A man walks into a lamppost, subsequent encounter

by | Jun 1, 2020 | Articles, Conditions, General Interest, Just For Fun

No, he didn’t walk into the lamppost a second time, but he did follow up with his doctor for subsequent care, after the “initial encounter” where he was diagnosed with a contusion to the head, also known as code S00.03XA, now associated with code W22.02XD for walking into a lamppost, subsequent encounter. It seems calling it a follow up visit for a “bump on the noggin” just won’t fly and simply providing excellent medical care doesn’t count without the right code.

Used to be, in order to get paid by insurance, doctors had to choose from about 17,000 various codes to go with the reason for the visit. We can make a brilliant diagnosis and provide exceptional care, but if we don’t code the diagnosis just right we don’t get paid. The world of coding got a whole lot more complex a few years ago as we were forced to adopt a new system with over 160,000 codes. Just what you want your doctor to be focusing on, huh?

The International Classification of Diseases (ICD) version 9 has been around since about 1979 and pretty much includes every known disease on the planet. The ICD9 book is about 2 inches thick and many years ago I flipped through the entire thing page by page, intrigued with all the possible diagnoses. It is truly a compendium of differential diagnoses. So how, and why, do we need to increase our coding responsibilities almost 20 times over? Are there 140,000 new diseases?

Ostensibly, according to the Center for Medicare and Medicaid Services (CMS), the new ICD10 coding system is required to provide a more accurate means of tracking and gathering data, doing research, clarifying risk and severity, reducing fraud, and lowering costs. That sounds good, but let’s take a closer look.

If you break your left arm, then let’s code it as a left arm fracture. Not enough, we need to know how you broke it and where you were when you broke it. We need to know if it is a visit to treat the break, monitor the healing, or deal with some problem later that was caused by the initial break. We need to know if the break was in the closest, middle, or farthest part of the bone. The old system had a single code for a badly healed fracture, while the new system has about 2,500 codes to choose from.

Bit by a bird? We need to specify whether it was a macaw, duck, goose or parrot, because that really matters when trying to categorize risk and severity. There’s a code for getting “bit by a turtle” versus “struck by a turtle”. I’m curious, how does one get struck by a turtle anyhow? Would this be from the infamous Ninja box turtle or the high-flying Judo snapping turtle?

One of the more concerning new codes is V91.07XA, which involves a “burn due to water-skis on fire”. Seriously. Under what circumstances would water-skis catch fire? The coding experts were slacking on this one as they didn’t think to include whether the fire occurred on fresh-water or salt-water, because that could make a difference you know. And really, is lacks attention to detail not including the brand of ski. As there is no code for a “burn due to snow-skis on fire” I want to know what the coders have against snow skiers.

Drowning is serious business, and apparently it matters what kind of watercraft one has fallen from prior to drowning. Does drowning due to a fall off sailboat, fishing boat, canoe, kayak, merchant ship or passenger ship, really make a big difference in the type of care one might receive? I question how you can use the “subsequent encounter” code after the initial drowning.

There are codes for injuries sustained while sewing, knitting, and crocheting. According to CMS officials, getting the correct data on these injuries is supposed to have an impact on public health and safety of course, as we are always seeing stab wounds caused by those darn knitting needles. Somebody needs to start a knitting needle awareness group. Not to be confused with the “crochet needle injury foundation” or the “seamstresses for safety” club.

Some codes seem rather harsh. What doctor would risk putting the codes R46.1 “bizarre personal appearance ” or R46.0 “very low level of personal hygiene” into a patient chart? That’s not likely to go over well when the patient gets a copy of their medical records. Heck, that could be considered discriminatory. Next thing you know the ACLU will be after you for making such a diagnosis. Are these medical diagnoses or observations made while people watching at the mall?

With millions and millions of pieces of healthcare data streaming back and forth between offices, hospitals and insurers, I wonder if this expanded coding system will lead to less errors, or more errors. Will it lead to better care? Will it lead to physicians having more time to spend with their patients? Will it steady the surgeon’s hands or improve the internist’s wit? I’m feeling anxious from this stress, which would be code F45.8 for “anxiety, associated with occupation”.

I want my doctor to put forth all energy and focus on being in the present and listening intently to my story while using all capacity of their brain to solve the problem. I don’t care how they code it. I’ll gladly pay for a service and a solution no matter how it’s coded. There should be a code for “being sick of increasing healthcare costs”, subsequent encounter of course.


Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).   Call (970) 245-6911 for an appointment or more information.

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