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Friday, September 16, 2011

Madness strikes! The new ICD-10 list

by Torsten Bernewitz

Doctor: “How did you get your S0010XA?”

Patient: “Well, you know that I have a Z9181, especially when I am doing F1010.  So I entered this Y92511, where I W51XXXA. In response, that person started Y042XXA which triggered my Y042XXD. This started Y040XXA and Y040XXD and that’s how I got the S0010XA, but the other person has S060X0A.”

(To decode see the end of this post. Or read on for hair-raising entertainment.)

If we thought healthcare is already caught up in red tape, we got another thing coming. 

You may know that today hospitals and doctors use a system of about 18,000 ICD-9 codes to describe medical services in bills they send to insurers. Apparently that’s not enough, so we’ll increase that by a factor of eight to about 140,000! These are the ICD-10 codes.

The Centers for Medicare & Medicaid Services (CMS) have set the ICD-10-CM/PCS compliance date to October 1, 2013. According to CMS there will be no delays and no grace period, i.e. after that date providers will no longer be able to report ICD-9-CM codes for services provided, if they want their claims to be paid.
What do we gain?

Well, for example, we can now use code Y9272 to indicate that a chicken coop was the place of occurrence of our injury. For a barn the code is Y9271, Y9273 for a farm field and Y9279 for other farm locations.

If you don’t hang out on a farm but follow more highbrow distractions, there’s a code for you, too. We have the gallery (Y92250), opera house (Y92253) and theater (Y92254). For a shop the code is Y92513 - but be careful to use Y92512 for a supermarket, store or market.

Codes Y92020-29 indicate various locations in a mobile home where an injury has occurred, in the order of kitchen, dining room, bathroom, bedroom, driveway, garage, swimming pool, garden and yard (can use the same code for these two), and including “other place” as well as “unspecified place”. Again – all of that in a mobile home; naturally there are specific codes for these locations if the home is single-family (private) house.

BTW, you’ll have noticed that these codes all start with “Y” – why indeed!

There are also codes for contact with powered household machinery - initial “encounter” (W292XXA) and contact with powered household machinery - subsequent “encounter” (W292XXA) - I guess if it doesn't kill you first time you can always get up and try again .

I also like “assault by hot household appliances - initial encounter (X983XXA).

There are three codes for walking into a lamppost – including, yes, you guessed it, initial and subsequent encounters.

We have three codes for falling from in-line roller skates, which are different from non-in-line rollerskates, which are different from heelies, skateboards (also three codes each), and, of course, “other rolling-type pedestrian conveyance” (love the language).

All this will make the mining of patient data even more interesting - hurray!


So here are the codes for the story at the beginning:
S0010XA: Contusion of unspecified eyelid and periocular area (a.k.a. “black eye”), initial encounter
Z9181: History of falling
F1010: Alcohol abuse, uncomplicated
Y92511: Restaurant or cafe as the place of occurrence of the external cause
W51XXXA: Accidental striking against or bumped into by another person, initial encounter
Y042XXA: Assault by strike against or bumped into by another person, initial encounter
Y042XXD: Assault by strike against or bumped into by another person, subsequent encounter
Y040XXA: Assault by unarmed brawl or fight, initial encounter
Y040XXD: Assault by unarmed brawl or fight, subsequent  encounter
S060X0A: Concussion without loss of consciousness, initial encounter


Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at
ZS Associates.

This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.


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