Retiring at the right time - ICD-10 starts in October

[Frostbit]

Slowly but surely the delivery of medical care has been complicated by regulations instituted by the Government and Insurance Companies. The excuse for these regulations starting in 1983 with the institution of DRG's (Diagnostic Related Groups) was the rising cost of healthcare and a way to "justify" the need for certain services. If you don't "code" the diagnosis or procedure properly the insurance companies delay or refuse payment or in the case of the Government with Medicare/Medicaid they may even fine you retroactively.

In October we are mandated to switch from ICD-9 to ICD-10. ICD-9 had approximately 17,000 codes to use to decide the "exact" diagnosis in order to set billing levels and hope to be paid for your services. ICD-10 has 155,000 codes.

I kid you not...there are codes for attempted suicide by Jellyfish, separate codes for initial incident of being sucked into a jet engine and for any repeat accident of jet-sucking. This may sound like a joke but it is not.

Our Electronic Medical Record at work searched for the ICD-9 based on your named diagnosis. The system just added the search for the ICD-10 codes "so we can start to get used to them". I had a patient today with Pneumonia. In the past all I ever had to put in was 684 (pneumonia), It didn't matter which lobe of the lung was effected. Let's face it, the treatment and thus the cost is the same. When I put in pneumonia this time I ended up with about five pages of choices. It took me a good ten minutes just to find a code I could use. There is no ability to be generic with this system.

Like I said, I'm glad I'm retiring in December. For those of you that like big Government Nanny State politics enjoy where your health care is headed because tech weenies, insurance companies, drug companies, and the Government are your new providers.

[Frostbit]

CODE CHAOS

"Coburn believes the new system will require doctors to spend more time coding. “You’re just not going to trust a nurse to do that,” he says. “If they put in the wrong code, they’re going to hammer you. The penalties are getting more severe. If you fail a recovery audit, they don’t just take your money, they penalize you on top of that.”

Coburn’s concerns go beyond the likelihood of a rough transition to ICD-10 to the long-term effect the changes could have on the doctor-patient relationship. The specificity of the codes will require doctors to spend more of their time on documentation. “Let’s say it takes you an extra two minutes per patient to do the coding yourself,” he says. “It doesn’t sound like much. But if you see 30 or 40 patients a day, that’s at least an extra hour you’re spending on this stuff. That minute or two that you’re not spending talking with the patient might be the minute when you learn something critical to your diagnosis or treatment plan.”

His prescription: “Delay it forever. The health care system can’t take another cost, especially right now.”

Coburn has introduced legislation to do just that, but most industry experts believe the prospects for a delay are poor. ICD-10 implementation has already been delayed twice, most recently in April 2012, giving “covered entities” an extra year that expires at the end of September. “I’d be shocked” if there’s a further delay, says Holly Louie, the ICD-10 coordinator for the Healthcare Billing and Management Association.

CMS administrator Jeff Hinson, in his conference call with Colorado providers, offered a stern warning about the October 1, 2014, compliance date. “You need to know that the deadline is firm,” he said. “The deadline is firm.”

That could spell disaster.

Despite desperate pleas from virtually every corner of the health care industry, the federal government has offered no details for comprehensive end-to-end testing of the new coding system before it goes live in seven months. “In meetings over the past two or three years between commercial payers and CMS, we were told that if everything went relatively smoothly, and we just saw the typical hiccups associated with a major transition like this, there could be as much as a one-year disruption in cash flow—for both large and small practices,” says Louie. “And that’s when we thought there would be end-to-end testing.”

Coburn, along with the other Republican physicians in the Senate, is trying to force CMS to perform comprehensive testing or to delay the start date. “Given the size and scope of the potential transition to ICD-10, the brevity and limited scope of this test is worrisome,” they wrote in their letter to Tavenner.

Annie Boynton, the ICD-10 trainer, says that 20 of the 50 states have done “nothing” to update their systems for ICD-10. “The sector of the industry that scares me the most is government,” says Boynton. “Historically, they are not great with major regulatory implementation rollouts,” she adds with a knowing smile. “HealthCare.gov was a perfect example. When [Health and Human Services] Secretary Sebelius was sitting in front of Congress, the Energy and Commerce Committee, answering all those questions, I had this really sinking feeling that in 2015, we’re going to be there again.”

