Insurance coding absurdities. Shaking my head.

[3catwoman3]

I examined a little boy a couple of days ago, who had a bee sting under his left eyebrow.

The current ICD-10, which has, IIRC, over 68,000 codes, has a ridiculously detailed set of descriptors for many diagnoses. For example, an ear infection is no long just otitis media.. It is:
Acute vs chronic
Suppurative (pus) vs serous (fluid)
Recurrent or non-recurrent
With or without perforation
Left, right or bilateral

The descriptors available for bee sting were:
Accidental or unintentional
Intentional/self harm
Assault
Undetermined intent

WTF? Seriously? The child would get himself stung on purpose? The bee acted with malice aforethought?

The bee was not available for an interview.

I soooooooo badly wanted to choose assault just to see if the insurance company would notice.

[PoliticAverse]

1. "Undetermined intent" - I mean you didn't get to ask the bee why, right? n/t

[virgogal]

2. Suicide by bumble bee ?

[Hoyt]

3. They would likely pay it, just like they'd pay for skin irritation, itching, burning, etc.

As long as you are somewhat in the ballpark, you’d get paid.

Now an overnight stay in a hospital, might require more accuracy because the payment is often based on severity. Although, a bee sting is not the best example.

The coding system is definitely absurd, though, and quiet laughable at times. But, better data might actually help in the long term through better research.

[democratisphere]

4. And these are the people running American Healthcare.

I think the bee should be indicted and found criminally neglect then the insurance company could civilly sue the bee to recover the cost of services, pharmaceuticals, legal fees, ect..

[Farmer-Rick]

5. It's really bad

When my wife died of sudden cardiac arrest, the insurance company claimed malpractice against the hospital because the drugs adminstered were at dangerous levels. Every rib was broken trying to bring her heart beat back, pain killers were given for obvious reasons.

When I called the insurance company to explain, I was told the claim was flagged for unusual scratches.....Maybe so, they really tried to save her and why do I get different explanations every time I call? This After I told them she had died. What is the code for "you all failed, she died"?

Bunch ignorant fools all of them. I hope they have to go thru their own incompetent ignorance when they lose a loved one.

[LittleGirl]

7. I'm so sorry Farmer Rick

I really am.

My brother died of heart failure in March. He was 57.
He had his first heart attack at 29 but even so, we were totally shocked. He was my baby brother and my favorite. My Mother can't even talk about it.

My sincere condolences.

[Farmer-Rick]

11. Thank you

You at least understand the grief. So many people try to hide it as if it is something to be ashamed of.

I have decided I am going to talk about it, if I think it is related to the topic.

Our society is really uncomfortable with death and grief, even medical professionals. It's like a taboo. So, I'm breaking the taboo. We need to deal with death on a day to day level because it is there in everything living.

[LittleGirl]

13. Totally agree

My first loss was my neighbors’ father who committed suicide while we were playing outside his bedroom in the front yard. We heard the shot. I was 5 years old.

We must talk about these things!

May you find peace.

[3catwoman3]

16. People don't know what to do when someone is grieving. They want to help, but they...

...don't know how.

In 1978, I was 26 when my only sibling, my 23 year old brother, Tom, died, during a scuba diving trip gone wrong. Possible cardiac arrhythmia from cold water. Didn't drown/ no equipment malfunction.

Something my mother said some time later was that she wished people had not been afraid to talk about Tom, to share memories. She knew that people avoided doing so because they didn't want to make her sad. She sad she couldn't have been any sadder than she already was, and that it helped, at least a little, to know that he was not forgotten.

That is a suggestion I pass on to people who are dealing with the loss of someone dear - when people ask you if there is anything they can do, tell them not to be afraid to talk about the person that everyone is missing.

I hope you have people willing to share memories with you.

[Heartstrings]

6. Covering all their bases....

Wouldn't want any minor pre-existing condition to go unnoticed in the future.....

[mwooldri]

8. Yet another argument for single payer.

Wouldn't have all these messed up codes. Sadly I'm used to it too ... my eldest son requires catheters (has an artificial bladder made up of his own intestine) and has a stoma to insert said catheter into. One set of codes - not covered by insurance. Another set - fully covered. Thank goodness my son's doctors liaise with the medical equipment company otherwise the medical equipment company would probably use the wrong code and we would get a large billing sensation from them.

[Recursion]

9. Ummm.... Medicare uses those codes

A single payer system nationally would absolutely have to have codes like that.

[Hoyt]

12. Not true. As poster above mentions, Medicare uses these codes AND is they are very picky in

how the codes are used and in auditing provider records.

[Ms. Toad]

10. On the other hand, my daughter's rare disease

now has its own ICD-10 code (K83.01) (as of October last year).

It is a step toward being able to gather data specific to her disease, rather than generic cholangitis. It will make some insurance claims far easier, since annual screening for primary sclerosing cholangitis (which carries with it the risk of between a half-dozen and dozen cancers) is legitimately more expensive than screening for generic cholangitis - but until a year ago they shared the same code (and generated a number of insurance fights).

I agree that the descriptors for bee sting are silly - but I actually don't see any irrelevant data being gathered as to an ear infection.

[3catwoman3]

17. I think which side an ear infection is on is completely irrelevant. It does not...

...influence the course of treatment I choose. It's not as if I choose Amoxicillin if there is a right ear infection, and Zithromax if it is on the left.

