Letting Bureaucrats Run With Codes | According To Hoyt

For everyone who has ever thought “this would be best done by a centralized bureaucracy” let me remind you that when you let things be done by “the government” what you’re doing is giving power to people who have sat behind desks so long they’ve turned into Terry Pratchet’s auditors and think reality is classifiable into codes and numbers.

Perhaps it is because I’m one of those people who whenever she runs into a carefully coded system that I feel leery of such systems.  Though with National Health Care to give them credit (it’s credit, right?) they’re trying to cover every possible instance…  Except I bet I still fall between the cracks.

They’re also classifying as pathologies things that… you’ll see.

So, this started because son shouted from his room “WT ACTUAL F People?”

In such circumstances I run to see what he’s looking at.

It was this!

We’ll start with the codes that most affect our people, shall we?

​1. R46.1: Bizarre personal appearance.

The Funny Take: We call this a Science fiction convention!

The Serious Take: Bizarre according to WHOM?  Perhaps I don’t like your mustache, doc!

From the other side:  We call this a Science fiction convention!

W5609XA: Other contact with dolphin, initial encounter

Funny Take: Don’t do it, Lady!  Make him buy you dinner first!

Serious Take: Well done, you.  Now all the employees of Sea World are covered when a dolphin gets amorous.

The other take: What happens at the convention pool stays in the convention pool.

2014 ICD-10-CM Diagnosis Code W53.21 Bitten by squirrel W53.21 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below W53.21 that describe this diagnosis in greater detail. ICD-10-CM codes become active beginning October 1, 2015, therefore, this and all ICD-10-CM diagnosis codes should only be used for training or planning purposes until then

Funny take: Bitten?  Bitten?  The bastards had lances!

Serious take: seriously wouldn’t “animal bite” do?  What is it with the weird specificity?  Is this how you justify your sucking at the tax-payer teat?  And really, really, THREE more specific codes?  And guys, no one get bitten by a squirrel for another year, okay?

The other take: Were you at one of those Science Fiction cons?

5. Y93.D: V91.07XD: Burn due to water-skis on fire, subsequent encounter​.

Funny Take: Yes, I know you discovered the formula for Greek Fire.  Don’t use it to make water skis

Serious Take: Someone turn off the Merry Melodies cartoons in this bureaucrat’s office.

Take from the other side: Was this Sunday morning, at worldcon?

16. V97.33XD: Sucked into jet engine, subsequent encounter.

Note for those not speaking the lingo — subsequent encounter means the patient came to the doctor who wasn’t on the scene of the accident.

Funny take: Does the code cover that much superglue?

Serious take: Dude!  Dude.  A jet engine is a blender.  A really large blender.  With fire in it.  If you get sucked into it, you’re not going to need a code.  You’re going to need a coffin.

Other side take: Well, we call it a jet engine, but it was really Mike down in the Klingon party after, you know–  Ahem, anyway, you get him a couple of drinks, and he can get a little rough.

W22.02XD: V95.43XS: Spacecraft collision injuring occupant, sequela.

Funny Take: Was this a Star Trek “sequela”?

Serious Take: Another code that affects millions, no, mayhap billions of people a year, and so totally warrants its own code, right?

Take from the other side: It's all true

S1087XA: Other superficial bite of other specified part of neck, initial encounter.

Funny take: I don’t think it’s billable.  Do you know a chick named Buffy?

Serious take: How serious was this bite?  How often does this happen?  Or do people go to the doctor for a hickey

Other side take: What do you mean those fangs weren’t fake.  Kate Paulk SAYS she writes FICTION.

Z63.1: Problems in relationship with in-laws.

Funny take: Wait, what?  You go to the doctor for that?

Serious Take: No, seriously?

From the other side: They found out you go to science fiction cons????

Y34 Y34 Unspecified event, undetermined intent

The funny take: At last.  A code to end all codes.

The serious take: W the actual F people?  REALLY?

From the other side: It’s okay.  You can admit to us you go to science fiction conventions.  It was Mike, wasn’t it?

