Patients can be struck by numerous objects leading to pain, disability, physical therapy, and perhaps embarrassment, if the new
ICD-10 codes an accurate indicator. Some of the codes seem nonsensical or unlikely. The fact that the codes exist amply demonstrate that these incidences have occurred – and multiple times in some cases.
There’s an extensive array of items that can be thrown, tossed and dropped that will cause injury. Most will lead to a visit to the ER or the physical therapist. Clinicians will definitely want to be ready for patients who have been hit by rowdy wildlife, from dive bombing macaws (W61.12XA) to head butting cows (W55.22XA) who may object to being milked.
If Grandma gets hit by a reindeer, code it as a V06.00xA, but for individuals who get thrown from a sleigh pulled by reindeer, that’s a code V80.929A. People interacting with churlish chickens with a propensity for throwing themselves at bipeds will code as a W6a.32XA. The codes make no differentiation between rubber chickens and real chickens, but there are codes for multiple encounters.
Land animals aren’t the exclusive cause of injuries. For the luckless patients who experience injury at the fins of water-dwelling creatures, it may feel like a script for a disaster movie. Clinicians will find coding options for clients with first and subsequent encounters with outraged orcas (W56.22xA), those who have been exposed to turtles (W59.29) and not-so-playful dolphins (W56.02XA).
Some individuals are just unable to multi-task while doing even the simplest things. Distracted talking and texting has led to multiple mishaps that practitioners will be coding for and may lead to some strange encounters with payers. There’s a code for people running into a lamppost (subsequent encounter, W22.02XD) and when walking the family canine (W54.1XXA).
Mankind is adept at conceiving new ways of having fun and doing it in the most dangerous venues possible. Bungee jumping (Y93.34), parasailing (Y93.19) and even playing a percussion instrument (Y93.32) or Y93.J4 for lips stuck to an instrument, can lead to unwanted conclusions. A friendly game of ultimate Frisbee (Y93.74) is cited as the reason for pulled muscles, broken bones and even whiplash.
Even fun with imaginary and inanimate creatures can be hazardous. Individuals who sustain an injury by running through a snowman, (thereby committing snowman homicide or possibly a hit and run) will code as Y02.8xxA. For those who are confused about where to put the carrot during a snowman build and insert it in their own ear, use code T16.2xxA. On the dark side, those bitten by a vampire (superficial bite of other specified part of neck, initial encounter), that’s a code S10.87xA.
When hair causes constriction (initial encounter) clinicians will turn to code W49.01XA and E928.4 for an external hair constriction. For a non-scarring hair loss, there’s code L65.9. There’s no telling when a bad hair day will result in serious injury.
Even the very air is fraught with potential danger. For clients who discover they have an air leak, use code J93.82. Patients may be injured through falling spacecraft (V95.49XA). When clients displace their balloon, code it as a T82.523S, but for victims of a falling alligator, that’s code W5803XA.
ICD-10 codes reflect real incidents and complaints, but the ways in which they’re worded often make them fodder for fun. The primary points clinicians need to remember is that they need to code to the highest level possible and as accurately as possible – even if it results in long conversations with payers who have disbelieving minds. Perhaps they could code for a therapeutic massage.
ICD-10 implementation means changes at all levels. One of the first responsibilities for managers will be to analyze the practice environment and personnel to determine specific needs to bring the practice into compliance and readiness for implementation. The entire process will require many managers to assume duties with which they’re unfamiliar or require them to step out of their comfort zone.
Managers will take on the role of overseeing and coordinating the implementation of ICD-10 and that will include contacting vendors, payers, clearinghouses and billing professionals. Contracts will all need to be evaluated, revised, updated and receive final approval before the official implementation date. New policies for employees will need to be revised, distributed and a signed copy returned.
Budgetary concerns will occupy a large part in managers’ responsibilities. Operating funds must be set aside to account for the inevitable reimbursement delays to come. There will be numerous software and hardware updates, purchases and IT considerations. Testing is a crucial part of preparation to ensure that the practice can communicate appropriately with others in the system. It’s a process that will take time and will rely on the readiness of other entities.
