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!

Tuesday, August 14, 2012

Code for the Day: Culture Shock F43.23

How I spent my summer vacation...
Today is my first day back at work after vacation.  Yay.  As you can probably tell from my previous blog postings, I love my job.  But I also love sandy beaches, exploring new areas, sunsets over the Pacific Ocean, and just generally goofing off with no specific agenda.

I spent the first few days of my vacation working my little tail off around the house and getting ready for the payoff: 4 days on Oregon's northern coast.  Our trip involved a very scenic tour of Astoria and surrounding areas and, as you can see from my little photo montage here, it was simply breathtaking.  We visited 2 beaches, hiked, visited 2 lighthouses (saw a third from afar), hiked, watched the seals, hiked, visited filming locations for three movies, and hiked some more (and yes, that is a shipwreck you see in the bottom right picture!).

But now I am back in Denver where it's hot and dry instead of cool and comfortably damp.  Colorado is a beautiful state too, it's just different.

And then this morning, there was something else different - an alarm clock.  I became reacquainted with the snooze button.  And even though I love what I do, it was with trepidation that I made my way back to my office, turned on my computer for the first time in over a week, and started sifting through emails and to do lists.

It was culture shock.

And yes, my friends, as it happens, there is an ICD-10-CM code for that!

When I looked up culture shock in the ICD-10-CM code book, I wasn't expecting much.  But there it was - a code for culture shock... in the mental and behavioral health chapter.  Hmmm.  I was happy to see that it actually codes to an adjustment reaction, which simply means, I'm having trouble adapting to something new.  And I had choices for accompanying symptoms.  Today I chose both depression and anxiety.  I'm both happy and depressed when I look at my vacation pictures.  I wish I was still there.  And I'm anxious when I look at my to do list.  So here is the code for today:
  • F43.23, Adjustment disorder with mixed anxiety and depressed mood
I know it's a temporary condition, but for today, I am living in the culture shock of being home and back to work.

Friday, August 3, 2012

Code for the Day: Something Clark Griswold Never Thought About Z75.5

I hope you have enjoyed the last few weeks of Code for the Day posts and please savor this one.  Because I'm going on vacation!  For a little more than a week, I plan to take a small trip, get to some of those things around the house that there never seems to be time for, and read a book or two poolside.  My biggest plan is to turn off all work-related emails and leave my code books shut.  I couldn't leave, though, without giving you one last installment of the code for the day.  Don't worry, I'll be back and blogging more codes for the day in a couple of weeks.

Let's see, what code would be appropriate with a vacation theme?  How about this?
  • Z75.5, Holiday relief care
Okay, you caught me.  There's an identical code in ICD-9-CM (V60.5), so it's hardly new.  But I always liked the code description.  Let's break it down.  The word holiday gives me visions of taking off to exotic locals outfitted in a flowing sundress, big sunglasses, and a floppy hat.  The word relief, to me, means that getting away is such a relief to be out of the day-to-day bustle.  And finally, care - taking care of yourself during your holiday relief.

The reality is so much more boring.  First of all, when I take off, it's usually not to an exotic locale.  When I travel, it's not in a flowing sundress and floppy hat - more like slip-on shoes and clothes comfortable enough to hoof it through the airport and then sit on a plane for hours without worrying about catching my skirt on the plane seat arms.  And floppy hats are not really conducive to storage in the overhead bin.  And finally, code Z75.5 isn't about me taking care of myself at all - it's the code we use for admitting a patient to the hospital because his family went on vacation and couldn't arrange other care for him.

When I first heard about holiday relief care, I couldn't believe it was true.  People actually take their elderly and sick family members and leave them at a hospital when they can't take them with them or arrange other care?  It does happen.  But not in the movies, apparently.  As I type this, I have the theme song from National Lampoon's Vacation going through my head.  Good old Clark Griswold never did think of leaving Aunt Edna at a hospital and maybe he should have.  Of course, they were trying to transport her to another relative and had no idea she would die on the way.  But it does give a humorous look at a serious subject - what do we do with our elderly relatives when it's time to take a holiday? 

Have a terrific weekend and I will see you after my holiday!

Thursday, August 2, 2012

Code for the Day: Fate Worse Than Death for a Baltimorean Z91.013

I have a client who sends me pictures of food.  It all started when he began on a series of business trips and he wanted to sample the local fair.  Having traveling quite extensively myself, he asked my advice on what and where to eat in the cities of Baltimore and Chicago. 

