Saying Yes to NOS

I suspect that some of you saw the changes in the ICD-9-CM codes that were published in the September 2011 issue of the AAP News. But I’ll bet that very few of you took the time to read them. Certainly, had I not had several hours to kill in an airport waiting for a connection delay, I wouldn’t have even paused on the page.

When it comes to coding, I’m a less-is-better kind of guy. I keep about a dozen near the front of my memory banks. There is URI, UTI. There’s one for otitis and one for pneumonitis. I make frequent use of the NOS (Not Otherwise Specified) option. 729.5 is a favorite for any extremity pain or injury.

When your patient is bitten by a bird, you can specify from as many as nine species of duck, macaw, parrot, goose, or chicken.

While I see a wide variety of patients, the range of illnesses and injuries is actually quite narrow. Looking at my ICD-9-CM coding profile, even if I quadrupled it by being more specific, some people might consider my professional life boring. For me, the fun comes not from seeing 20 different diseases in a day but from watching how dozens of unique children manifest a few common conditions.

I realize that there are some physicians who see more complex conditions than I do. And as I reviewed the new ICD-9-CM codes, I could understand why it might be helpful to them to have specific codes for three different kinds of shock or for four different thalassemias. For the most part, the more than 100 new additions listed in the AAP News seem reasonable.

However, when I returned from my trip and began working through a backlog of newspapers, I discovered a story by Anna Wilde Mathews in the Wall Street Journal (Sept. 13, 2011, "Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way") that took me to the coding wonderland that is just over the horizon. ICD-10 is coming on Oct. 1, 2013, and with it, your coding choices will expand from a more than generous 18,000 to a mind-blowing 140,000. If you are into serious hair splitting, you will have found nirvana.

When your patient is bitten by a bird, you can specify from as many as nine species of duck, macaw, parrot, goose, or chicken, for example. You will be able to specify whether your 7-year-old patient is bitten by or struck by a turtle. If your 17-year-old patient is burned when his water skis catch fire, V91.07XA is for you. Unfortunately, I’m not making this up. In 2 years, coding will move from its current status as a serious inconvenience to a boondoggle of unworkable lunacy.

Who’s driving this bus to the funny farm? It’s certainly not you or I. It’s a collection of government agencies that are data hungry. Pat Brooks, senior technical adviser for the Centers for Medicare and Medicaid Services says, "It’s for accuracy of data and quality of care." Really?

I guess I haven’t been paying enough attention to the critical issues that differentiate the care of macaw bites from turkey peckings. I hope the new system ferrets out those unscrupulous doctors who have been billing for snapping turtle bites when their patients have been merely bruised by tossed box turtles.

It’s all about data collection ... and the money. It takes time and that means money to collect data. If they are expecting me to move beyond my simple NOS style of coding, they had better pay me for my time.

I have a better idea: PDC, Patient Directed Coding. When the patients (or parents) arrive in the office, they will be given the coding book and be asked to select the code(s) that describe their problem. The physician is paid based on those previsit codes. Codes for vague complaints are of higher value because they take more time and effort to get to the bottom of things. And, of course, the more codes the patient selects the more the doctor is paid.

PDC would relieve us of the time-consuming burden of ICD coding and reward those of us who accept more time-consuming and effort-intensive patients. What do you think? Isn’t worth a try?

I suspect that some of you saw the changes in the ICD-9-CM codes that were published in the September 2011 issue of the AAP News. But I’ll bet that very few of you took the time to read them. Certainly, had I not had several hours to kill in an airport waiting for a connection delay, I wouldn’t have even paused on the page.

When it comes to coding, I’m a less-is-better kind of guy. I keep about a dozen near the front of my memory banks. There is URI, UTI. There’s one for otitis and one for pneumonitis. I make frequent use of the NOS (Not Otherwise Specified) option. 729.5 is a favorite for any extremity pain or injury.

When your patient is bitten by a bird, you can specify from as many as nine species of duck, macaw, parrot, goose, or chicken.

While I see a wide variety of patients, the range of illnesses and injuries is actually quite narrow. Looking at my ICD-9-CM coding profile, even if I quadrupled it by being more specific, some people might consider my professional life boring. For me, the fun comes not from seeing 20 different diseases in a day but from watching how dozens of unique children manifest a few common conditions.

I realize that there are some physicians who see more complex conditions than I do. And as I reviewed the new ICD-9-CM codes, I could understand why it might be helpful to them to have specific codes for three different kinds of shock or for four different thalassemias. For the most part, the more than 100 new additions listed in the AAP News seem reasonable.

However, when I returned from my trip and began working through a backlog of newspapers, I discovered a story by Anna Wilde Mathews in the Wall Street Journal (Sept. 13, 2011, "Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way") that took me to the coding wonderland that is just over the horizon. ICD-10 is coming on Oct. 1, 2013, and with it, your coding choices will expand from a more than generous 18,000 to a mind-blowing 140,000. If you are into serious hair splitting, you will have found nirvana.

