"The only way to tolerate the frustration is to be amused."
"To the dismay of geriatricians and good fortune for personal injury attorneys, there are scads of ways to fall, from the mundane to the bizarre. Only slipping on a banana peel is missing."
I found your list of specialized diagnoses quite amusing, and it reminded me that I once suffered from a kidney stone that was painful enough to make me drop to the floor moaning and groaning, an alarming behavior that inspired my colleagues to drive me straight to the emergency room. In the spirit of good humor I whimsically suggest adding the following to the list of ways to fall:
"Confucius say, man who fall in vat of molten glass, make spectacle of self"
Thank you Dr. Stern. Not sure if you meant this post to be funny or not, but I giggled all the way through. At one point I thought you were going to break out into a Dr. Seuss rhyme.
I am on the receiving end of doctors' ICD 10 coding. As I sit reading the H&Ps I receive from ER docs, hospitalists, PCPs, and so on, I sometimes wonder if they are slinging things at the wall to see what sticks. I know how I feel trying to make heads or tails from the hodgepodge laid in front of me, it must be migraine material for a physician to muddle through.
As I transitioned to primarily being a patient and had to read the diagnosis instead of list them, I realized that a lot diagnoses are simply wrong, I have to assume due to the ridiculous number of possibilities listed in the EMR. The biggest problem I’ve come across is when transitioning care to another HCP, rather spend time talking to your patients, health professionals are taking information in the EMR as gospel, and unnecessary testing is ordered.
I also adhere to the “you might as well be amused” school of thought- I am a sexual health nurse- I test people for STI’s, treat people for STI’s discuss symptoms of STI’s all day but if my attempt to input my Diagnosis starts with STI, I will get auto filled to “exposure to Stingray” every-time…did I mention I live on the prairies???
As a former fee-for-service family doctor who escaped into the heavenly arms of direct primary care, I rejoiced at the seminal rite of passage: throwing billing and coding into the lake of fire where it belongs. No hand-wringing or gnashing of teeth over what flavor of former smoker to call my patient. I just document "former smoker- congratulated patient on his success" and move on with my day.
I'm a computer scientist, not a healthcare professional, but I am familiar with the expression "He who pays the piper calls the tune". The third party payer is stuck in the position of having to justify payments, and this inevitably means lots of bureaucracy and red tape for payers, providers, and patients. Congratulations on your escape from the system.
Thank you. I'm the happiest I've ever been in medicine, mostly because I get to take care of my patients the way they need to be. It's incredible how efficient and affordable medical care can be when you get rid of the middleman.
AI actually has a great use case for simplifying doctor’s lives here - you should be able to just type in what you mean in plain old English (better yet, speak it), and the AI can match your words to the most relevant, highest reimbursement, most Scrabble points codes and terms. Actually pretty easy to build this, but the current EHR companies make money from making admin’s life easier, not doctors.
In a perfect world, everything serves some purpose. And the other way round, that purpose is the justification of the existence of everything.
In medicine, a proper, accurate diagnosis would serve the purpose of applying the proper means of restoring the health of the person. There are no other components. You diagnose a person to make sure that their health is restored. (Or, in unfortunate cases, that their health deterioration is minimized.)
By definition, any other factor that makes the above clouded, should be eliminated. Financial settlements are the first to go. Because you cannot justify why losing a particular finger is twice as expensive as losing a different finger. Or why losing it following a particular set of events (or ailments) is worth a different amount. Finances assigned to codes being about benefits only to third parties. Sorry, it’s time to go.
Statistics is next to go. Because neither the doctor nor the patient care about it, and stats of a particular “case” is irrelevant to the condition of the particular person. Statistics should only be important at the academic stage, where the efficiency of practical treatment measures should be analyzed and converted into recommendations. I don’t want my doctor to tell me that I have 37% of survival chances with drug X and 78% chances with drug Y. I want to have 100% success rate in my treatment.
But… I would welcome to see a track record of the doctor whom I am consulting. Displayed in large, bold letters on the wall, right in front of me. How many patients were cured or treated with success? How many were neglected? How many gave up because the doc was not human to them? How many were difficult to communicate with and why? How many died while in the care of my doc? This statistics is more important to me as a patient than all ICD-related vapourware. However, I haven’t seen anything like that anywhere. Have you?
