Eyeworld

EW NEWS & OPINION 30 November 2015 by J.C. Noreika, MD, MBA V91.07. If you were unlucky enough to be hit by a flaming water ski while jumping from it, code V91.37. Makes one wonder how coding of poor Fawn Liebowitz's untimely demise in a kiln explosion at Emily Dickinson College that was immor- talized in National Lampoon's 1978 Animal House might proceed. The good news is that ICD-10 was launched on October 1 after years of delay. Fear and loathing can end. The bad news? Only two years behind schedule, WHO has sched- uled the release of ICD-11 in 2017. This is fortuitous because ICD-10 was germinated in the 1990s. Sadly, medical technology advanced and parts of ICD-10 are already obsolete, imprecise, and inadequate. If you must know, the code for cutting one's right wrist is S61.511 (laceration without foreign body of the right wrist); if you get the radial artery of the right forearm that would be S55.111 (laceration of radi- al artery at forearm level, right arm). If a fan of old Errol Flynn movies and employing a "sword or dagger," add Y28.2. I think. If I'm wrong, a well-meaning but infallible reviewer can email me: HaveMercy@CodesRUs.ICD10. EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for more than 30 years. Contact information Noreika: JCNMD@aol.com afternoon was sublime. Our patient was driving his convertible as geese overhead honked southward. An animated dialogue with his wife whether to ask for directions to their destination was in progress. Geese being geese, an aromatic, airborne payload landed squarely on the car's windshield splattering organ- ic shrapnel everywhere. Collateral damage, our patient immediately felt something in his right eye. The lunch reservation could wait. Oh, the possibilities! It is un- doubtedly an accident involving an automobile and a goose, albeit indirectly. The driver was having a quarrel with his wife. Without warning or malice, he sustained a foreign body injury to the right eye causing pain and discomfort; it isn't a stretch to say his vision, including stereopsis, was impaired. His perior- bita was—how to say this delicate- ly?—befouled. With just the right line of questioning, this is a slam- dunk Level IV, New. Need hints? W61.59, Other Contact with Goose and Z63.0, Problems in Relationship with Spouse or Partner. Some of the most egregious codes have already been publicized. Burned due to water skis on fire? Go with Y93.1—Activities Involving Water and Watercraft. If you water ski for cardiorespiratory exercise, try Y93.A. Slaloming for muscle strengthening, use Y93.B. If water skiing while on a roller coaster, consider Y93.I. But we're not done. You were burned because your water skis were ablaze. That would be Corleone would have tweeted, "OMG, my loan sharks can't keep up with the demand." It'll be great. Big data wonks will have job security for decades, retiring with government benefits doctors only dream of. Consultants have the mother of "shovel-ready" projects. Public health hazards will be identified and fixed tout de suite. Someone launches a nuclear bomb? No problem. The Y36.5 codes in the Tabular List cover "war operations involving nuclear weapons." Might the internet acronym, "KYAG" 36.5, be more appropriate? Lunchtime compliance sessions will be great fun as staff debate how best to capture dollars left on the table by undercoding. Greater detail and specificity to support the patient's need for examination and treatment add incremental revenue. Secondary diagnoses validating "complexity" are the ambrosia of medicine's new golden age of reim- bursement. Case study for your next com- pliance meeting? A new patient presents as an emergency with a red, painful eye. He states it is swollen and scratchy. The exam reveals non-metallic foreign material in the lower conjunctival fornix. ICD-9 is straightforward: 930.1, Foreign Body, Conjunctival Sac; 921.1, Contusion of Periocular Area; and, 379.91, Ocular Discomfort. Might consider a CPT Level III, New. With ICD-10, the backstory for which CMS's officials clamor can be brilliantly laid bare. The autumnal A tongue-in-cheek analysis of ICD-10 with suggestions of how to take advantage of its ridiculously sublime implications I CD-10! What might Woody Allen, Jay Leno, or Stephen Colbert do with this gift of wacky material? You can't make it up. Sadly, according to the Henry J. Kaiser Family Foundation, there are merely 915,000 active physicians in the U.S. Only MSNBC would think this demographic large enough to attract ad dollars. But given the topic's absurdity, a philo- sophical ironist like droll comedian Steven Wright should be in huge demand at medical conclaves for years to come with gems such as: "If at first you don't succeed then skydiving isn't for you," "I think it's wrong that only one company makes Monopoly," and "I'd kill for a Nobel Peace Prize." The International Statistical Classification of Diseases and Relat- ed Health Problems falls under the aegis of the World Health Organiza- tion (WHO). WHO was founded in 1948 by the United Nations. Long before that, Florence Nightingale, perhaps on well-deserved break from the Crimean War, suggested collect- ing data on maladies visited upon London's hospitals. Her concept was embraced and ICD-1 was published in 1900. It was a small pamphlet. Revisions have been bestowed on physicians periodically since then. All save Amelia Earhart, Jimmy Hoffa, and Bill Clinton ("I have no recollection") know ICD-10 increas- es the number of codes from 14,000 to 70,000 for doctors and an aston- ishing 4,000 to 72,000 for hospitals from its guileless predecessor, ICD-9. The Wall Street Journal meaning- lessly estimated costs for conversion from ICD-9 to 10 at $10,000 to $225,000 for small practices. Fear of cash flow disruptions due to pay- ment delays have caused a run on banks for lines of credit. Michael ICD-10: Idiocy Confusing Doctors-I Opine J.C. Noreika, MD, MBA Insights

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