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Nov 10 2011

ICD10 and turtles: but where are the White Rabbits?

Published by at 12:05 pm under Complexity Catastrophe,Heath IT

Here is an example of the new ICD10 coding system required by HHS.  The ICD-10 codes contain more than 155,000 codes and can describe far more diagnoses and procedures than the ICD-9 series, which contain about 17,000 codes.  Coding things at this level – whether a patient was struck by a turtle or bitten by a turtle – is supposed to improve our understanding of health.  This is not a joke:  see http://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W59-#W59.8

W59.2 Contact with turtles
W59.21Bitten by turtle
<span class="identifier">W59.21XA</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.21XA…… initial encounter
<span class="identifier">W59.21XD</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.21XD…… subsequent encounter
<span class="identifier">W59.21XS</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.21XS…… sequela
W59.22Struck by turtle
<span class="identifier">W59.22XA</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.22XA…… initial encounter
<span class="identifier">W59.22XD</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.22XD…… subsequent encounter
<span class="identifier">W59.22XS</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.22XS…… sequela
W59.29Other contact with turtle
<span class="identifier">W59.29XA</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.29XA…… initial encounter
<span class="identifier">W59.29XD</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.29XD…… subsequent encounter
<span class="identifier">W59.29XS</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.29XS…… sequela
and, of course, the huge health issue of being crushed by non-venomous reptiles:
W59.83 Crushed by other nonvenomous reptiles
<span class="identifier">W59.83XA</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.83XA…… initial encounter
<span class="identifier">W59.83XD</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.83XD…… subsequent encounter
<span class="identifier">W59.83XS</span> is a specific ICD-10-CM diagnosis code” width=”16″ height=”16″ /><a name=W59.83XS…… sequela
One 2003 study they cited, by consulting firm Robert E. Nolan Co. for the Blue Cross and Blue Shield Association, estimated the implementation cost for the conversion to ICD-10 will run from $5.5 billion to $13.5 billion with additional productivity losses of $752 million to nearly $1.4 billion for hospitals and physician practices. The Nolan study did not count the impact on nursing homes, clinical laboratories, durable medical-equipment suppliers, claims clearinghouses, small and midsize payers and third-party administrators.
Of course, this will allow us to detect medicare fraud from nefarious docs who code a treatment as W59.83XD – “Being crushed in a subsequent encounter with a non-venomous reptile,” when the real problem was W59.29XS – “Sequela of other contact with a turtle.”
I can’t find any code for “contact with rabbit,” not even the 10 feet tall white rabbits that the Jefferson Airplane talked about in the 60′s that lead folks into impenetrable rabbit holes.  Maybe this will come in ICD11.
Of course, all this presumes that our health care system is going to survive the complexity castrophe that HHS is perpetrating.  Maybe when we have a million ICD codes and 250,000 pages of health care legislation, we’ll finally fix the health care system.
Or, maybe we just have to simplify things somehow.
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