August 18, 2014

There’s a Code for That


Recently, an article was published ridiculing ICD-10 by profiling the most obscure (and frankly, ridiculous) coding combinations that could be identified. “There’s a code for that” has become synonymous with these highly publicized codes, which cover scenarios such as turtle bites, water skis on fire, being hit by meteors, and other circumstances widely considered preposterous.

Obviously, these authors are focused on things that are truly irrelevant, though entertaining, and completely missing the point of ICD-10. Those knowledgeable in coding and ICD-10 know that there are other far more important points that are being ignored because they are not funny and/or do not make headlines.


Suppose you were initially diagnosed with cancer in the upper outer quadrant of your right breast, then find that you additionally have a new benign neoplasm in the left breast.  Today, laterality is not inherent in the diagnosis coding choices. Some payers will permit adding a modifier to designate right versus left, but many others do not. Right now there is not really a way to report this scenario with any significant degree of accuracy. You can report a benign neoplasm in a breast and a breast malignancy, but that’s it. Using ICD-9, there is no way to designate that the new problem is in the opposite breast from the cancer. If we were using ICD-10, both conditions could be coded precisely, because there’s a code for that.

Suppose you are one of our veterans who lost your right leg in combat. Now suppose you just sustained a severe fracture of your left ankle. Obviously, this is a much more dire scenario than that of a patient who had two normal legs prior to a fracture, because mobility is further compromised. Because no laterality exists in ICD-9, there is no way to report this scenario in our current coding methodology. With ICD-10, there’s a code for that.

Suppose you have a heart attack involving the anterior wall of your heart. Although there are a variety of coding choices in ICD-9, none currently specify which coronary artery is involved. Although it is virtually certain that your cardiologist knows and relies upon this information for treatment and prognosis, there is no way to convey that with current coding choices. In ICD-10, your cardiologist can specify whether the heart attack affected the left main coronary artery, the left anterior descending coronary artery, or another anterior wall artery. With ICD-10, there’s a code for that.

Suppose you see your physician for pain in your arm, and suppose another patient sees the same physician for pain in the leg. Currently, both of you will receive the same diagnosis even though your problems are very different (and not even of the same anatomic area). It would be far more helpful to know that your pain is in your upper left arm and the other patient’s pain is in his lower right leg. With ICD-10, there’s a code for that.

These few examples are just a tiny snapshot of new options to report diagnoses, conditions, signs, and symptoms. While we have heard many times that not all physicians are documenting to the level necessary to code in ICD-10, those physicians who are masters at capturing all the relevant details in their documentation are currently handicapped by the imprecise code choices available in ICD-9.

Insurers making payment decisions, rating severity, or trying to predict recovery time and prognosis all need specific coding information. Effective and efficient coordination of care and clinical communication both hinge on the details of patient encounters. Risk of morbidity and mortality help establish and steer public health policies, wellness benefits, and preventive services. If we focus solely on what diagnosis coding can do for patients and care, the possibilities are exciting. 

So let’s put an end to the ridiculous articles on ridiculous codes. ICD-10 is not perfect, but for the vast majority of patients and what matters for their care, there’s a code for that.

Holly Louie, RN, CHBME

Holly is the Compliance Officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho.  Holly is the 2016 President of the Healthcare Billing and Management Association (HBMA) and previously chaired the ICD-10 Committee.  Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing and regulatory compliance.  She has previously held compliance officer positions in local and international billing companies. Holly is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.