I heard Atul Gawande say that modern medicine has about 6000 drugs, 2500 surgeries and 1500 non surgical procedures they can do. Are these accurate numbers? They sound low, at least the non surgical procedures.
There are 62,022 medical and surgical procedure codes in ICD-10. That doesn’t include a bunch of others coded under Obstetrics, Imaging, Extracorporeal Therapies (ultrasound therapy, phototherapy, etc.), Osteopathic, Chiropractic, Placement, Measuring and Monitoring (usually of surgical devices and bandaging), Nuclear Medicine, Radiation Oncology, Physical Rehabilitation, Mental Health and Substance Abuse treatment. Oh, and “Other”.
A lot of similar procedures can be shoehorned into a code or group of codes (at least in the past).
Even ICD-9 was pretty comprehensive for common procedures. For example, this page lists most of the things that could be done during a knee scope. However, there were no specific codes for removing a bone spur from specific portions of the femoral head (to use one example) which would at least in theory constitute distinguishable procedures.
This Abbott page offers help with both ICD-10 codes and CPT codes (which are how procedures get charged).
Yes, things have gotten quite specific. Some of this depends upon whether you are a lumper or a splitter. Angiography, angioplasty, and stenting are all different things. Is placement of some stents significantly different from other stents? Is working on the right different from working on the left? Is working on a vessel in the thigh substantially the same or significantly different from working on a vessel in the knee (which flexes).
This page mentions that ICD-10 has 68,000 billing codes, “as opposed to a paltry 13,000” in ICD-9.
But it’s unclear if there is a distinction between “procedure codes”, “diagnosis codes”, and “billing codes” . . . ???
ICD-10, of course, has come in for massive ridicule for it’s absurdly comprehensive codes. e.g.,
There seems to be something here for everyone!
More silly examples here, with even sillier illustrations! (And a book of same you can buy!)
ETA: Srsly, there are so many places on-line mentioning this stuff – is this for realz, or is the whole medical establishment being whooshed?
Some of this is useful information if, say, one is running a study on farm safety and wants to see how many people are injured by cows annually. (Which is apparently not a small number: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5829a2.htm) This can help a rural public health nurse decide whether she should teach a class on cow handling safety or, say, securing ladders. Data is good.
Some of this is computer programmers having fun.They were used to test the system without skewing real data. And yes, they’re hilarious. My favorite is “W56.12XD Struck by sea lion, subsequent encounter,” which is, I think we can all agree, a vast improvement over the vague ICD-9 “E906.8: Other specified injury caused by animal.” I like it because one can imagine someone being struck by a sea lion somewhere, somehow…but it’s still hilarious.
These are all in the diagnosis section. There may be some similar ones in the procedure codes, but I haven’t found any yet.
Most of the silly ones are “location codes” (or something like that), which describe the circumstances of the diagnosis.
FYI… ICD-9/10 codes are typically used for diagnoses, while CPTs are used for procedures, which makes sense, considering that ICD = “International Classification of Diseases” and CPT = “Current Procedural Terminology”.
I’m surprised nobody’s mentioned modifiers yet-you may have a CPT for setting a bone, and then a whole bunch of modifiers to say which limb, or things like that.
ICD is used for procedures done in inpatient settings and home health care, CPT for outpatient.
Someone may need to explain that to Blue Cross and perhaps the American Medical Association, which is the copyright holder on CPT, as they (Blue Cross) recently gave approval for another round of chemotherapy for my husband, and the first service code on the list that they’ve approved is CPT-99223, inpatient hospital care.
Another exercise in minutia is the Healthcare Common Procedure Coding System (HCPCS) - One example from our approval letter is HCPS-J9100, Cytarabine 100 mg injection - the coders have not only referenced the medication but the dose, all in one tidy code.
What, so the programmers’ test data got commingled with real live data, and the ICD-10 we got is the combination of all that? :smack:
And does there now need to be a distinct code for every injury that can result from encounters with every species of animal? Among the silly examples alone (that I listed above), there are codes for encounters with a duck, cow, pig, and macaw. Then are there other codes for encounters with a goose, buffalo, peccary, and canary? There’s also W56.22xA Struck by Orca. Where does it end?
Oh, I agree, it’s very silly. But yes, I think it’s the result of two distinct groups of people trying to use one system - you’ve got the researchers on one end, who do indeed want data diced as finely and sort-ably as possible, just in case, someday, it becomes important to someone’s research to distinguish duck related injuries from macaw related injuries…and then you’ve got the doctors and nurses who are just trying to get their damn billing done so they can actually see another patient.
There are now classes - online and in meatspace - in how to code with ICD10. Expensive classes. People really hate it (although not as much as they hated it before it was released.) Me, I just google what I’m looking for, same as I did with ICD9. So far, it’s worked out pretty well. But then again, I’ve never had to deal with a buffalo related injury…
The inclusion of “possible other uses for this data, let’s make slots” I understand but can be applied to any such system on the planet. vBulletin registration, for example.