The transition to ICD-10 will require training and education for all staff members and sufficient money will need to be appropriated. Implementation will affect staff members in different ways. Managers will be responsible for determining the level of education each individual requires, ensure staff participation and that they’re fluent upon completion. Managers will want to explore various instruction methods, from online options to on-site instruction. Not all staff will need the same level of training.
The workflow in practices and the billing department will experience delays. These should be expected. Staff training and system testing will require a significant amount of time, resulting in a loss of productivity prior to implementation. It may be necessary to hire extra staff in various departments to alleviate back-up and loss of productivity. Additional personnel may be required for up to six months following implementation.
Significant risk accompanies ICD-10 implementation. HIPAA compliance for securely transmitting medical information is critical. Sufficient safeguards must be in place. Part of the implementation process involves how information will be stored and manipulated by those within the practice and entities with which the practice works.
The additional documentation and coding required by ICD-10 places much more patient information at risk and security measures must be addressed. Risk management also extends to potential loss in revenues after the conversion. The best laid plans may encounter snags and delays. A contingency plan to handle any problems will be essential.
The implementation of the new coding system is a major undertaking at all levels of the practice. It will require new methods, practices and policies. Medical practice managers will be extremely busy ensuring that staff receives training, the revenue flow experiences minimal disruptions, and the practice is in compliance for the ICD-10 conversion. During the transition, managers should take care not forget to obtain the ICD-10 training they need.
The rules of coding for ICD-10 have been established in cooperation by the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). It’s a standard to which all clinicians must adhere.
Reviewing The Basics
ICD-10 encompasses 21 chapters and expanded code options that have been reorganized and expanded. Injuries are described by site first and then by type. They include laterality, greater specificity and combination codes.
ICD-10 codes are now identified with an alpha-numerical system that can include up to seven characters and the first will always be a letter. The letters I and O are not used, as they can easily be confused with the numbers 1 and 0. Letters aren’t case sensitive.
The first three identifiers represent the category, the next three describe the anatomical location and severity, and the last is an extension that identifies if it as the first or subsequent encounter, or the result of a previous injury or disease. X is used as a placeholder in some codes.
Injuries are grouped by body part rather than injuries. Clinicians will focus on documenting the current complaint of the client. Never assume that “standard” treatment has been provided or code on a suspected diagnosis. Payers just want the facts of what’s readily observable.
Practitioners will need to document variables that were not required under ICD-10. Clinicians will need to include data on all external causes that led up to the actual injury, the exact location of the injury, and the patient’s actions at the time of the injury.
Documentation will also require information about the environment in which the injury took place, and any measures the patient has taken to alleviate the problem. Additional data must be included on any complications, the results of tests and exams, and very detailed data on the treatment plan.
The conventions for ICD-10 have an alphabetic index of terms and codes that may apply. It’s broken down into four parts: Index of Diseases and Injury, Index of External Causes of Injury, Table of Neoplasms, and Table of Drugs and Chemicals. ICD-10 also has a tabular list that divides codes into different chapters that’s based on condition or body system.
ICD-10 coding conventions dictate that clinicians record the underlying or casual condition first. This should be followed by the condition displayed. Up to 12 diagnosis codes can be included for accurate representation of all conditions related to the patient’s visit.
A new coding convention for ICD-10 provides laterality in reporting. Clinicians now have designations for right, left, bilateral and unspecified. Coding can then be specified for the type of injury, disease or condition, along with an even more finely detailed description of the affected area.
Medication conventions have also been expanded. An example of this is drug under-dosing, a concept that doesn’t exist in ICD-9 but can be coded for under ICD-10. Many of the new codes reflect changes in terminology and technology. Some codes have been updated, while other terms have been eliminated or disassociated from specific conditions.
Even punctuation is addressed in the conventions. Specific guidelines have been established for the use of parentheses to designate supplementary words and terms that should be documented, but won’t change the diagnosis. Clinicians can differentiate between signs, symptoms and unspecified codes.
While ICD-10 codes are extensive and comprehensive, the good news for practitioners is that they generally won’t have to contend with the entire complement of code options, only those that affect their specialties. For instance, physical therapists and dermatologists won’t be coding for the same types of disease or injuries.