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There are separate charge codes for everything, and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's
by thomascgalvin 3y ago
There are separate charge codes for everything, and all of those codes need to be reflected in the pricing data.
There's a price to slap on a bandaid.
There's a price to give someone a Tylenol.
Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again."
Medical billing is broken, and it's no surprise that the amount of data is overwhelming.
- iambateman 3y ago“Bitten by a duck, initial encounter” needs to be Bon Iver’s next single.
- bradgessler 3y agoHere's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W61.69 Other contact with duck == W61.69XA …… initial encounter == W61.69XD …… subsequent encounter == W61.69XS …… sequela There's codings like this for parrots, macaws, chickens, turkey, etc. Hell there's an entire section for alligators and crocodiles at https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W58- https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W58- that includes crushing, bites, etc.
- kderbyma 3y agoBeagle Boys health records probably have a lot of W61.6... on their files.
- guidoism 3y agoDucktales?
- coding123 3y agoI wonder if bitten by duck is more expensive that bitten by chicken.
- chimeracoder 3y ago> I wonder if bitten by duck is more expensive that bitten by chicken. They're diagnosis codes, so they're mostly irrelevant for determining cost. You don't get charged for "having the flu" - you get charged for the various services or treatments you received in the course of your illness. Diagnosis codes do factor into claims reimbursement indirectly. For example, some services can be done either as treatment or for preventive purposes, and insurance is legally required[0] to cover the latter at no cost to the patient, whereas insurers can require that the patient pay for the former. But that's pretty indirect - by and large, the payment agreements between insurers and in-network providers apply to services rendered, which doesn't really factor in diagnoses codes (assuming that the service was appropriate for the diagnosis in the first place). That's assuming fee-for-service: capitation is a whole other model, although in that case it's still typically determined independent of the diagnosis, because the whole point of capitation is to minimize care delivered. But getting bitten by a duck vs. a chicken is unlikely to cause any difference in the price you pay, unless: (a) the injuries from the duck bite were significantly different from the injuries from a chicken bite, or (b) one was considered an occupational exposure and the other wasn't (in which case worker's compensation would be billed for it). [0] well, until March of this year, when a judge in Texas overturned that clause of the ACA
- btown 3y agoNot even ironically, this all smells of insurers wanting sufficient data to raise rates on different types of farmers and breeders. It might be scandalous if they didn’t collect the data and then were biased against, say, chicken farmers. But if they do collect the data, they can say they analyzed it, whether or not they did, to support any kind of tactic they desired.
- lotsofpulp 3y agoYou are smelling something that is not there because, in the US, health insurers are only allowed a few factors to determine someone’s premium. https://www.healthcare.gov/how-plans-set-your-premiums https://www.healthcare.gov/how-plans-set-your-premiums > Five factors can affect a plan’s monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents.
- chimeracoder 3y agoThose are ICD codes, which are not the same as billing codes. ICD represent diagnoses, not services rendered. ICD codes also are somewhat procedural in their generation - that is, there's a whole grammar to how they're formed. For example, you'll have something like "contact with", then a whole number of different animals, and then each of those will have three different varieties (initial encounter, subsequent encounter, sequela). So it does end up with very funny lists, like the one you posted, but: (a) most of those codes are never used, and (b) just because it's assigned just means that it's a "grammatically valid" combination, not that it has any particular clinical relevance. The goal is to assign granular and hierarchical codes at the outset, to allow for more robust analysis later, at least in theory. But again, all of that is irrelevant to billing, because while ICD codes are typically submitted along with the billing info (along with a whole other slew of data), ICD codes are not the actual code that's billed - there's a whole separate list of codes used for billing.
- marcus0x62 3y agoThat's really interesting, because I had a customer that did nothing but provide medical billing services, and about 15 years ago when the industry was moving from ICD-9 to ICD-10, that customer seemed really focused on their billing coders learning ICD-10.
