Monday, May 6, 2013

Use ICD-10 to tell a better story about the patient

Use ICD-10 to tell a better story about the patient

I love the ICD-10-CM external causes codes. I’m weird, I know, but I’m also a writer and I love telling good stories. When I first started coding, my boot camp instructor Peggy Blue, MPH, CPC, CCS-P, said coders tell the patient’s story using codes. ICD-10-CM allows coders to tell better stories about patients and detail what happened to them and how.

Some of the external causes codes are pretty funny and you’ll probably never report them. If you work in an urban setting, you’ll probably never report W61.4- (contact with turkey) unless someone is trying to kill his or her own Thanksgiving dinner.
If you don’t live near water, you likely won’t need V94.1 (bather struck by watercraft) or W56.2- (contact with orca). Well, you might need the orca, dolphin (W56.0-), and sea lion codes (W56.1-) if you work near Sea World. But let’s hope you don’t have cause to use them.
The ICD-10-CM external causes codes include codes for encounters with a variety of animals including, but not limited to:
  • Alligator
  • Crocodile
  • Nonvenomous reptiles
  • Parrot
  • Macaw
  • Chicken
  • Goose
  • Frogs
  • Toads
  • Squirrel
  • Cow
  • Dog
  • Cat
  • Mouse
The only thing missing seems to be an attacking partridge in a pear tree. Oh wait, that’s contact with other birds (W61.9-).
Those codes seem to get the most attention. In fact, Rep. Ted Poe, R-Texas, called out the turkey codes as a way to bolster his argument that the government should stop ICD-10 implementation. He’s even introduced a bill—H.R. 1701: Cutting Costly Codes Act of 2013—to that effect. Take two minutes and read the bill. Trust me, you’ll only need two minutes. It’s not very long.
Poe also mocked the codes for walking into a lamp post (W22.02-). I’ve made fun of that code too, mainly because I can’t image anyone actually admitting he or she walked into a lamp post. At least not sober.
Here’s something he didn’t consider though. How often does an abuse victim claim to have walked into a door or fallen down the stairs? So if a physician or nurse sees a patient who is always walking into things, the clinician might suspect abuse. Or that the patient has a problem with vision. That can be valuable information when forming a diagnosis and also to potentially support a criminal charge against an abuser. Or a bully.
We know ICD-10 will change the way we code. We know it’s going to cost a lot of money and decrease productivity. But we also know (at least I hope we do) that ICD-10 will give us better data and a better clinical picture of the patient’s condition. That alone is a good reason to move forward with implementation.
Here are four other good reasons:
  • ICD-9 is out of space
  • We’ve already spent literally millions preparing for the change
  • We can’t talk to the rest of the world about healthcare, diseases, and mortality rates
  • We’re 15 years behind Canada
On a more serious note, we all hope we never have to use any of the codes under Y36.5 (war operations involving nuclear weapons).

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