8 ms·

Coding errors abound in this space. For example, you can go to the CMS.gov to lookup ICD codes. This is what you get when you lookup the word "finger" https

by jhulla 11y ago

Coding errors abound in this space. For example, you can go to the CMS.gov to lookup ICD codes. This is what you get when you lookup the word "finger" https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx?KeyWord=finger&bc=AAAAAAAAAAACAA%3d%3d& https://www.cms.gov/medicare-coverage-database/staticpages/i... It contains hundreds of entries. Here are just a few selected at random: S61.352S Open bite of right middle finger with damage to nail, sequela S61.353A Open bite of left middle finger with damage to nail, initial encounter S61.353D Open bite of left middle finger with damage to nail, subsequent encounter S61.353S Open bite of left middle finger with damage to nail, sequela S61.354A Open bite of right ring finger with damage to nail, initial encounter S61.354D Open bite of right ring finger with damage to nail, subsequent encounter S61.354S Open bite of right ring finger with damage to nail, sequela S61.355A Open bite of left ring finger with damage to nail, initial encounter S61.355D Open bite of left ring finger with damage to nail, subsequent encounter S61.355S Open bite of left ring finger with damage to nail, sequela S61.356A Open bite of right little finger with damage to nail, initial encounter S61.356D Open bite of right little finger with damage to nail, subsequent encounter S61.356S Open bite of right little finger with damage to nail, sequela S61.357A Open bite of left little finger with damage to nail, initial encounter S61.357D Open bite of left little finger with damage to nail, subsequent encounter S61.357S Open bite of left little finger with damage to nail, sequela S61.358A Open bite of other finger with damage to nail, initial encounter S61.358D Open bite of other finger with damage to nail, subsequent encounter S61.358S Open bite of other finger with damage to nail, sequela S61.359A Open bite of unspecified finger with damage to nail, initial encounter S61.359D Open bite of unspecified finger with damage to nail, subsequent encounter S61.359S Open bite of unspecified finger with damage to nail, sequela

