Coding is the Bane of my Existence!

 -pure-ridonculousness-

 

So a huge part of medicine that you don't see (and you barely know exists until your finally a resident and your life is consumed by it) is coding and billing. Blech...I cringe at the thought. There's this whole ridiculous set of codes that we have to use (now the ICD-9, but come later this year, the ICD-10....a whole new set....again, blech!) We have to sift through about 80,000 codes now, and the new ICD set will have (gasp) over 140,000 diagnoses. Kill me now!! I am forever frustrated with the ICD-9, not being able to find codes for things I need that are common diagnoses, and the fact that there exists all sorts of ridiculous codes that I imagine aren't all that common at all.....For example - 

I had a patient who came in complaining of dizziness....not vertigo, but just a little bit of dizziness. I went through a review of systems with her and believe me when I tell you nothing else was wrong. Her physical exam was completely benign too! Now, what I thought was the problem is besides the point here....I wanted to work up her symptom, so I tried to code her for dizziness....no such luck. I could diagnose her 780.4 - Dizziness and Giddiness, but the woman wasn't giddy!

Now I just checked with the ICD-10 (save me now), and sure enough, still no way to code someone with just dizziness. There are, however, three different codes regarding being 'struck' by a turtle...

W5922XA Struck by a turtle, initial encounter

W5922XD Struck by a turtle, subsequent encounter

W5922XS Struck by a turtle, sequelae

So just picture having to use W5922XD - "Hey doc...look, I know you said for me to avoid them, but I'll be darned: I got hit in the head with a turtle again!!" Seriously? This they have a code for, but dizziness? Oh no! And that's not the only frequent complaint that can't be found...

Fibromyalgia: has to be coded as myalgia/myositis NOS. Personally, I think it's pretty specified...in the people that I believe actually have this condition (didn't believe in it at all at first, with so many of my 'fibromyalgia' patients having a million other things wrong with them... in every system of the body.... at age 30. Then I had a couple of patients who I really believed. That being said, I don't trust a diagnosis who's mainstay of treatment is exercise and sleep.) Now at least they have fixed their mistake with this new ICD-10 coming out, and there is in fact a code for this...M79.7

Back Pain: From what I understand, this is the most common complaint in doctors offices across the country (and likely in Canadia too). Back pain...seems simple, no? Well again, welcome to the ridiculousness that is the ICD-9: you can use 724.2 Lumbago (low back pain...most common sure, but definitely not all-encompassing), 724.5: Back Ache (but what if it doesn't ache? What if it's actual pain?), and the closest thing that you can use if someone has non-lower back pain (not ache) is 338: Pain. Luckily the ICD-10 really cleared things up for us - M54.9: Dorsalgia, unspecified.

Viral Gastroenteritis (likely the most COMMON cause of GE): there's a few ways to diagnose this one....separately as Gastritis and Enteritis, Viral syndrome NOS, but not just gastroenteritis. It has to be toxic, or radiation, or with colitis. Who comes up with this? The same people who watch slapstick movies apparently, cause look what's in the ICD-10 -

W22.02XA walked into lamppost, initial encounter
W22.02XD walked into lamppost, subsequent encounter

Really? People coming in reporting multiple lamppost-related injuries get two codes? Really?!

Or how about this addition to any sort of trauma/injury/illness diagnosis...

Y92146 swimming pool of prison as the place of occurrence of the external cause

Really?! REALLY?! I mean putting the ridiculousness aside that there are swimming pools in prisons, how much stuff goes on in there that there's a whole diagnostic modifier for it? Actually wait...I've seen Oz....I take that back. 

V91.07XA burn due to water-skis on fire 

Darwin Awards....thought that would be enough said, till I found this one...

 V9027XD Drowning and submersion due to falling or jumping from burning water-skis, subsequent encounter

Implying that you have previously survived an episode of drowning after jumping off of burning water skis, and then you did it again? That alone would leave said person open to a whole slew of other codes on top of the subsequent drowning one...

F73: Profound Intellectual Disabilities

V40.0: Problems with Learning

(and likely) 303.0: Acute Alcohol Intoxication

E845.9 accident involving spacecraft injuring other person

E928.0 effects of weightlessness in spacecraft

Now I don't argue the fact that there are people in this world (likely only astronauts though) who suffer from these problems, but do you mean to tell me there are more of them then there are people with fibromyalgia? Or gastroenteritis? Or dizziness? Preposterous. 

I'm tired from all this ranting. Bottom line, coding sucks. And what sucks about that? We don't get paid unless we code. I have decided that when my loans are paid off and I am out of residency, I will (when I can afford it) hire someone to follow me around and just do all of my coding for me. Money well spent if you ask me! I'm just lucky in the meantime that I'm surrounded by nurses, fellow residents, faculty and others who are far more proficient in this art than I. 

I am left thinking of coding suffering from the following diagnoses myself...

R45.4: Irritability and Anger 

Z73.0: Burn-Out

797: Senility w/o psychosis

To finish things off, here are a few more that I think are either ridiculous, funny, or just way too weird to beat out those missing common diagnoses. Pleasant evening all!

• 787.03 Vomiting alone - This is just sad...cause it's always more fun to vomit with friends ;-)
• 704.3 variations in hair color - Look out punk-rockers and emo kids....we have a code for you!
• R46.1 bizarre personal appearance - See the above comment. Definitely should be used a lot more than I'm sure it is.
• R46.0 very low level of personal hygiene - I have no issue with this one...it's more common than you (or the people this affects) think
• E905.4 bite by venomous centipede - We had those living in the dorms in Grenada! One got into bed with Mel one night...
• E922.5 Accident caused by paintball gun - That's what you get for voluntarily letting yourself get shot at!
• E923.0 Accident by fireworks explosion - I feel sorry for the professional people this happens to, but am suspicious that this code will get used more for drunk idiots on July 1/4 trying to 'have our own light show!'
• S1087XA: Other superficial bite of other specified part of neck, initial encounter - So there's even a code for a hickey...
• S30867A: Insect bite (nonvenomous) of anus, initial encounter - Initial encounter?  Implying subsequent encounters exist somewhere?
• G4482: headache associated with sexual activity - Bummer :-(
• Z9989: Dependence on other enabling machines and devices - A diagnosis fit for so many trips to Vegas
• Y92250: injured in an art gallery - Watch out for those rogue artist-types who get all hopped up on Starbucks and then cause mass destruction in the gallery
• T7501XD: shock due to being struck by lightning, subsequent encounter - And you thought your luck was bad?

Note: for anyone who cares, the codes above are from ICD-9 and ICD-10....yes they are mixed up, and it's purely for entertainment purposes, not because of my lack to know the difference.