snow shovels down the street to see who can get the best time.

There are lots of other things going on as well.  Last year, we went to Howelsen Hill - home of the Steamboat Springs Winter Sports Club and training ground of many Olympians - to watch some ski jumps.  But perhaps the biggest draw is Saturday night's fireworks display and the Lighted Man.  This show begins after dark at Howelsen Hill as skiers carrying flares make their way down the mountain.  Cut your eyes to the right, and you will see ski jumpers with flares jumping through a ring of fire.  But the grand finale is always the Lighted Man - a skier outfitted in a suit of LED lights making his way down the hill while fireworks shooting from his body.

As for me, since I don't downhill ski, I spent the weekend running barefoot through snow-lined walkways from pool to pool at the hot springs, traipsing through a man-made ice castle, and giving cross country skiing a try. There were so many options for a code for the day, but I kept coming back to the Lighted Man.  Because codes on a claim tell a story, I just wonder what the insurance company would say should the Lighted Man have to report these codes:

• W39.xxxA, Discharge of firework, Initial encounter
• Y93.23, Activity, snow (alpine) (downhill) skiing, snow boarding, sledding, tobogganing and snow tubing

It's such a fun tradition, I hope he never has to find out. I didn't get close enough to the mountain this year to get a good pic of the Lighted Man, but if you'd like to see some great pictures of the Winter Carnival is like, there is a good synopsis if you click here.

Code for the Day: There's Even a Code for One of My New Year's Resolutions! (Y93.E9)

How do people start New Year's resolutions on January 1?  Am I the only person in the world who bakes, entertains, gift wraps, and parties myself into oblivion until the point where I don't want to do a darn thing come New Year's Day?  Here we are on January 14 and I am finally getting things organized enough to focus on how to better myself in 2013. 

Oh sure, I had lofty goals.  Last year, we took an awesome New Year's day hike at Red Rocks Park near Denver.  And we were going to do it again.  But this year 2013 hit us in a sleep deprived state so we decided to forgo the hike and head to a late breakfast instead.  We did end up at Ikea, though, so I suppose a few hours there could technically be classified as a hike.

In general, I hate New Year's resolutions.  I think they are incredibly cliche and what's even more cliche is the fact that they never last.  I think the number 1 New Year's resolution should be to make your New Year's resolution last longer than a few weeks - maybe even the whole year. 

I try to start out every year with a general plan to get organized and unload myself of unnecessary clutter. I am, after all a super organized coder and that carries over into my home and daily life. So I've spent the last couple of weeks organizing my kitchen, planning menus, organizing closets, cutting back on what I eat (duh, who doesn't have that resolution!), and decluttering my physical space.  And I was so delighted to find that there is, in fact, a code for that:

• Y93.E9, Activity, other interior property and clothing maintenance

If only there was a companion code specific to shoe shopping - then I could code the before and the after!

What's in Store for 2013?

Happy New Year to all of you!  I am not sure what is in store for my blog in 2013, but I continue to look around for inspiration. For now I am still inspired by the Code for the Day, even though it doesn't seem to come every day. Look for an FAQs page coming some time in the next couple of months for people interested in a coding career.  And best wishes for keeping your New Year's resolution past first quarter!

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!!!

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)

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!

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)

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)

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!

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)

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)

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!

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.