- chimeracoder 3y ago> That's really interesting, because I had a customer that did nothing but provide medical billing services, and about 15 years ago when the industry was moving from ICD-9 to ICD-10, that customer seemed really focused on their billing coders learning ICD-10. I mean, sure? You can't bill for a service without a diagnosis code that justifies the service. Anyone who does medical billing is going to need to be able to format that data. But ICD codes are not the codes that insurers are billed for - billing codes are completely separate and not even determined by the same party.
- baishtar 3y agoThat's to ensure that the service provided (procedure code) matches the diagnosis. For example, the procedure (HCPCS) code "71045" corresponds with the procedure "RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW" for billing purposes. If you were to match that up with the diagnosis code (ICD10) S80.211 for "Abrasion, right knee" there would be a mismatch between the diagnosis and the procedure. This happens all the time due to human error and often results in insurance denials, which sadly take a long time to fix since now you have to get MORE HUMANS involved.
- maweaver 3y agoBut why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion?
- 88913527 3y agoWell, it employs a lot of people to have this complex billing. And whoever argued the need for it got to do some major empire building, maybe scored a promotion.
- brendanyounger 3y agoMedical billing is a dreary business. Check out https://www.reddit.com/r/CodingAndBilling/ https://www.reddit.com/r/CodingAndBilling/. It's not clear that anyone is _trying_ to build an empire out of this. More likely, they're trying to build a bigger trash heap to climb on top of.
- nradov 3y agoNo one got a promotion out of it. The USA adopted the WHO ICD code system for diagnoses on billing claims because it was good enough, and much easier than defining a whole new code system. Some of the codes are never used, but so what.
- Ylpertnodi 3y ago[flagged]
- mensetmanusman 3y agoBitten by a communist just yesterday. I wonder how it is coded.
- squeaky-clean 3y agoLooks like it's W50.3XXA if it was accidental. Or Y04.8XXA if it was intentional. If you were the communist and bit yourself on the upper right arm it would be S40.871A or S41.151A depending on how deep the bite went.
- deleted 3y ago[deleted]
- mensetmanusman 3y ago"I'd like to file a complaint. This is my fourth time being bitten by a duck not my second time. You have overcharged me!" This is possible in America today. Great job post ww2 employer coverage side effects!
- arcticfox 3y agoAs others have explained, the subsequent encounter is for a follow-up visit, not a repeated duck attack.
- galleywest200 3y agoThis is still silly.
- deleted 3y ago[deleted]
- Alupis 3y agoIt's not when you want statistics about all injury types, treatments, etc.
- deleted 3y ago[deleted]
- boredpeter 3y agoYou don’t need arbitrary codes to get statistics for something that can be typed in a description field.
- paulddraper 3y agoYou don't need to type arbitrary descriptions for something that can be a standardized code.
- vanattab 3y ago
- deleted 3y ago[deleted]
- tanseydavid 3y ago>> There's codings like this for parrots, macaws, chickens, turkey, etc. Yeah, but how much do they cost? </sarc>
- pixelatedindex 3y agoThankfully, W61 is a non-billable code family… hope it stays that way! I do wonder what all the billable code families are, maybe I should find out.
- apwheele 3y agoThe Z codes (ICD to be specific) are similar. Although those two are not exhaustive -- it can be conditional so can be confusing. You have different rules for chronic conditions, so for example something could be rolled up into a billable DRG one visit, but should not be included in a follow up visit. The DRG example on this website is interesting -- so I think these are valuable services, but I look at claims data everyday for my job and I would have a hard time knowing the exact codes before I go for a visit. (Also obviously in an emergency I am not shopping around!) And then there are service modifiers for "how long" for CPT codes for just outpatient visits -- you wouldn't be able to know 15/30/60 minutes before hand even if you did know the specific CPT code. So for that you may want to know the proportion the doctor bills, not compare the prices on the same CPT.
- flangola7 3y agoClarifying, encounter means a visit with a provider.
- pc86 3y agoMy personal favorite is V97.33XD "Sucked into jet engine, subsequent encounter."