If I do not fill that part in, the computer program will not let me proceed to sending an electronic prescription to the patient's pharmacy, and the insurance company will not honor the claim. I'm glad a specific code has been developed for your daughter's diagnosis. Insurance companies are a real pain in the ass oftener than not.

We were told that electronic medical records were going to make our jobs easier and more efficient. Nothing could be further from the truth. I now take 2-3 hours worth of charting home with me because I cannot get it done in the time allotted for the office visit. That never happened with hand-written charts.

[Ms. Toad]

18. It may not be needed for insurance,

or for the immediate choice of antibiotic. But if one ear is repeatedly getting infections (as documented by the charting over time), surgical treatment may be indicated for that ear but not the one in which there has never been an infection.

Not everything that is carted is necessarily relevant for the treatment on the particular occasion when it is charted.

I actually have hearing loss related to a severe infection in my right ear as a child. That hearing loss, combined with multiple other injuries to my right side combined to create vertigo specifically because they were all one-sided (and ultimately prevented full range of neck motion). I have a decent memory, and am pretty articulate as to medical matters - but I know quite a few people who aren't. I'm sorry it's a pain for you - but I am ultimately glad that medical records are more complete and accessible.

We were at a conference for my daughter's rare disease, out of state, a couple of months ago. She developed her first ever UTI. We went to clinic in a pharmacy - and she was too miserable to type in her complete med list and complete list of drug allergies. We just figured we'd tell the NP when we went back for the exam. Before my daughter even opened her mouth, the NP was confirming the allergy and med list that my daughter had declined to enter, which she was able to pull from a completely different hospital system, in a completely different state, because of electronic medical records.

That said, my cancer treatment records are completely inaccessible - even within the hospital system that treated me (3 different sub-groups all witin the breast cancer treatment center, 3-different electronic systems).

[3catwoman3]

19. More complete records/information is, of course, beneficial...

...to all involved. I can’t count the number of times over my 40+ year career as a peds nurse practitioner that a parent has said something along the line of, “We need some more of that white cream in the little tube.” As if there were only one.

There are several problems with EMR (electronic medical record, for those who may not know.). The biggest one is how long it takes. There is so much more to do, and no extra time allotted in which to do it. My employers have actually made the sick appointments shorter rather than longer. They were only 20 minutes anyway, and now they are down to 15 minutes. That is not much time to take a history, do an exam, prescribe if needed, AND teach a parent what they need to know about how to manage whatever the problem is, never mind documenting it all. I am not a proficient typist, so I cannot listen to a mom and type at the same time. Even if I could, I don’t think I would - IMO, that’s very rude. I need to look a parent in the eye while they are telling me about their child.

Next problem is the pre-designed “point-and-click” templates for describing history of the illness and physical findings. They sound nothing like what I would say/write. The descriptions are stilted and awkward, and do not lend themselves to individual details. One of the default choices for duration of fever is “from 1-7 days.” It makes a hell of a lot of difference as to how concerned I need to be about a child if they have had a fever for only 24 hours as opposed to 5 days or more. I have designed all my own templates that say things the way I want them stated.

The “point-and-click” templates also, IMO, make it too easy for people not to pay full attention to what they are choosing. Point-click-point-click-point-click. One of the templates used by several of my colleagues contains a standard phrase “Family, medical and social history reviewed and updated today.” Then, when I open that section of the record where those details should be, there is nothing there and those sections are all marked “Never reviewed.” If I haven’t done something, I don’t want my documentation saying that I did because of a template that someone else created.

I am fanatic about thoroughness and accuracy in my documentation. I don’t want any typos/misspellings, I want easy to read paragraphs in my narratives, and I want what I say to create an unambiguous picture of what I found during an office visit and what I decided to do about it. I have always have been like this and will be until I retire, which will be happening in a little less than 2 years if I can hang on that much longer. The increased demands coupled with the decreased time in which to meet those demands have taken most of the fun out of my job. It’s sad.

[Ms. Toad]

21. Our family doctor fills out the record during the visit.

He is self-employed, so he gets to set his own schedule.

My favorite doctor in the entire world never saw me within an hour of my appointment with him (including the two surgeries he did on me - and he walked out of the second to go clean up someone else's mess) His timing issue wasn't records, primarily - although he did all of his charting outside of my presence so I'm sure it contributed. His primary issue with timing is that he won't leave a patient until the patient is ready for him to leave. His employer schedules his time - he just doesn't stick to it. I'd follow his path if I were in medicine . . . as evidenced by the fact that I'm on hour 47 of a theoretical 40-hour work-week, and it's the first formal work-day this week.

I guess my "lunch" break is over, so back to work for another hour or so before I head home.

[milestogo]

14. They needed a category for the bee's intent?

Intentional assault.

[Fla Dem]

15. Technically it was assault. The bee assaulted the young boy.

Could also have been undetermined intent. Who knows what was on the bee's mind when it attacked.

[Liberal Veteran]

20. V91.07XD: Burn due to water-skis on fire, subsequent encounter

This seems like a very specific and unlikely set of events to use this code.

[Dave Starsky]

22. V97.33XD is another classic ICD-10.

Sucked into jet engine, subsequent encounter.