Know Why Those “Absurd” ICD-10 Codes Aren’t So Funny After All?

 

“Struck by Duck” Makes a Good Meme, but Specific Coding’s a Serious Thing

In October 2015, U.S. healthcare providers started using the ICD-10 coding guidelines. But even before the much-delayed implementation took place and even since, this system of over 69,000 diagnostic codes and nearly 72,000 procedural codes has been giving the internet a lot to laugh about.

Search the web for ICD-10 codes, and it won’t be long before you find cherry-picked lists of codes labeled everything from “funny” and “silly” to “wacky” and “absurd,” even “ridiculous” or “outlandish.” These aren’t adjectives you’d normally expect to find in healthcare discussions, let alone discussions about a subject as technical as medical coding.

Now, we at MDCodePro enjoy a good joke. And it’s hard to deny some ICD-10 medical coding examples sound… well, odd… out of context and in isolation. But even the seemingly strangest ICD-10 codes start to make sense when you consider the guidelines’ commitment to and capacity for specificity.

We value specificity, too, and stress it in our physician coding training, because caring for patients and submitting medical claims to your payers without sufficiently specific documentation and codes is no laughing matter.

 

5 Much-Mocked Entries on the ICD-10 Code List

So what are some diagnoses from the ICD-10 coding guidelines frequently singled out for ridicule?

  • W61.62XD – Struck by duck, subsequent encounter
    “Struck by duck” shows up on most lists of “bizarre” ICD-10 codes, maybe because it conjures mental images of a certain supplemental insurance mascot angrily and repeatedly pecking a potential customer while loudly quacking the product’s name. Plus, it’s an undeniably memorable rhyme.
  • V91.07XA – Burn due to water-skis on fire, initial encounter
    The flaming water-skis draw plenty of online potshots. Did some water-skiing daredevil attempt a stunt that went horribly wrong? Or did a beach bum suffer too close a brush with unconventional bonfire kindling?
  • V97.33XA Sucked into jet engine, initial encounter
    Here’s another one on the web to make fun of. It might even evoke designer Edna Mode’s firm rule about superhero costumes in The Incredibles:  “No capes!”
  • Y92.241 Library as the place of occurrence of the external cause
    This one sometimes gets glossed as “hurt at the library” in selections of “weird” ICD-10 codes, as though it’s absurd to think a safe, quiet haven for books could present any dangers. What injury code would accompany this circumstantial one—a paper cut (W26.2)?
  • Z63.1 – Problems in relationship with in-laws
    One last example: The code that may seem to scream for a punchline from a vintage Henny Youngman routine.

Lists of “laughable” ICD-10 codes seem to imply the quest for specificity in diagnosis and coding can be taken to outrageous extremes. But is snickering at specific codes justified?

 

“Funny” ICD-10 Coding Examples Don’t Make Everybody Laugh

As you may already know from your own practice, one person’s “funny” code is another’s all too serious problem.

“[W]e can be [a] bit too flip when we encounter ICD-10 codes that sound rather zany or absurd,” ICD10 Watch editor Carl Natale wrote for Healthcare IT News. He talks about two people who have, in fact, survived being sucked into jet engines—and about as many as 40 cases annually of young children who did not survive drowning in five-gallon buckets of water (W16.221).

Or consider code Z63.1, or others along the same lines like Z62.891 (sibling rivalry) or Z62.1 (parental overprotection). These codes represent real, problematic family dynamics taking a serious toll on people’s health, or their access to health services. Providers must consider these factors to give patients the holistic healthcare they want (and that value-based payment rewards).

 

Why Getting Detailed Matters in Medical Coding and Billing

Even setting aside empathy as a reason for not mocking ICD-10 codes, the system’s ability to capture more information for better patient care, richer clinical data, and improved revenue makes these codes matter.

Medical writer Jennifer Della’Zanna urged readers to focus not on “crazy things” but “critical things [that] can be coded with ICD-10 that could not be coded with ICD-9,” such as Ebola (A98.4). She points out the “funny codes” people snigger at are all external cause codes most coders seldom if ever have to deal with. The remaining 91% of the codes prove the system’s worth.

icd 10 coding guidelinesBecause they are capturing more data when using ICD-10 coding guidelines, providers can, as AHIMA’s Sue Bowman explains:

  • Track patient outcomes more effectively and gain more insight into improving them.
  • Identify patients needing disease management more easily and customize their care in more appropriate ways.
  • Contribute to researchers’ clearer understanding of diseases, which can ultimately improve public health and influence more informed health policymaking.
  • Evaluate new medical procedures and technologies more accurately, investing their time and money in those proven to impact patient care in positive ways.
  • Reduce ambiguity and increase consistency in their documentation and coding, which means a lower coding error rate and fewer rejected claims.

Granted, none of these or ICD-10’s other benefits come automatically. Providers must take advantage of the opportunity the system offers for higher specificity, as Dr. Joseph Nichols emphasized for ICD10monitor. But those whose documentation supports its more specific diagnosis codes should ultimately see those codes pay off for their patients and their practices—no joke!

 

The Fastest Way to Make Your Documentation and Coding More Specific

The MDCodePro app helps you assign each patient visit its optimal CPT® code. It assumes your correct knowledge and use of diagnostic codes.

But its emphasis on charting patients with greater accuracy, comprehensiveness, and specificity will also serve you well as you work with the ICD-10 coding guidelines, not just the CMS E/M documentation rules. Documenting visits in enough detail to support the most specific and highest appropriate codes possible is key in both systems.

The easy-to-use principles you’ll discover in MDCodePro’s short video lectures and watch at work in its powerful Code Generator will make your documentation and coding more specific. You’ll capture more of the hard work you do treating your patients, and claim more of the reimbursement you’ve legitimately earned.

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