- chimeracoder 3y ago> My personal favorite is V97.33XD "Sucked into jet engine, subsequent encounter." If you were sucked into a jet engine, you'd probably sustain serious injuries, so hopefully you'd have a followup visit with your doctor about it after the fact, rather than just one single visit. (Yes, I get that you're joking, but that's what "subsequent encounter" actually means.)
- marcus0x62 3y agoIf a person were sucked into a jet engine, they'd be turned into soup. Maybe they could be poured into a container and the doctor could subsequently encounter them in that state.
- arcticfox 3y agohttps://twitter.com/NavalInstitute/status/1230542979124822022?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1230542979124822022%7Ctwgr%5Ebbe0b28105a35cd3c64e56483ceefd67566eb7b7%7Ctwcon%5Es1_c10&ref_url=https%3A%2F%2Fwww.military.com%2Fhistory%2Fsailor-survived-getting-sucked-jet-engine-during-operation-desert-storm.html https://twitter.com/NavalInstitute/status/123054297912482202... Here's a video of a guy getting sucked into a jet engine and surviving. Most, of course, do die. I don't quite understand why everyone is so bothered by the extensive ICD taxonomy; it clearly needs to be extremely extensive to cover even fairly common scenarios, and once you're past the point that things can be easily managed why not cover everything?
- thfuran 3y agoSure, it's necessary to have some specificity so that providers and insurance companies can be reasonably informed about what's going on, but this stuff has a very real cost. Healthcare providers have entire departments of people dealing with coding. The more complex it gets, the more time consuming and expensive it is to correctly code things. At some point (I suspect well behind us), the added cost isn't worth the marginal benefit.
- vsareto 3y agoIIRC the "initial encounter" refers to the first visit between the patient and doctor about the duck bite, and "subsequent encounter" means a follow-up visit about the issue, not a second maiming by the duck. It makes for a fun first impression though
- thomascgalvin 3y agoThat does make more sense, but I refuse to let go of the image of a duck with a vendetta tracking some poor bastard down, and the stalwart medical coding technician who is dutifully documenting it all.
- paulddraper 3y agoThat is correct. Obviously, there's little value in distinguishing between the first and second occurrences of duck bites. Rather, the suffix describes which treatment it is. A - initial encounter (initial treatment) D - subsequent encounter (continued treatment) S - sequela (after the treatment plan is completed)
- gnfargbl 3y agoThe initial/subsequent encounter coding seems to refer to the encounter with medical personnel (for the specified issue), not the number of times the same issue has been encountered by the individual. Which is maybe a good thing for recipients of T18.5XXA.
- mwerd 3y agoNuanced but important distinction: these are ICD-10 diagnosis codes. They are only loosely related to what is billed and would not show up in the pricing data referenced by the OP.
- paulddraper 3y agoICD-10 codes are used for DRG billing which is what most inpatient billing operates on. But aren't included in the data I think.
- marcus0x62 3y agoThe nominal reason for the (seemingly insane) billing codes is the codes are based on ICD-10. The ICD (International Classification of Diseases) system was supposedly originally developed for epidemiological tracking.
- FireBeyond 3y ago> Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." All this means is "first visit", as in "I need immediate attention for this", and "subsequent encounter" doesn't mean "another duck" it means "follow up for X, but it's already been 'counted' (and presumably the care is less acute)" (i.e. for statistical purposes, "X,000/year people bit by ducks".