And that is a small sample.  If you search ICD-10 codes and are willing to part with a good portion of your time, you’ll find many, many more instances where you’ll laugh out loud.  Mostly because, paraphrasing  what Heinlein said in Stranger in a Strange Land, laughing is what you do when the situation is too sad to cry about.And perhaps the most laughter/crying worthy of all is this comment on this site after an article about the codes:

#Cassie Kiehl commented on September 25, 2011:While the Wall Street Journal may think it’s a laugh, with over 300 million citizens, macaw mishaps are going to happen. The specificity of the codes helps to track public health hazards that could occur in pockets due to particular services, vendors, products, or even the pet de la mode. Interestingly, the US pioneered injury coding , changing our ICD-9 version to include causes of injury. Clearly the WHO ran with it in ICD-10. Fortunately, there are software solutions to speed iCD-10 coding like SpeedECoder, http://www.speedecoder.com. There’s no difference in time typing macaw than dog when someone comes in for an animal bite.

Yes, indeed.  But the specificity in codes betrays the type of mind where EVERYTHING must be classified.  What this person doesn’t seem to understand is that once the code exists, you become the code, and if you fall outside the code, you stop existing.

And that, ladies and gentlemen is the evil of letting bureaucrats run with codes.  They poke their moral sight out, and start seeing people as things: Classifiable, measurable widgets easily pluggable into the system, each intrinsically valueless.

I hope laughter is the best medicine, because a lot of us are going to die laughing.

Medicare Site ICD 9 Payable Codes

AARP MedicareRx Plans United Healthcare (PDF download)

United healthcare medigap (PDF download)

CIGNA HealthCare Medicare (PDF download)

United Healthcare Medicaid (PDF download)

medicare healthcare (PDF download)

Medicare Site ICD 9 Payable Codes

PDF download:


sites (to 8 wks). □ 702.0 …. *These are ICD-9 codes used for Medicare
Reimbursement. Please code appropriate ICD-9 codes based on the patient

2013 Billing Guide – PAML

Page. Introduction ..1. Key Points for Diagnosis Coding ..2. Medicare Billing 3-13.
Successful … order for payment to be made to the entity furnishing the service.

2013 Billing Guide – CLS
Apr 1, 2013 … form of ICD-9 codes, narrative diagnoses or symptoms. …. Page 9 … for which
Medicare payment is subsequently denied as not. “reasonable …

Ch 6 Coding and Billing Basics final – The American Academy of …
This does not mean that every encounter will be reviewed prior to payment. ….
The CMS (Medicare) may accept up to eight diagnosis codes, but the …. carrier
billing guidelines and know the web site for each carrier in order to find specific.

Tips and Strategies for Billing for Mental Health Services in a …
Page 1 … ICD-10-CM (diagnosis) and ICD-10-PCS (hospital procedure) code
sets effective Oct. 1, 2014. MENTAL HEALTH TREATMENT … For Medicare
payment, CMS specifies which HCPCS codes will be covered as part of their.
Medicare …

CPT and ICD-9 Coding for Surgical Residents and New Surgeons in …
Jun 15, 2005 … Table of Contents. PAGE. Disclaimer and Copyrights. 2. Chapter 1 Introduction to
Coding. 3. Chapter 2 Diagnosis Coding: ICD-9-CM Defines Medical Necessity. 9
…. For Medicare payment purposes, all of the CPT codes have.

Download the PDF – National Osteoporosis Foundation
to that page in the PDF. ⇨ To return … Medicare Payment for Physicians and
Outpatient Facilities 35 … ICD-9-CM Diagnosis Codes for Osteoporosis and

Frequently Asked Questions about Transitional Care Management
Page 1 … A2: There are two CPT codes that may be used to report TCM, effective
January 1, 2013: … performed in a non-facility setting, the Medicare payment.

Typical covered diagnosis codes
All Medicare LCDs for Eye codes contain a list of covered di- agnosis … Typical
Covered Diagnosis Codes for eye Code exams. 013.10 … of unspecified site.

2013 GI Endoscopy Coding and Reimbursement … – Cook Medical
Page 1 … Hospitals use ICD-9-PCS codes to describe procedures performed
during hospital admissions. The following … Inpatient Hospital Medicare Payment

Medicare Screening Services 2013 – ACOG
download a copy by visiting Medicare’s website at the addresses listed below: ….
The diagnosis codes for Pap smear collection and screening pelvic exam are …

and High Intensity Behavioral Counseling (HIBC) – STD TAC
Page 1 of 8 … REVISED products from the Medicare Learning Network® (MLN)·-
… be used consistent with FDA approved labeling and in compliance with the
Clinical … The use of the correct diagnosis code(s) on the claims is imperative to

DDE Users Manual for Medicare Part A – Palmetto GBA
Oct 1, 2013 … A CMS Medicare. Administrative Contractor. October 2013. Page 2. Page 3. DDE
User’s Manual. Table of Contents. Palmetto GBA. Page i …. Diagnosis &
Procedure Code Inquiry – ICD-9 . … Home Health Payment Totals .