Interesting. This company is already using AI to do auto-coding with better results than humans. Those smoking codes were pretty funny … no judgment there at all!
Thank you for your observations. After nearly 30 years of billing third party party payors, it is obvious to me that the chosen (either by clinician or coder) diagnoses are heavily influenced by various payors' requirements. Therefore, the entire database of diagnoses in any given data set in USA can not be trusted as accurate. Yay. :-(
It's clear clear evidence that patient care is not the first priority of the system. If it were, then our assessment would flow from that consideration and not from the consideration of billing concerns and data collection concerns. Even from those perspectives, the system makes no sense. How did we get to this place? What can we do to get out of it?
I'd like to know the history of and a detailed (truthful) review of the actual purpose of ICD 10 coding schema. We went from approx 13,000 codes under ICD 9 to approx 70,000 codes in ICD 10. Why? What purpose does this all serve? Getting into the specificity of which side of the body something is on, etc etc - what body, what committee, what research group - who needs to know this?? And what does anybody actually do with this information?
Adding to this, who came up with HCC (hierarchical condition codes)? I've never figured that out. Who decided this limited set of codes was so much more important, complex, costly than the thousands of others? What data did they use? Again, for what purpose?
It should be something we know as these code systems play an outsized role in the daily life of medicine: from physicians, to billers, to hospital systems, to CMS. Under Medicare Advantage, HCC has allowed a several billion dollar scam to occur! We should all know more about this than we do.
As someone working with the system on a daily basis (and as attested to here), the stress, anxiety, inefficiency that simply choosing the "code" creates is outrageous.
And we all try to figure out the work around that lets us get through the day. The modifier "Unspecified", "not otherwise specified", is used as often as humanly possible.
How does this entire situation make the accuracy of ANY of this better?
I don't know about the ICD codes but the AMA licenses the CPT codes for roughly 300 million per year. The AMA has a 45 page (!) pdf to advise doctors on choosing a billing code for office visits.
"The only way to tolerate the frustration is to be amused."
"To the dismay of geriatricians and good fortune for personal injury attorneys, there are scads of ways to fall, from the mundane to the bizarre. Only slipping on a banana peel is missing."
I found your list of specialized diagnoses quite amusing, and it reminded me that I once suffered from a kidney stone that was painful enough to make me drop to the floor moaning and groaning, an alarming behavior that inspired my colleagues to drive me straight to the emergency room. In the spirit of good humor I whimsically suggest adding the following to the list of ways to fall:
"Confucius say, man who fall in vat of molten glass, make spectacle of self"
Thank you Dr. Stern. Not sure if you meant this post to be funny or not, but I giggled all the way through. At one point I thought you were going to break out into a Dr. Seuss rhyme.
I am on the receiving end of doctors' ICD 10 coding. As I sit reading the H&Ps I receive from ER docs, hospitalists, PCPs, and so on, I sometimes wonder if they are slinging things at the wall to see what sticks. I know how I feel trying to make heads or tails from the hodgepodge laid in front of me, it must be migraine material for a physician to muddle through.
Dr., heal thyself?
As I transitioned to primarily being a patient and had to read the diagnosis instead of list them, I realized that a lot diagnoses are simply wrong, I have to assume due to the ridiculous number of possibilities listed in the EMR. The biggest problem I’ve come across is when transitioning care to another HCP, rather spend time talking to your patients, health professionals are taking information in the EMR as gospel, and unnecessary testing is ordered.
Reminds me why I am happy to be retired.
What a travesty.
I also adhere to the “you might as well be amused” school of thought- I am a sexual health nurse- I test people for STI’s, treat people for STI’s discuss symptoms of STI’s all day but if my attempt to input my Diagnosis starts with STI, I will get auto filled to “exposure to Stingray” every-time…did I mention I live on the prairies???
As a former fee-for-service family doctor who escaped into the heavenly arms of direct primary care, I rejoiced at the seminal rite of passage: throwing billing and coding into the lake of fire where it belongs. No hand-wringing or gnashing of teeth over what flavor of former smoker to call my patient. I just document "former smoker- congratulated patient on his success" and move on with my day.