- abeppu 3y agoOk, so it's _broken_. As a system of recording stuff is it also ... incoherent? Slapping on a bandaid or giving someone tylenol are _services_. "Bitten by duck" is a _cause_, and different people bitten by ducks could need different services, and people impacted by different causes could need the same services. If I have a laceration, I'm guessing that how I'm treated should depend on how deep/large/severe it is, rather than what kind of implement was involved? If they're equally sharp, dirty, etc, a kitchen utensil, non-powered tool, scissors, or other sharp implement may all result in the same slapped bandaid, right? https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W20-W49/W27- https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W20-W49/W27- https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W20-W49/W26- https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W20-W49/W26-
- adolph 3y agoYes, the cause or problem is needed as well as the procedure or treatment that was delivered to treat the problem. The treatment will be charged separately for professional (like MDs) and technical (like nurse, pharmacy). It also matters who is performing a procedure. An MD slapping the bandaid charges more than a PA, Nurse Practitioner or PharmD. https://www.icd10data.com/ICD10PCS/Codes https://www.icd10data.com/ICD10PCS/Codes
- skissane 3y ago> Ok, so it's _broken_. As a system of recording stuff is it also ... incoherent? Slapping on a bandaid or giving someone tylenol are _services_. "Bitten by duck" is a _cause_, and different people bitten by ducks could need different services, and people impacted by different causes could need the same services. As others have explained, these are diagnosis codes; there are also procedure codes. Procedure codes are the primary thing billed for, the diagnosis code is just to justify the procedure - some doctors will perform (or falsely claim to have performed) medically irrelevant procedures as a form of billing fraud, and cross-checking the procedure and diagnosis is meant to prevent that. And the reason why there are so many diagnosis codes, is because their primary purpose is public health statistics not insurance billing; and ICD codes are global (although the US also adds its own US-specific ones.) Probably, somewhere in the world, some bureaucrat is tracking the public health cost of animal attacks by species, and those species-specific animal attack codes exist to enable them to do that.
- talldatethrow 3y agoI wish instead of charging 100x for random things to pay for the hospital, they'd just charge per minute of room and per minute of doctor contact. I understand why you need to charge me $2000 to have an entire hospital ready in case I need stitches at 3am. But I get annoyed when you try to play it off as having to charge $85 for an aspirin. Just be upfront and say, we charge $100 a minute and this is going to take 15-20 minutes.
- colejohnson66 3y agoBut then there’s an incentive to be slow
- banannaise 3y agoSo then you also add a constant per patient, but then there's an incentive to be rushed. Gosh, it seems like profit incentive is a really bad way to run a healthcare system, doesn't it!
- SilasX 3y agoEven systems without a profit motive will have to economize, and therefore will track resource usage and discourage waste. The NHS still has e.g. PSAs telling people not to go to the emergency room for non-emergencies.
- ivalm 3y agoA friend of mine started a substack of all the kind of broken ICD10 codes, as recited by chatgpt: https://icdstories.substack.com/ https://icdstories.substack.com/
- lisasays 3y agoMedical billing is broken Is it? Seriously - how do you know? More specifically: broken compared to what? What would you replace it with? Be specific, please. Keeping in mind that it's like, an extremely complex domain and all, you know.
- johntiger1 3y agoYep, this seems like surface level complexity. Like adding a new/non-existing key to a dictionary, it shouldn't surprise us that there can be different codes for getting bitten by different things
- lmm 3y agoBroken compared to what literally any other country in the world does? Personally I'd replace it with publicly funded healthcare, but even those countries that still feel the need to bill the victim have avoided the whole billing-insurance complex that the US has.
- lisasays 3y agoWell obviously (or so I thought) was referring to how it's modeled (with the crazy codes and all) based on the way the system currently is -- not on how the system "should be". The comment I was responding to just seemed to be saying: "Gee, this is complicated." Well yeah. Because what it has to do is (based on the way things are presently, and beyond anyone's ability to change in the near-term) complicated. Crazy billing codes are a pain signal. They aren't the underlying malady itself.
- EliRivers 3y agoCan we bill it like my mechanic does? Parts and labour. I could see that some medical people would want to have their time considered more valuable, so how about bill for parts, and labour depending on minimum qualification to do it.
- m_0x 3y agoI remember a comment (not sure if here at HN or at Reddit) Whenever a hospital staff gives you a medicine they put it first in your table then give it to you because that way they can bill you twice. Take it in a grain of salt because I can't verify it and I can be misremembering details.
