Codes, codes, and more codes!
Thumbing through the ICD-9 book of diagnostic codes is an eye-opening experience. For starters, who needs a code for "hit by a nuclear bomb?" I mean, will the patient or doctor need to worry about a proper Medicare ICD-9 code if a nuclear holocaust occurs? And how often does a patient survive a head-on collision with an oncoming train? And come to think of it, I haven't used code E832 (patient forced off a gang plank) in the last few centuries. Then there's the diseases I'd never heard of: Dum dum fever and Twiddler's syndrome. . .
Some codes are vague. For example, when my husband forgets the milk I reminded him to pick up on the way home, does code 317 for "febbleminded" need to be entered into his medical record? When my sister loses ten pounds and I gain ten, does that constitute code 331.3 (sibling jealousy disorder?)
Some codes we pray we'll never need, such as code E876.6, "procedure performed on wrong patient," or V15.80 "failed anaesthesia." (Apparently, patients do wake up in the middle of their by-pass surgery.) How about code E876.7? Wrong body part cut off. (You go in for a new knee and come out with a new hip!) Then there's the "wrong side" code. You develop breast cancer and go in for a RIGHT side masectomy and wake up in the recovery room with your LEFT breast gone. Can you spell L-A-W-S-U-I-T?
Some codes are "politically incorrect." We all know never to call mentally-challenged people "retards" but the ICD-9 coding book still lists in its index the old insulting codes for low IQ: moron, imbecile, and idiot. (In case you were wondering, it's much better to be a "moron" (IQ of 50-69) than an "idiot" (IQ of less than 25.) But even if you're a genius, the coding book may still label you a "moral imbecile" with code 301.7.
Now that we are converting to Electronic Medical Records, do you want code 784.99 (Fetid breath) or 787.3 (Flatulence) to be on your problem list for every doctor and nurse of every specialty to see? Or what if a harried doctor hits a wrong key and your medical record now labels you as a "necrophiliac" (someone who likes sex with dead people) or worse yet, a coprophiliac. (Don't know what that is? Look it up!) An employee of mine consulted a specialist for anemia but somehow got miscoded as "struck by lightening."
Most of the codes seem beaurocratic. For example, does it matter whether you sprain your ankle playing rugby, soccer, football, dodge ball, water polo, cricket, ultimate Frisbe, Bungee jumping, dancing, trampolining, or cheerleading? Yet the code book has a separate code for EACH of these sports and many more. But as a doctor, I'll use rest, ice, ACE wraps, and elevation on the sprained ankle regardless of HOW you sprained it. Similarly, they have a separate code for whether you almost drown falling out of a row boat, a motor boat, or a canoe. To which I ask, "WHAT DIFFERENCE DOES IT MAKE??? What matters is how much water gets in your lungs and how long your brain goes without oxygen! Likewise, does it matter whether I get kicked in the head milking a goat (code E019.0) versus shearing a goat? (code E019.2) Seems to me, the important thing is how much damage the goat's hoof does to my brain. And who cares if it's a moose, a horse and buggy, or a telephone pole that my bicycle crashes into? (Except, perhaps the moose.) But you guessed it, there's a separate code based on the item I crash into!
And how about that code for "fertile eunuch syndrome?" (257.2). Isn't a fertile eunuch, by definition, an oxymoron?
Now that Medicare is cracking down on "fraud," will I be sent to jail for coding a patient with a tape worm infection when it was actually a hook worm, round worm, or pinworm? This "miscoding" could be deemed fraudulent, a felony worthy of time in the slammer. Or God forbid, what if I code a patient with Rocky Mountain Spotted fever using the Rocky Mountain tick code (082.0) when it was actually a Colorado tick? (066.1) I mean, do all Colorado ticks know the exact state boundary lines?
The nightmare is soon to get worse. In 2013, Medicare releases its new ICD-10 coding book that adds 50,000 additional codes with which to torment me. Will I now have to count the number of white spots on the back of the Colorado tick to select the proper code? Or document the number of horns on Bullwinkle's antlers when I crash into him with my bicycle? Perhaps it will no longer be deemed acceptable to code that I broke my ankle falling off a flag pole (yes, there's a code for that.) Now, they'll want to know which state's flag was flying from the flag pole.
It's no wonder Congress can't come up with a balanced budget in over 1,000 days-- they're too busy scheming up 50,000 useless codes to waste my time instead. But cheer up, there's bound to be a new code for the frustration I feel.