hga 11y ago
Well, this is the notorious ICD-10 "upgrade" from ICD-9. Which has some "wonderful" codes, e.g. try https://www.google.com/search?q=icd+10+codes+funny https://www.google.com/search?q=icd+10+codes+funny Everyone's unfair favorite is "V97.33XD: Sucked into jet engine, subsequent encounter." Unfair because that doesn't mean you were stupid enough to do that twice, but had to see a doctor after the first visit. "W55.41XA: Bitten by pig, initial encounter" is OK, it happens. But "W61.62XD: Struck by duck, subsequent encounter." WTF??? I'm from a hunting family, and I've never heard of smallish birds like ducks harming people in this way. Ditto "W61.12XA: Struck by macaw, initial encounter" and "W59.22XA: Struck By Turtle" (now, being bitten by a big snapping turtle is horrific, but being struck by any turtle???). But this remains the most bizarre of all I've heard: "V91.07XD: Burn due to water-skis on fire, subsequent encounter." OK, at least we can laugh about ICD-10. For now.
- jhulla 11y ago
  That is funny. The wide range of codes is a great setup for coding errors: errors of omission, imprecision, using multiple codes to describe an event when a more accurate single code exists, etc. In the best case scenario, every doctor/nurse/PA/etc would have a technician follow them around just to manage the coding on EMRs.
- jhulla 11y ago
  OK - I had to confirm the water-skis. You're not kidding: https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx?KeyWord=V91.07XD&bc=AAAAAAAAAAACAA%3d%3d& https://www.cms.gov/medicare-coverage-database/staticpages/i... Has Monty Python taken over the ICD?
  - hga 11y ago
    I don't blame you, I should have tried that myself. I'm still trying to figure out how that could be a legit code. Jet skis, of course. But ... ah, while trying to see if anyone else had a brainstorm, I found a better one that eliminates a lot of possibilities: V90.27XA: Drowning and submersion due to falling or jumping from burning water-skis, initial encounter Got that from http://skepticalscalpel.blogspot.com/2011/09/icd-10-codes-drowning-and-submersion.html http://skepticalscalpel.blogspot.com/2011/09/icd-10-codes-dr..., which suggests: I have come up with an answer. Someone, possibly an actor from the Jackass series of movies, sets up his water skis on milk crates in the back yard. The skis are positioned over a kiddie pool. He mounts the water skis while an accomplice sprays them with gasoline. The skis are lit, and the man jumps or falls from the burning skis, submerging and drowning himself in the process. Luckily there is an ICD-10 code for that. Maybe we're being trolled? You know, there are trolling motors, but they're (all?) slow, battery powered ones to avoid disturbing fish, not at all suitable for water skiing.
    - Mz 11y ago
      When I paid accident claims, I paid a surprising number of claims for 2nd degree burn on lower leg from motorcycle exhaust pipe. You make me wonder if there is a code specifically for that. /weird but true
vacri 11y ago
While it seems overkill, it is unambiguous. Errors are easy to make in medicine. When I was a neuro tech, I remember doing a nerve conduction study on a patient, on one arm only, and the patient had no abnormality, when went into my report. The doctor doing the final report for the record copy/pasted from his list of stanzas, and forgot to switch 'left' in his copypasta to 'right', which I caught. This particular doctor was perfectly competent; it's just that there's a thousand ways to make errors like this (and yes, copying from a list of stanzas isn't the best method, but neither is individually typing out the same diagnosis paragraphs again and again). Being unambigous with which side of the body and which body part is very important in medicine.
- hga 11y ago
  OK, that's a good argument, although the system of coding each as a separate code without a "system" is crazy (for a bit I thought they were at least using Sinister/Dexter, but that didn't seem to be the case). But probably required due to legacy systems. Although I'd say this is still an experiment in which will result in the fewest mistakes. Maybe someone should have paid Kaiser or the like to try this out first to find out some of the consequences?
  - vacri 11y ago
    The lack of a system to the coding is crazy. You find all sorts of nonsense next to each other. Unfortunately, there is a hell of a lot of politics in medicine - infrastructural change is extraordinarily difficult.
Floegipoky 11y ago
Moderate to large hospitals generally have full-time coders, whose job is to take the records generated during a patient's stay and figure out which codes apply. There's a lot of money in what's called 'up-coding', or using a similar code that pays more.
- hga 11y ago
  While lower population areas are losing their only hospitals due to "one size fits all" stuff like this (see e.g. http://www.usatoday.com/story/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/ http://www.usatoday.com/story/news/nation/2014/11/12/rural-h...), and in my "moderate" sized market, all the doctors I know of are now working for "the man", one of the two big hospital complexes, or otherwise outsourcing this sort of thing to them.
  - Floegipoky 11y ago
    You're right, that's a huge problem. Critical access hospitals are really struggling, and many smaller hospitals and clinics are getting swallowed up by big hospitals somewhat nearby. A side effect of that is that the newly-acquired sites are often migrated to the records system of the new owner, which is creating silos of medical records. The problem is that the silos still aren't connected to one another, which means the vast majority of hospitals still have to transfer records through fax. I really wish I was joking about that.

by jhulla 11y ago

hga 11y ago

Well, this is the notorious ICD-10 "upgrade" from ICD-9. Which has some "wonderful" codes, e.g. try https://www.google.com/search?q=icd+10+codes+funny https://www.google.com/search?q=icd+10+codes+funny Everyone's unfair favorite is "V97.33XD: Sucked into jet engine, subsequent encounter." Unfair because that doesn't mean you were stupid enough to do that twice, but had to see a doctor after the first visit. "W55.41XA: Bitten by pig, initial encounter" is OK, it happens. But "W61.62XD: Struck by duck, subsequent encounter." WTF??? I'm from a hunting family, and I've never heard of smallish birds like ducks harming people in this way. Ditto "W61.12XA: Struck by macaw, initial encounter" and "W59.22XA: Struck By Turtle" (now, being bitten by a big snapping turtle is horrific, but being struck by any turtle???). But this remains the most bizarre of all I've heard: "V91.07XD: Burn due to water-skis on fire, subsequent encounter." OK, at least we can laugh about ICD-10. For now.