Page 1 … The Medicare deductible. & co-payment must be paid. … HCPCS/CPT
code–90740, 90746, or 90747 (vaccine) … ICD 9 CM code–V04.89 or V05.8.

Common Codes and Unadjusted Medicare Payment Rates* – Medrad
Mar 31, 2014 … Page 1 … Physician and Outpatient Hospital Coding & Unadjusted Medicare
Payment Rates. Physician … ICD-9-CM Diagnosis Codes.

Impact of the Transition to ICD-10 on Medicare Inpatient … – WEDi
report diagnosis data across all sites of service and the International
Classification … In the FY 2009 update of ICD-9-CM there were 14,025 diagnosis
codes and 3,824 … payment in the Medicare inpatient prospective payment
system (IPPS).

Quick Reference Guide – BlueCross BlueShield of Tennessee
Page 1 … Medicare Advantage Plans, such as BlueCross BlueShield of
Tennessee, based on the health … payment model that included diagnosis data

ICD-9 Basics Study Guide – Board of Medical Specialty Coding and …
Page 1 … Introduction. To master the basics of ICD-9-CM coding, you must
understand the …. to facilitate payment under the Medicare Prospective Payment

Knee Orthoses – DJO Global
Print Message: If you are experiencing issues printing this page, then please click
‘Return … For any item to be covered by Medicare, it must 1) be eligible for a
defined … has KNEE instability due to a condition specified in any diagnosis
listed above; … payable or incompatible with prefabricated KNEE orthosis base

Step-by-Step Guide to Medicare – Indian Health Service
Step 4: Learn More about Procedural (CPT) Codes and Diagnosis (ICD-9) Codes
for …. CMS Website Medicare Learning Network . ….. The Medicare Part B MNT
payment will be 80% (because a 20% patient co-pay applies) or the lesser of …

News 7/10/14 | HIStalk Practice | ICD-10 Medical Coding Classes

Top News


HHS Secretary Sylvia Burwell announces the availability of $100 million from the Affordable Care Act to support 150 new health center sites across the country in 2015. The funds will likely add to the 550-plus health centers that have sprung up in the last three years thanks to ACA funding. Today, over 1,200 health centers provide care to over 21 million patients across 9,200 delivery sites. Community-based organizations that deliver primary care have until August 20 to complete the first part of the application process.


A new report from the National Academy of Sciences and the Institute of Medicine finds that the Department of Homeland Security is struggling to implement an enterprise-wide electronic health management system capable of collecting and analyzing the health data of its 200,000 employees. The 380-page document notes that, “Although DHS is moving toward an enterprise approach to HIT, the committee did not find evidence that the department is fully aware of the informatics capability required to maximize the potential of an integrated health information management system.” The department is apparently in the process of acquiring  such a system, but funding has not yet been approved. No doubt its HIT needs have been put on hold while the DoD and VA get their respective problems sorted out.

Announcements and Implementations


Cigna announces it has achieved its 2014 goal of creating 100 Cigna Collaborative Care arrangements with large physician groups that reach 1 million customers. While the announcement doesn’t specifically note technology’s role in the success of the programs, I can only assume it played an important one given several of Cigna’s noted keys to success: sharing claims data; predictive modeling; communication and collaboration; and clinical integration.


NuPhysicia Inc. (TX) launches a telemedicine-based tobacco cessation program for Caterpillar sales and service company Mustang CAT, already a customer of NuPhysicia’s telemedicine on-site clinic service. Clinic medical staff will deliver live, face-to-face counseling via videophone to employees enrolled in the program.

Acquisitions, Funding, Business, and Stock


Allscripts acquires Oasis Medical Solutions Ltd., a privately held, London-based provider of patient administration systems and health informatics solutions. Allscripts will combine the Oasis PAS technology with its Sunrise clinical platform to offer a single-source electronic patient record solution throughout the U.K.


Following a disappointing second quarter, Royal Philips announces it will implement a new management structure within its healthcare sector, with all healthcare business groups reporting directly to Philips CEO Frans van Houten. Philips Healthcare CEO Deborah DiSanzo has decided to leave the company.