[Adam]

I was going to post something about this last week, but I got side-tracked and never came back to it. Someone, somewhere had a list of some of the most absurd of these, which the article touched on, such as injuries sustained from crash-landing your spacecraft. Methinks this might be related to the expansion of availability of pot....

"Man, what if someone hurts themselves when their spaceship crashes? We should have a code for that, man! You know, like, what if someone is just minding their own business riding a unicorn when they get struck by a meteor? And that collision, like, causes their bong to get lodged around their ankle? There should be a code for that, man! It could happen!"

[Frostbit]

I was going to post something about this last week, but I got side-tracked and never came back to it. Someone, somewhere had a list of some of the most absurd of these, which the article touched on, such as injuries sustained from crash-landing your spacecraft. Methinks this might be related to the expansion of availability of pot....

"Man, what if someone hurts themselves when their spaceship crashes? We should have a code for that, man! You know, like, what if someone is just minding their own business riding a unicorn when they get struck by a meteor? And that collision, like, causes their bong to get lodged around their ankle? There should be a code for that, man! It could happen!"

I just checked the system. There are only four codes for Marijuana Abuse.

[gary m]

I just checked the system. There are only four codes for Marijuana Abuse.

Probably more than that for shoulder injury due to rifle or shotgun recoil.
They probably break it down by what you were shooting and what you you were shooting at.

[Norm dePlume]

I just checked the system. There are only four codes for Marijuana Abuse.

But did you look under "cannabis"?

http://www.icd10data.com/ICD10CM/Codes/F01-F99/F10-F19/F12-

• F12 Cannabis related disorders
  • F12.1 Cannabis abuse
    • F12.10 is a specific ICD-10-CM diagnosis code F12.10 …… uncomplicated
    • F12.12 Cannabis abuse with intoxication
      • F12.120 is a specific ICD-10-CM diagnosis code F12.120 …… uncomplicated
      • F12.121 is a specific ICD-10-CM diagnosis code F12.121 …… delirium
      • F12.122 is a specific ICD-10-CM diagnosis code F12.122 …… with perceptual disturbance
      • F12.129 is a specific ICD-10-CM diagnosis code F12.129 …… unspecified
    • F12.15 Cannabis abuse with psychotic disorder
      • F12.150 is a specific ICD-10-CM diagnosis code F12.150 …… with delusions
      • F12.151 is a specific ICD-10-CM diagnosis code F12.151 …… with hallucinations
      • F12.159 is a specific ICD-10-CM diagnosis code F12.159 …… unspecified
    • F12.18 Cannabis abuse with other cannabis-induced disorder
      • F12.180 is a specific ICD-10-CM diagnosis code F12.180 Cannabis abuse with cannabis-induced anxiety disorder
      • F12.188 is a specific ICD-10-CM diagnosis code F12.188 Cannabis abuse with other cannabis-induced disorder
    • F12.19 is a specific ICD-10-CM diagnosis code F12.19 …… with unspecified cannabis-induced disorder
  • F12.2 Cannabis dependence
    • F12.20 is a specific ICD-10-CM diagnosis code F12.20 …… uncomplicated
    • F12.21 is a specific ICD-10-CM diagnosis code F12.21 …… in remission
    • F12.22 Cannabis dependence with intoxication
      • F12.220 is a specific ICD-10-CM diagnosis code F12.220 …… uncomplicated
      • F12.221 is a specific ICD-10-CM diagnosis code F12.221 …… delirium
      • F12.222 is a specific ICD-10-CM diagnosis code F12.222 …… with perceptual disturbance
      • F12.229 is a specific ICD-10-CM diagnosis code F12.229 …… unspecified
    • F12.25 Cannabis dependence with psychotic disorder
      • F12.250 is a specific ICD-10-CM diagnosis code F12.250 …… with delusions
      • F12.251 is a specific ICD-10-CM diagnosis code F12.251 …… with hallucinations
      • F12.259 is a specific ICD-10-CM diagnosis code F12.259 …… unspecified
    • F12.28 Cannabis dependence with other cannabis-induced disorder
      • F12.280 is a specific ICD-10-CM diagnosis code F12.280 Cannabis dependence with cannabis-induced anxiety disorder
      • F12.288 is a specific ICD-10-CM diagnosis code F12.288 Cannabis dependence with other cannabis-induced disorder
    • F12.29 is a specific ICD-10-CM diagnosis code F12.29 …… with unspecified cannabis-induced disorder
  • F12.9 Cannabis use, unspecified
    • F12.90 is a specific ICD-10-CM diagnosis code F12.90 …… uncomplicated
    • F12.92 Cannabis use, unspecified with intoxication
      • F12.920 is a specific ICD-10-CM diagnosis code F12.920 …… uncomplicated
      • F12.921 is a specific ICD-10-CM diagnosis code F12.921 …… delirium
      • F12.922 is a specific ICD-10-CM diagnosis code F12.922 …… with perceptual disturbance
      • F12.929 is a specific ICD-10-CM diagnosis code F12.929 …… unspecified
    • F12.95 Cannabis use, unspecified with psychotic disorder
      • F12.950 is a specific ICD-10-CM diagnosis code F12.950 …… with delusions
      • F12.951 is a specific ICD-10-CM diagnosis code F12.951 …… with hallucinations
      • F12.959 is a specific ICD-10-CM diagnosis code F12.959 …… unspecified
    • F12.98 Cannabis use, unspecified with other cannabis-induced disorder
      • F12.980 is a specific ICD-10-CM diagnosis code F12.980 Cannabis use, unspecified with anxiety disorder
      • F12.988 is a specific ICD-10-CM diagnosis code F12.988 Cannabis use, unspecified with other cannabis-induced disorder
    • F12.99 is a specific ICD-10-CM diagnosis code F12.99 …… with unspecified cannabis-induced disorder