- paulddraper 3y agoCo-founder of rivethealth.com here. Take however complicated you think medical billing is and multiply 5x. For starters. --- You are using a bit of a mixed example with bandaids, aspirin, and duck bite. The simplest billing is FFS (fee for service). This associates a fee for each procedure/drug/product using a 5-digit CPT/HCPC code. For example, 29877 would be Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chrondroplasty). Add a 50 modifier to make it bilateral (both knees). Add an AS modifier if billing for an assistant surgeon. Add a 26 if the bill is only for the professional (human services) portion. And so on. The in-network price will be based on the health organization (9-digit tax ID), the rendering physician (10-digit NPI), the insurance plan/network (no standardized format), and the place of service (2-digit code, e.g. 24 Ambulatory Surgery Center). The price is further modified by a variety of adjustments, such as MPPR (multiple-procedure price reduction), MACRA, etc. W61.61XA (Bitten by duck, initial encounter) is a ICD10 diagnosis code. That is, a diagnosis of a condition, not a service. While you will always have a diagnosis, it's not relevant for FFS pricing. This is used in a whole other set of billing called DRG (diagnosis-related groups) typically used for inpatient care. And of course there are even more billing methods. --- This is all very, very complicated. A lot of it is essential complexity -- modern medicine is indeed very complex. And a lot of it is incidental complexity. Not unlike a certain software industry. /:
- banannaise 3y agoI like that you specifically chose "Bitten by duck" which you could say is itself a form of billing.
- ochoseis 3y agoWhile there is a mapping between them, ICD10 (diagnosis) codes and CPT (billing) codes have different purposes.
- DoreenMichele 3y agoI worked in health insurance. The code is supposed to make it easy to pay. It doesn't. We could do away with the codes. In addition to having to look up the codes, I read records all day, called and wrote providers for additional info, consulted my technical lead regularly to see if it was covered and once had to print the entire file and get it reviewed by the retired surgeon who came in once a week to read surgical reports on difficult cases. I'm underwhelmed with the value they provide and I paid claims as my job for 5+ years.
- swalsh 3y agoI'm in healthcare analytics, the codes are for me.
- DoreenMichele 3y agoWe were drowning in data. It was a Fortune 200 company and every few years they completely overhauled their system for looking up state exceptions etc, which meant longstanding employees could no longer use it efficiently and new people still didn't magically get it instantaneously and inevitably some important thing could no longer be accessed at all. It was all in-house, homegrown software, I tried more than once to suggest moving to GIS -- a map-based system -- for some things and was ignored. I'm curious how that works for you because I just have trouble imagining that actually works. Like what value does that provide that you cannot do some other way and which justifies the systemic cost burden? Please edify me a smidgen.
- swalsh 3y agoWe're one of the guys who are creating all that work for you lol. We too have been through a number of systems. Since i've been with the company, we've gone from SQL Server, to an on-prem Hadoop cluster, to Databricks on the cloud, and plenty of home grown software. The cloud has been a real game changer for us from the simple fact that we finally have enough compute to start running some machine learning models. We have this standard data model with something like 300 columns, but every clients data is so different, some of them have around 400 columns in the data.... We're in theory using the medallian architecture, but there's so many legacy business processes we're not anywhere close to an ideal implementation. We've also recently started using AI in a big way as well. My email is in my bio, we should chat sometime i'd be facinated to hear more of your perspective.
- webnrrd2k 3y agoI don't know... I've been bitten by a goose, and, when you're a small kid, they are fairly terrifying.
- deleted 3y ago[deleted]
- dodslaser 3y agoThere's also V97.33XD - Sucked into jet engine, subsequent encounter. For when you're sucked into a jet engine, ejected on the other side, only to be sucked into another jet engine.
- treeman79 3y agoYep. Was involved in medical billing software. Health companies do everything they can to “upgrade” billing to more expensive codes. Lots of AI and such. Especially if it’s government funded.