IOD Inc. and athenahealth partner to offer IOD’s ICD-10 readiness program to athenahealth customers via its More Disruption Please program. The ICD-10 program includes terminology training for coding and billing staff, online education for physicians, documentation training for clinicians, and an interactive platform to share ongoing best practices.

Government and Politics


The ONC Health IT Policy Committee meeting presents data that show that, as of July 1, over 2,800 eligible professionals have attested for Meaningful Use for the 2014 reporting year, with 443 new participants, and 972 eligible professionals attesting for Stage 2. Eight EHR vendors are used by those who have attested for Stage 2, with 61 percent using athenahealth and 20 percent Epic. This reporting period marks the first time CMS has conducted them based on calendar quarters rather than 90-day timeframes.


Students have just one day left to apply for an unpaid ONC internship in Washington, D.C. The chosen one will assist with such projects as high quality research memos, the preparation of background memos for the National Coordinator in advance of meetings, assisting with the legislative affairs portfolio and the execution of large meetings, and performing some administrative duties, among other tasks.

Research and Innovation


A new study examines characteristics associated with enrollment in and utilization of portals by patients with diabetes. Barriers to enrollment included a lack of patient capacity, desire, and awareness of portal functions. Barriers to utilization included patient capacity, lack of provider and patient buy-in, and negative usage experience.  It seems to me that diabetic patient utilization faces many of the same challenges that non-diabetic patient utilization does, all of which likely stem from provider buy-in and patient education.


Survey results find that EHR adoption and implementation issues rank as the number-one IT problem of physicians for the second year in a row. A lack of interoperability between EHRs, and implementation and utilization costs follow closely behind, though costs are not of as much concern as they were last year.



HealthTrust appoints Kent Petty (Wellmont Health System) as CIO.



Researchers at GE develop a prototype device that will one day determine the calories in a plate of food, and deliver that data to consumers via smartphone. The device, which uses microwaves to measure fat content, water content, and weight, right now only works on blended foods. The company is already thinking ahead to incorporating the technology into microwave ovens and other kitchen appliances. Those of us that have abandoned tedious calorie-counting apps after just a week or two may also find this sort of “baked in” technology better able to deter us from unhealthy choices. I’d like to think this is the sort of innovation Jack Donaghy would be proud of.

Sponsor Updates

  • Hennepin County Medical Center (MN) details how it was able to save almost $11 million after working with Leidos Health on a revenue cycle optimization plan.
  • Hayes Management Consulting explains the details of decision support extracts. 
  • DrFirst announces in a new briefing that there are now over 28,000 pharmacies nationwide that accept electronic prescriptions for controlled substances.
  • NextGen forms an agreement with HMC/CAH Consolidated Inc. by which NextGen solutions will be deployed at five of HMC’s critical access hospitals.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.


The Differences Between ICD-9 Codes and ICD-10 Codes | Job Enjoy

Are you a professional medical coder? Then you have an important job, because your careful coding is vital for proper diagnoses, to monitor the health of the general population, accurate reimbursement, the smooth operation of facilities that provide medical care and more. That’s why a firm understanding and comprehensive training for the ICD-10 transition will be incremental to your medical coding career.ICD-10 will replace ICD-9 on October 1, 2013 as the Unites State’s industry-wide coding system. Don’t stress. According to the AAPC, ICD-10-CM shares many similarities with ICD-9-CM, like the guidelines, conventions and rules. Anyone who is qualified to code ICD-9-CM should be able to easily make the transition to ICD-10-CM coding with the proper training. However, as a professional medical coder, there are several important differences between the two coding systems that you will need to prepare for.According to the AAPC, Major Differences Between ICD-9-CM and ICD-10-CM Include:

ICD-9-CM is mostly made up of numeric codes with three to five digits. ICD-10-CM will consist of alphanumeric codes with three to seven digits. The expanded characters of the diagnosis codes will provide more information concerning disease type, severity and anatomic site.

ICD-9-CM has about 13,600 codes and ICD-10-CM will consist of approximately 69,000 codes.

A single ICD-10-CM code can be found to not only pinpoint a particular disease, but also its current manifestation.

The current ICD-9-CM coding system does not require mapping. A two-year transition period, will allow access to both ICD-9 and ICD-10 coding systems until the transition is complete. Mapping will be required so that equivalent codes can be found for outcomes studies, medical necessity edits and more.