[Norm dePlume]

Well, this is fun.

Moose are so cute:

W55.82XA Struck by other mammals, initial encounter

THE HILLBILLY VASECTOMY Alternative:

W39.XXXA Discharge of firework, initial encounter

[Frostbit]

But did you look under "cannabis"?

http://www.icd10data.com/ICD10CM/Cod...9/F10-F19/F12-

Thank you for confirming the obfuscation of this absurdity.

[Novaheart]

Change is bad.

[Frostbit]

Change is bad.

Certainly is in this case. Most people go to a medical provider with the expectation of receiving medical care not watching an ill-fated attempt by people trained in medicine to comply with an obfuscated system designed by non-medical people in order to control costs that in reality increase those costs exponentially in an attempt to comply with the complexity.

Change is bad

More Government is bad

[Novaheart]

Certainly is in this case. Most people go to a medical provider with the expectation of receiving medical care not watching an ill-fated attempt by people trained in medicine to comply with an obfuscated system designed by non-medical people in order to control costs that in reality increase those costs exponentially in an attempt to comply with the complexity.

Change is bad

More Government is bad

About 15 years ago I had ambulatory surgery at St. Somebody Hospital. Months later, I got a collection call from the hospital because my insurance company (United) hadn't paid them. I called my insurance company and they said that the hospital had failed to bill in time and that I owed nothing, to refer the hospital collections to United. So the hospital got stiffed for thousands of dollars. That had nothing to do with Obama care.

Over the years I have had statements from the insurance company about claims denied, which were eventually paid. Why? Coding. Had nothing to do with Obamacare.

Huge article in the Times Sunday about HCA billing people and insurance companies for outrageous charges. $33,000 to come through the door of the trauma center. $99,000 for minor injury. They estimated that HCA (of Rick Scott fame) had gouged 1 billion dollars from Medicare and Medicaid alone.

Spare me.

[Frostbit]

Spare me.

Apparently you have been. multiple times.

[Frostbit]

ICD-10 implementation now delayed until October 2015. Gee.....maybe it's now such a good idea afterall.

[Gingersnap]

This seems to be the new normal: pitch some ground-breaking, extra special solution to a problem and then delay all or part of it until people forget how awful it is.