When your patient is bitten by a bird, you can specify from as many as nine species of duck, macaw, parrot, goose, or chicken, for example. You will be able to specify whether your 7-year-old patient is bitten by or struck by a turtle. If your 17-year-old patient is burned when his water skis catch fire, V91.07XA is for you. Unfortunately, I’m not making this up. In 2 years, coding will move from its current status as a serious inconvenience to a boondoggle of unworkable lunacy.

Who’s driving this bus to the funny farm? It’s certainly not you or I. It’s a collection of government agencies that are data hungry. Pat Brooks, senior technical adviser for the Centers for Medicare and Medicaid Services says, "It’s for accuracy of data and quality of care." Really?

I guess I haven’t been paying enough attention to the critical issues that differentiate the care of macaw bites from turkey peckings. I hope the new system ferrets out those unscrupulous doctors who have been billing for snapping turtle bites when their patients have been merely bruised by tossed box turtles.

It’s all about data collection ... and the money. It takes time and that means money to collect data. If they are expecting me to move beyond my simple NOS style of coding, they had better pay me for my time.

I have a better idea: PDC, Patient Directed Coding. When the patients (or parents) arrive in the office, they will be given the coding book and be asked to select the code(s) that describe their problem. The physician is paid based on those previsit codes. Codes for vague complaints are of higher value because they take more time and effort to get to the bottom of things. And, of course, the more codes the patient selects the more the doctor is paid.

PDC would relieve us of the time-consuming burden of ICD coding and reward those of us who accept more time-consuming and effort-intensive patients. What do you think? Isn’t worth a try?

I suspect that some of you saw the changes in the ICD-9-CM codes that were published in the September 2011 issue of the AAP News. But I’ll bet that very few of you took the time to read them. Certainly, had I not had several hours to kill in an airport waiting for a connection delay, I wouldn’t have even paused on the page.

When it comes to coding, I’m a less-is-better kind of guy. I keep about a dozen near the front of my memory banks. There is URI, UTI. There’s one for otitis and one for pneumonitis. I make frequent use of the NOS (Not Otherwise Specified) option. 729.5 is a favorite for any extremity pain or injury.

When your patient is bitten by a bird, you can specify from as many as nine species of duck, macaw, parrot, goose, or chicken.

While I see a wide variety of patients, the range of illnesses and injuries is actually quite narrow. Looking at my ICD-9-CM coding profile, even if I quadrupled it by being more specific, some people might consider my professional life boring. For me, the fun comes not from seeing 20 different diseases in a day but from watching how dozens of unique children manifest a few common conditions.

I realize that there are some physicians who see more complex conditions than I do. And as I reviewed the new ICD-9-CM codes, I could understand why it might be helpful to them to have specific codes for three different kinds of shock or for four different thalassemias. For the most part, the more than 100 new additions listed in the AAP News seem reasonable.

However, when I returned from my trip and began working through a backlog of newspapers, I discovered a story by Anna Wilde Mathews in the Wall Street Journal (Sept. 13, 2011, "Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way") that took me to the coding wonderland that is just over the horizon. ICD-10 is coming on Oct. 1, 2013, and with it, your coding choices will expand from a more than generous 18,000 to a mind-blowing 140,000. If you are into serious hair splitting, you will have found nirvana.

When your patient is bitten by a bird, you can specify from as many as nine species of duck, macaw, parrot, goose, or chicken, for example. You will be able to specify whether your 7-year-old patient is bitten by or struck by a turtle. If your 17-year-old patient is burned when his water skis catch fire, V91.07XA is for you. Unfortunately, I’m not making this up. In 2 years, coding will move from its current status as a serious inconvenience to a boondoggle of unworkable lunacy.

Who’s driving this bus to the funny farm? It’s certainly not you or I. It’s a collection of government agencies that are data hungry. Pat Brooks, senior technical adviser for the Centers for Medicare and Medicaid Services says, "It’s for accuracy of data and quality of care." Really?

I guess I haven’t been paying enough attention to the critical issues that differentiate the care of macaw bites from turkey peckings. I hope the new system ferrets out those unscrupulous doctors who have been billing for snapping turtle bites when their patients have been merely bruised by tossed box turtles.

It’s all about data collection ... and the money. It takes time and that means money to collect data. If they are expecting me to move beyond my simple NOS style of coding, they had better pay me for my time.

I have a better idea: PDC, Patient Directed Coding. When the patients (or parents) arrive in the office, they will be given the coding book and be asked to select the code(s) that describe their problem. The physician is paid based on those previsit codes. Codes for vague complaints are of higher value because they take more time and effort to get to the bottom of things. And, of course, the more codes the patient selects the more the doctor is paid.

PDC would relieve us of the time-consuming burden of ICD coding and reward those of us who accept more time-consuming and effort-intensive patients. What do you think? Isn’t worth a try?