There’s a revolution coming to medical care. Not a new surgical procedure to rejuvenate the aging baby boomers, or even the recently approved drug for female libido. No, it is ICD-10 CM.
If it is such a breakthrough, you are probably wondering how you have missed it. ICD-10 CM, International Classification of Diseases, tenth version, is how physicians and hospitals code medical diagnoses to get paid.
Currently, ICD-9 has 18,000 diagnostic codes. In ICD-10 there are 140,000. Are there really nearly eight times as many diagnoses? No! The new system reorganizes medical diagnoses with increased specificity. The following examples highlight changes in the new coding system.
Let’s say you broke your toe by closing it in a door. The doctor would tape it, give you something for pain, and code it for payment as “closed fracture of one or more phalanges of foot, Diagnosis Code: 826.0.
Obviously, there is a lot of ambiguity in that diagnosis. The increased specificity of ICD-10 changes the diagnosis to: “Other fracture of left great toe, initial encounter for closed fracture: S92.492A.” Okay, you say, it doesn’t seem to be that bad.
But the physician also has to describe where and how the injury occurred. If it was caught in a door at home it is also must include: “Caught, crushed, jammed, or pinched between moving objects, initial encounter: W23.0XXA.” And since it happened at home: “Unspecified place in other non-institutional residence as the place of occurrence of the external cause: Y92.099.”
Before, the code for a cut to the finger was enough. Now, all details must be coded. Estimates by coding professionals (who are going to be making a lot of money off this transition) suggest that physician productivity will decline forty percent due to the change. (Warning: your office wait time just got longer.)
Imagine the physician walking into an examination room and finds Mr. Schneider with a cloth wrapped around his hand.
“What happened to your hand Mr. Schneider?”
“I cut my finger.”
Today, it is a breeze; diagnosis: “Open wound of finger(s), without mention of complication: 883.0.” He gets a dressing to the wound, a tetanus shot, and on his way in ten minutes.
Beginning this fall that encounter will be just a fond memory.
“Mr. Schneider, what happened to your hand?”
“I cut my finger.”
“I got pecked by a chicken.”
“Are you sure?”
“Of course I’m sure. It’s my chicken, Gertie, my best layer, and she pecked me when I went for the eggs.”
“So you were pecked, not struck?”
“Well, yeah, I guess she struck me with her beak.”
“So were your struck or pecked? Or some other contact.”
“She pecked me,” Mr. Schneider will reply.
By then, both the doctor and patient will be on edge.
“For the love of God, what is it with you and these questions! My chicken pecked me!”
“And it was a chicken? Not a turkey?”
In medicine patients are systematically interrogated about their symptoms and history. In the past, a bird peck would have been adequate. Now, physicians must “rule out” other potential instigators of the injury such as parrot, macaw, other psittacines, goose, duck, and the very vague “other birds”.
So, after cleaning and dressing the laceration, administering a tetanus shot, Mr. Schneider would be on his way, although probably upset why a simple chicken peck office visit took ninety minutes of history to put Neosporin™ and a Band-Aid™ on the wound.
It would be billed as: “Pecked by chicken, initial encounter: W61.33XA,” documented as: “Unspecified open wound of left ring finger without damage to nail, initial encounter: S61.205A,” and where it occurred: “Garden or yard in single-family house as the place of occurrence of the external cause: Y92.017.”
If erroneously coded as Y92.013, payment would be denied because that is “Bedroom of single-family house as the place of occurrence of the external cause” unless it also had the code F65.89 as “Sex with domesticated fowl in private residence.”
The insurance companies really don’t care if you have sex with a chicken. But if there is an injury, they want accuracy as to where the liaison occurred.