Or, as has been done by law, in college admissions. Doesn’t mean it is a good idea.
But equally interesting to me is the fact–and the equanimity (apparently) it is received–that the designers of the system left in their presence as, in the sense of WhyNot here, a system left in a state for three distinct users.
It is not particularly cute that test material is left in any end product. It seems to me in fact to be sloppy on the part of the designers and the people paying them. Moreover, as shown by this very thread and the other satire-by-demonstration excerpts out there, it casts doubt, rightfully, on the nature and concern of the attention of the producers and their product.
Trying to create overly finely-diced categories for everything also raises the question of how to deal with all the possible orthogonal categories. One pictures a multi-dimensional matrix of codes:
Do we need to have separate ICD-10 codes, e.g., for each of:
[ul][li] Head injury by encounter with cow[/li][li] Chest injury by encounter with cow[/li][li] Abdominal injury by encounter with cow[/li][li] Knee injury by encounter with cow[/li][li] Foot/ankle injury by encounter with cow[/li]
[li] Head injury by encounter with goose[/li][li] Chest injury by encounter with goose[/li][li] Abdominal injury by encounter with goose[/li][li] Knee injury by encounter with goose[/li][li] Foot/ankle injury by encounter with goose[/li]
[li] Head injury by encounter with boar[/li][li] Chest injury by encounter with boar[/li][li] Abdominal injury by encounter with boar[/li][li] Knee injury by encounter with boar[/li][li] Foot/ankle injury by encounter with boar[/li]
[li] Head injury by encounter with orca[/li][li] Chest injury by encounter with orca[/li][li] Abdominal injury by encounter with orca[/li][li] Knee injury by encounter with orca[/li][li] Foot/ankle injury by encounter with orca[/li][li] Et cetera ad infinitum?[/li]
(Missed edit window)
ETA: Foot/ankle injury by encounter with hippopotamus stamping out burning water skis ??? :smack:
Are the codes organized in such a way that a doctor, nurse, or billing clerk could understand them? That is, can you learn, in such a class, the general patterns of all the classifications and the codes for them, so that in each real-life case you could have a clue where it might fall in the ICD-10?
Or is it a totally chaotic system, such that you can only know what codes are there by memorizing all 68,000 codes and their meanings?
Example: Patient presents with infected broken femur caused by waterski tow-boat encounter with goose aboard a spacecraft.
Which of the details in this case are relevant to choosing a code? Femur vs ankle vs knee vs pelvis vs rib vs tibia vs wrist vs . . .? Infected vs not infected? Waterski tow-boat vs small fishing boat vs larger commercial fishing boat vs steam-powered locomotive vs diesel locomotive? Encounter with goose vs duck vs hippopotamus vs rhinocerous vs elephant? Aboard spacecraft vs private aircraft vs commercial aircraft vs car vs train?
It’s an abomination unto God, nature, and man.
Basically, it conveniently wraps together in one package:
an unfunded mandate to health care providers to collect research data for others;
an easy opportunity for payors to deny payment for justified and needed services, based upon any difficulties a provider may have applying a byzantine system.
We mock it because laughing hurts less than crying.
I haven’t taken the class, so I don’t know. There is a logic of sorts to them, in that if I find a number that’s close, I can look around it to perhaps find a better one. So if I see:
S72.301-Unspecified fracture of shaft of right femur
I can guess, and be correct, that an unspecified fracture of shaft of left femur will be somewhere nearby. It’s S72.302. And if I know more details about the fracture, I can find an even better code, like
S73.302D - Unspecified fracture of shaft of left femur, subsequent encounter for closed fracture with routine healing
S72.322 - Displaced transverse fracture of shaft of left femur
S72.322J - (left femur) Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
But, of course, you see the problem here, right? If I code it as S73.302D, and another nurse who knows more about the nature of the injury codes it as S72.322J…that’s really not so useful for that data mining we were talking about, and it also increases the chance that Medicare is going to decide that someone’s coding isn’t correct and we’re not going to get paid. Then we get to waste a lot of time and money on an appeal.
I’m not a fan of ICD10, if that wasn’t clear. I’m not here to defend the system, just to clarify that the most chuckleworthy codes, while funny, aren’t really used. Unless, I suppose, you really are struck by an orca. I’d code it as struck by an orca, because it’s there. Why not? Career goals. I’d love to code struck by an orca someday, just to say I did…
It’s also worth pointing out that “initial encounter” & “subsequent encounter” do *not * refer to the first time you got bit by a burning duck versus the second time you got bit by a different breed of burning duck.
The “encounter” is the one between the doc/nurse and the patient.
So when you as patient come in with your duck bite the first time. that’s the initial encounter. When the medics bandage it, give you a scrip, and say “come back in a week so we can check the wound”, that visit a week later is the “subsequent encounter.” As is the one the next week.
And the significance of this is to let the researchers tell the difference between how many duck bites there are versus how many doctor visits are caused by duck bites.
One of the silly examples I listed above was:
By any interpretation of “subsequent encounter”, one wonders how that happens. :smack: