Monday, February 13, 2012

ICD-10 is Big – Inefficiency Through Absurdity – When Bureaucracy Gets Out of Hand

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It appears that as is true with most things that grow beyond usefulness (i.e. - our 72,000 page tax code in the U.S.) ICD-10 has gone into the realm of regulating ridiculousness.  When you need billing codes that include the following items, you know that we are spending more tax dollars on coming up with these categories than we receive in efficiency of having them in the first place:

W5612XA: Struck by a sea lion, initial encounter

Now, I’ve been around the world. I’ve seen a lot of things. I have yet to encounter anyone that’s had an initial encounter of this nature with a sea lion. They’re big. They’re bad. I imagine if you egg them on enough they could do some damage, or, if you’re scuba diving they could mistake a flipper for a fish but, in all honesty, why not just “Attacked by marine animal (non-venomous), initial encounter”  and why “initial encounter”? Are there repeat offender sea lions? How about a “You’re not going to believe this one, explanation pending” billing code?


W5609XA: Other contact with dolphin, initial encounter

Hmmm. I am trying to figure out what exactly justifies “other contact with a dolphin” and how it could be “other” if it is the “initial encounter.” That aside, this one scares me a little. Granted dolphins aren’t prone to the same history of striking people like the evil sea lions but, I have always envisioned dolphins as the loveable, sea park kind. You know the aquatic entertainers that ride on their tails, running through a series of commands with their trainer for entertainment purposes. I have also heard of dolphins being used for medical and mental therapy purposes (although it’s a highly controversial practice and oddly enough, not covered by a lot of insurance carriers so – no billing code). However, I have heard that dolphins have come to the aid of humans and other creatures being attacked by sharks, punching them off the intended prey with their sturdy snouts.  Does Flicka have a secret Jekyl and Hyde complex? It all depends on the intent, if any, behind the wording of this code.

These highly obscure and extremely specific codes, except in the case of “other contact,” abound in ICD-10. That’s a problem for me and likely a problem for the billing coordinator that’s inputting the code as well.

This next one is almost beyond belief:

T7501XD: Shock due to being struck by lightning, subsequent encounter

Lottery ticket anyone? Come on! I know it has happened. I have read about a forest ranger that was struck seven times in his lifetime. A freak of nature?  Certainly.  Does that mean we need to add five more billing codes in case it happens again? Subsequent encounters with lighting seem like a statistical anomaly that likely should not warrant their own code. If you survive the first strike and make it through the second, I think they should throw out the bill. You’ve been through enough and it’s less absurd a thought than having two codes for lightning encounters.

As long as we’re exploring the edges of absurdity, I’d like to suggest a few more codes that we could incorporate into the code:

14THE8GES: “Other contact with an alien being, close tertiary encounter”

M1FAVR8:  “Shock due to being struck in hand by joy buzzer via hack comedian, subsequent annoyance”

Or the highly specific:

MY2CENTS:  “Struck by chair on pinky toe while walking barefoot through a dark room rendering it pretty much useless for the next two weeks and may require amputation, yearly encounter”    

Certainly there is a place for efficiencies and consistency in medical billing- but seriously, should there be a difference in medical BILLING between being struck by a sea lion vs. a dolphin? The astronomical and egregious rise in healthcare costs seemed to be caused by similar "inefficient efficiencies" throughout the system.

Although, even though highly specific, I know for a fact that most of us can relate to the proposed pinky toe billing code.