Oh, Baltimore.  I'm a Colorado native, but I owe a lot to Baltimore.  My grandmother grew up near there and had it not been for a fateful night in the early 40s at a Baltimore bus stop, she never would have met my grandfather and fallen in love.  My first trip to Baltimore wasn't until 2009 when I went to the AHIMA ICD-10 Academy but it was instilled in me from an early age that Baltimore is all about the crab cakes.  And there's nothing quite like a Maryland crab cake.  I've had lots of crab cakes over my life, many times in the presence of my now 92-year-old grandmother.  She will inevitably go for the crab cake and fries over the baked chicken and salad (love her!).  But there's nothing worse than giving a Baltimorean a non-Maryland crab cake.  I can see my grandmother now, nose turned up, "That's not a Maryland crab cake!  Too much filler and not enough crab!"  A few years before I ever got to Maryland, I contacted a cousin who still lives in Baltimore and asked her for her best crab cake reference and had some shipped out for Mother's Day.  Wow.  Best thing to ever come out of my oven (except maybe for prime rib).  And every trip to Baltimore since, my cousin takes me to that same restaurant that so lovingly shipped shellfish to Colorado.

Now that we've established my love of shellfish - I do hold the distinction of being one of the fastest crab crackers my former coworkers had ever seen, which was particularly amazing to them because I live in a land locked state - you can guess what I told my client.  Crab cakes.  You must have crab cakes!  And so he sent me a picture the next day.  And the day after that there was a picture of the crab mac and cheese. That was in April.

And just when I thought I could breathe a sigh of relief and get back to my salad, the Chicago pic came through last night.  When he asked me where to go and what to eat in Chicago I was stumped.  There are simply too many good places to eat in Chicago.  I did recommend Chicago style pizza, though.  I see he went with the thin crust.  Hmm.  I like thin crust, but really, it's Chicago!  I do see that he paired it with a glass of red wine, though.  Excellent choice.

But again, I digress.  His email last night got me thinking about the crab cakes again and about people who are allergic to shellfish.  To me - and I'm sure to countless Baltimoreans - this is a fate worse than death.  And like pretty much everything else, there's a code for it.  Today's code for the day is something I wouldn't wish on my worst enemy because, oh, there's nothing better than a Maryland crab cake!
  • Z91.013, Allergy to seafood

Wednesday, August 1, 2012

Code for the Day: Crystal Gayle Syndrome (Don't it Make my Brown Eyes Blue) W36.1xxA

Like so many people right now, I am glued to my TV each night watching Team USA go for the gold.  My favorite is women's gymnastics and there really isn't much that can tear me away from watching it.  Especially now that I have DVR.  First disclosure: I record the games every night and am usually a couple of hours behind real time, so I still haven't seen all of last night's events yet, even though I've heard the spoilers (note to self, do not go on Facebook if you are recording the Olympics).  And this morning, when I woke up, I had this weird thought in my head.  Don't it make my brown eyes blue.  As in the Crystal Gayle song from the 70s (okay young'ens - google it!).  And it's link to the 1984 Olympics.

Disclosure number two: my brother tells me I remember the weirdest stuff.

As I was watching women's gymnastics one afternoon during the 1984 Olympics, my brother had an accident with a pair of needle nose pliers and a spray paint can.  The result was a literal explosion of blue spray paint in his face.  Thanks to a quick thinking neighbor who happened to be a painter, my brother didn't lose his eyesight.  Potential sight-saving tip here: petroleum jelly on wet paint keeps it from drying and preventing paint from gluing your eyes shut.  After an agonizing evening in the emergency room - because the only thing they had on the Olympics in the ER waiting room was... ick... wrestling - and a bazillion cc's of saline washed through his nose and eyes, my brother's face, nostrils, and eyes were no longer blue.  And not a drop of blue paint got on his white t-shirt.  Today, the family lovingly refers to this incident as the time my brother tried to turn his brown eyes blue (Crystal Gayle reference complete!).

When I first started coding, I shared a house with my brother.  And since I started out as an ER coder, I could often be heard saying, "There's an E code for that."  It didn't take him long to pick up on that and he'd start asking me, "Is there an E code for that?"  Well, Bro, I'm here to tell you that in ICD-10-CM there is not an E code for that because external cause codes now have different letters.  But there is, in fact an external cause code for that:
  • W36.1xxA, Explosion and rupture of aerosol can, initial encounter
I am happy to report that my brother learns from his mistakes and so this code was never needed:
  • W36.1xxD, Explosion and rupture of aerosol can, subsequent encounter

I was so excited to code this 28-year-old case today.  I couldn't wait to get to the activity because we have all these great new external cause codes for what the patient was doing at the time of the accident.  But alas, there is no code for the activity of painting.  It's good to know there is one for injury during rhythmic gymnastics, though.  I hope none of the Olympians have to use it.  Of note, there is a specific place of occurrence code:
  • Y92.015 Private garage of single-family (private) house as the place of occurrence of the external cause
That's pretty specific.  And although my brother is pretty smart today and very successful, I couldn't resist looking up "Moron" in ICD-10-CM and it gave me this code:
  • F70 Mild intellectual disabilities
I mean seriously, even I - the younger sibling - knew you never used a pair of needle nose pliers to puncture a paint can.