I'm a computer scientist, not a healthcare professional, but I am familiar with the expression "He who pays the piper calls the tune". The third party payer is stuck in the position of having to justify payments, and this inevitably means lots of bureaucracy and red tape for payers, providers, and patients. Congratulations on your escape from the system.
Thank you. I'm the happiest I've ever been in medicine, mostly because I get to take care of my patients the way they need to be. It's incredible how efficient and affordable medical care can be when you get rid of the middleman.
AI will certainly replace physicians at billing, however. And soon, Praise Kier.
AI actually has a great use case for simplifying doctor’s lives here - you should be able to just type in what you mean in plain old English (better yet, speak it), and the AI can match your words to the most relevant, highest reimbursement, most Scrabble points codes and terms. Actually pretty easy to build this, but the current EHR companies make money from making admin’s life easier, not doctors.
Just like 20 years ago, computers were going to make our lives easier. Dream on
In a perfect world, everything serves some purpose. And the other way round, that purpose is the justification of the existence of everything.
In medicine, a proper, accurate diagnosis would serve the purpose of applying the proper means of restoring the health of the person. There are no other components. You diagnose a person to make sure that their health is restored. (Or, in unfortunate cases, that their health deterioration is minimized.)
By definition, any other factor that makes the above clouded, should be eliminated. Financial settlements are the first to go. Because you cannot justify why losing a particular finger is twice as expensive as losing a different finger. Or why losing it following a particular set of events (or ailments) is worth a different amount. Finances assigned to codes being about benefits only to third parties. Sorry, it’s time to go.
Statistics is next to go. Because neither the doctor nor the patient care about it, and stats of a particular “case” is irrelevant to the condition of the particular person. Statistics should only be important at the academic stage, where the efficiency of practical treatment measures should be analyzed and converted into recommendations. I don’t want my doctor to tell me that I have 37% of survival chances with drug X and 78% chances with drug Y. I want to have 100% success rate in my treatment.
But… I would welcome to see a track record of the doctor whom I am consulting. Displayed in large, bold letters on the wall, right in front of me. How many patients were cured or treated with success? How many were neglected? How many gave up because the doc was not human to them? How many were difficult to communicate with and why? How many died while in the care of my doc? This statistics is more important to me as a patient than all ICD-related vapourware. However, I haven’t seen anything like that anywhere. Have you?
Interesting. This company is already using AI to do auto-coding with better results than humans. Those smoking codes were pretty funny … no judgment there at all!
https://veuu.com/
Thank you for your observations. After nearly 30 years of billing third party party payors, it is obvious to me that the chosen (either by clinician or coder) diagnoses are heavily influenced by various payors' requirements. Therefore, the entire database of diagnoses in any given data set in USA can not be trusted as accurate. Yay. :-(
It's clear clear evidence that patient care is not the first priority of the system. If it were, then our assessment would flow from that consideration and not from the consideration of billing concerns and data collection concerns. Even from those perspectives, the system makes no sense. How did we get to this place? What can we do to get out of it?
I'd like to know the history of and a detailed (truthful) review of the actual purpose of ICD 10 coding schema. We went from approx 13,000 codes under ICD 9 to approx 70,000 codes in ICD 10. Why? What purpose does this all serve? Getting into the specificity of which side of the body something is on, etc etc - what body, what committee, what research group - who needs to know this?? And what does anybody actually do with this information?
Adding to this, who came up with HCC (hierarchical condition codes)? I've never figured that out. Who decided this limited set of codes was so much more important, complex, costly than the thousands of others? What data did they use? Again, for what purpose?
It should be something we know as these code systems play an outsized role in the daily life of medicine: from physicians, to billers, to hospital systems, to CMS. Under Medicare Advantage, HCC has allowed a several billion dollar scam to occur! We should all know more about this than we do.
As someone working with the system on a daily basis (and as attested to here), the stress, anxiety, inefficiency that simply choosing the "code" creates is outrageous.
And we all try to figure out the work around that lets us get through the day. The modifier "Unspecified", "not otherwise specified", is used as often as humanly possible.
How does this entire situation make the accuracy of ANY of this better?
It doesn't.
I don't know about the ICD codes but the AMA licenses the CPT codes for roughly 300 million per year. The AMA has a 45 page (!) pdf to advise doctors on choosing a billing code for office visits.
Glad to know I'm not the only one who the ICD-10 frustrates the hell out of