jhulla 11y ago
That is funny. The wide range of codes is a great setup for coding errors: errors of omission, imprecision, using multiple codes to describe an event when a more accurate single code exists, etc. In the best case scenario, every doctor/nurse/PA/etc would have a technician follow them around just to manage the coding on EMRs.
jhulla 11y ago
OK - I had to confirm the water-skis. You're not kidding: https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx?KeyWord=V91.07XD&bc=AAAAAAAAAAACAA%3d%3d& https://www.cms.gov/medicare-coverage-database/staticpages/i... Has Monty Python taken over the ICD?
- hga 11y ago
  I don't blame you, I should have tried that myself. I'm still trying to figure out how that could be a legit code. Jet skis, of course. But ... ah, while trying to see if anyone else had a brainstorm, I found a better one that eliminates a lot of possibilities: V90.27XA: Drowning and submersion due to falling or jumping from burning water-skis, initial encounter Got that from http://skepticalscalpel.blogspot.com/2011/09/icd-10-codes-drowning-and-submersion.html http://skepticalscalpel.blogspot.com/2011/09/icd-10-codes-dr..., which suggests: I have come up with an answer. Someone, possibly an actor from the Jackass series of movies, sets up his water skis on milk crates in the back yard. The skis are positioned over a kiddie pool. He mounts the water skis while an accomplice sprays them with gasoline. The skis are lit, and the man jumps or falls from the burning skis, submerging and drowning himself in the process. Luckily there is an ICD-10 code for that. Maybe we're being trolled? You know, there are trolling motors, but they're (all?) slow, battery powered ones to avoid disturbing fish, not at all suitable for water skiing.
  - Mz 11y ago
    When I paid accident claims, I paid a surprising number of claims for 2nd degree burn on lower leg from motorcycle exhaust pipe. You make me wonder if there is a code specifically for that. /weird but true

vacri 11y ago

While it seems overkill, it is unambiguous. Errors are easy to make in medicine. When I was a neuro tech, I remember doing a nerve conduction study on a patient, on one arm only, and the patient had no abnormality, when went into my report. The doctor doing the final report for the record copy/pasted from his list of stanzas, and forgot to switch 'left' in his copypasta to 'right', which I caught. This particular doctor was perfectly competent; it's just that there's a thousand ways to make errors like this (and yes, copying from a list of stanzas isn't the best method, but neither is individually typing out the same diagnosis paragraphs again and again). Being unambigous with which side of the body and which body part is very important in medicine.

hga 11y ago
OK, that's a good argument, although the system of coding each as a separate code without a "system" is crazy (for a bit I thought they were at least using Sinister/Dexter, but that didn't seem to be the case). But probably required due to legacy systems. Although I'd say this is still an experiment in which will result in the fewest mistakes. Maybe someone should have paid Kaiser or the like to try this out first to find out some of the consequences?
- vacri 11y ago
  The lack of a system to the coding is crazy. You find all sorts of nonsense next to each other. Unfortunately, there is a hell of a lot of politics in medicine - infrastructural change is extraordinarily difficult.

Floegipoky 11y ago

Moderate to large hospitals generally have full-time coders, whose job is to take the records generated during a patient's stay and figure out which codes apply. There's a lot of money in what's called 'up-coding', or using a similar code that pays more.

hga 11y ago
While lower population areas are losing their only hospitals due to "one size fits all" stuff like this (see e.g. http://www.usatoday.com/story/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/ http://www.usatoday.com/story/news/nation/2014/11/12/rural-h...), and in my "moderate" sized market, all the doctors I know of are now working for "the man", one of the two big hospital complexes, or otherwise outsourcing this sort of thing to them.
- Floegipoky 11y ago
  You're right, that's a huge problem. Critical access hospitals are really struggling, and many smaller hospitals and clinics are getting swallowed up by big hospitals somewhat nearby. A side effect of that is that the newly-acquired sites are often migrated to the records system of the new owner, which is creating silos of medical records. The problem is that the silos still aren't connected to one another, which means the vast majority of hospitals still have to transfer records through fax. I really wish I was joking about that.