These major differences will impact information technology and software. The transition to ICD-10-CM will help solve certain challenges that exist with the ICD-9-CM coding system. In fact, according to the American Medical Association (AMA), a primary concern today with ICD-9 is the lack of specificity of the information conveyed in the codes. The ICD-10 coding system seeks to ratify this challenge with characters in the code that identify left or right, initial encounter versus subsequent encounter and other important clinical information. With ICD-10, codes will increase in detail, offering more information, and also, greater laterality.Another challenge with ICD-9 is that some of the chapters have reached capacity, so there is no way to add new codes. To help ratify this, new codes have been assigned to various chapters. However, this often makes it difficult for these codes to be located. Under the ICD-10 coding system, codes have increased in character length, which greatly increases the number of codes for future use and decreases the chances that chapters will run out of codes.Overall, the move from ICD-9 code sets to ICD-10 code sets will mean more details, terminology changes and expanded concepts for laterality, injuries and other related factors. According to the AMA, while the complexity of ICD-10 will provide many benefits, the complexity also enhances the need for comprehensive ICD-10 training in order to fully grasp the changes that accompany the new code sets.Early ICD-10 preparation is a smart choice. With advanced preparation, you can allow yourself adequate time to grasp all the necessary changes, as well as increase your marketability to health care facilities, doctors and more, who will need ICD-10 trained individuals to help ensure a smooth transition.Consider taking an online ICD-10 course and enjoy the flexibility of self-paced learning that allows you to keep your career on track, focus on other personal responsibilities when needed and study 24/7 – in other words, when it’s most convenient for you. Before you know it, the October 1, 2013 deadline will be here, so take charge, seek out flexible, online ICD-10 training and gain the peace-of-mind and career edge you deserve.

Related Posts:

ICD-10 Implementation Postponed … Again: What Does This Mean …

icd10The race to replace the International Classification of Diseases, 9th Edition (ICD-9) with the 10th edition, ICD-10, appears to be going in circles. For years healthcare companies have been preparing to move to ICD-10, a longer coding system that will be used to report diagnoses and procedures and to enable patients to accurately pay for services. Industry expectations had been set by legislative bodies for the shift to take place on Oct. 1, 2014, but the Senate voted on May 31 to delay the implementation to Oct. 1, 2015.

The Centers for Medicare & Medicaid Services website only specified the following reason for the delay: “On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.”

The cutover to ICD-10 codes does not come without its challenges, which is why the field has been busily preparing for this implementation for months. For example, there are eight times the number of ICD-10 codes than ICD-9 codes. Under ICD-9, for instance, an angioplasty was represented by one code but under ICD-10, an angioplasty could be represented with one of 854 codes. Moreover, such a monumental change means U.S healthcare organizations will have to trade about 14,000 codes for about 69,000 codes.

The delay in execution has caused much frustration, as the healthcare industry has been upgrading its systems to handle this change—aggressively performance testing to make sure their new systems can properly handle the same volume of transactions as before. But such a delay does not mean healthcare officials can put performance testing on the backburner. Conversely, now is the time for these companies to step it up a notch so they are ready for the new go-live date. Here are a few things they should be considering:

• Leverage Professionals Who Do This Everyday: The switch to ICD-10 comes with complications, especially since healthcare companies will be handling much more data, which always comes with risks of failure. Leveraging a company with the expertise shifts the burden of production performance from the healthcare company to focus on what really matters—serving patients.
• Maintaining Training: At this point, your team is probably knee-deep in training, reassessing implementation processes and company readiness. Now is not the time to cut training cold turkey. Doing so will halt all the progress you have already made. Instead, keep charging forward with regular team meetings; continue to determine the operational risks associated with the cutover, and focus on testing and training to mitigate risk.
• Identify Your Shortcomings: Is your team slacking when it comes to testing the types of cases you will actually be treating and submitting for reimbursement with ICD-10 implementation? Is dual coding holding up your IT staff? In the coming months, identify your company’s shortcomings and make sure you onboard the experts needed to get you through the transition without hiccups.

Whether you are happy to have more time to prepare for the cutover—or are lambasting the Senate for more delays—ICD-10 is on its way and will fundamentally rock the industry. The best course of action is for companies to keep their head in the game and remain committed to a seamless, efficient implementation.

As AHIMA officials explained in a press release addressing the ICD-10 delay, “We know that the industry has already invested considerable time and money in implementation. We have long advocated for a coding system that offers flexibility and specificity, enables us to properly assess healthcare services, understand public health needs, and get the best rate of return from our national investment in EHRs and meaningful use. All along, AHIMA has urged our members to ‘stay the course’ of preparing for implementation.”