Roar

R for roar and rant and rats in the Blogging from A to Z Challenge

We have to buy new computers for the clinic because of ICD10. ICD-10 is the list of diagnosis codes. The list will increase from 17,000 diagnosis codes to codes to 42,000 and is a major pain in the butt. All new, all different, so hypertension is no longer 401.1. My five year old computers “work” but don’t have enough memory for the Amazing Charts Electronic Medical Record update. I need to go ahead and buy new computers because medicare is supposed to be accepting the new codes now (in theory. I haven’t checked if our local medicare provider Noridian really is accepting them.) I need to practice with the stupid new codes until they go full on live in October.

Will this make medicine more precise and give us better data? Well, no. From what I have seen, providers really care about patients and do not care about strings of numbers and letters attached to the diagnosis. At Madigan Army Hospital, the faculty said that they didn’t care about the codes and were not teaching them to the residents. However, medical policy gets based in part on the coding and insurance companies refuse to pay tons of bills because they are “coded wrong”.  I think we will lose even more of the solo providers and small medical practice and medicine in the United States will be even more controlled by big corporations. Why do you care? (That is, if you are from the US. If you are from a civilized country you are laughing at us.) Well, for example. In 2012 I was in my local hospital emergency room. I am a physician who worked for our local hospital district from 2000-2009. The emergency room doctor did a CT scan of my neck. I thought, this is the wrong test, he should be doing a lateral neck film, but hey, I was septic. Maybe I was confused. He put in his notes that he’d ordered a lateral neck film and the CT scan was an error.

They charged me and the insurance company anyhow. I went through my records and wrote to them this year. They paid me back the 900.00$. They say it’s “too late” to pay back the insurance company. If I can figure out which stupid insurance company I had in 2012, I will notify them to bill the hospital.

So read every single note in the clinic and the emergency room if you are a patient in the United States. And ask for the itemized bill. And complain to the patient advocate. Just check out how much they charge for the stupid little socks they “give” you. Fight back.

I wish I lived in a country with civilized healthcare not corporate healthcare.

The medicare website has a countdown clock to the initiation of ICD 10. The main advice to doctors is to have “3-6 months” of overhead money stashed, since they expect it to be a mess and we won’t get paid for 3-6 months. Right. Do the work anyhow and cross your fingers and pray. It’s a bit of a challenge for me, since I was out sick for 10 months. Used up that 3-6 month reserve.

Bet half or more of the doctors/hospitals/clinics in the country have to buy new computers. Watch your bill climb…..

A UK writer asks about ICD-10 international. No, that’s not what the stupid US is going to use. ICD-10 international has 14,000 codes that can be stretched to 17,000. No, we are going to use our own stupider version of ICD-10 with 42,000 codes so that more insurance companies can refuse to pay for more visits. Meanwhile, ICD-11i will be released in 2017.

The stupid US has multiple electronic medical records that don’t talk to each other, so yes, I can sort of code with my computer electronic medical record except I have to look things up in the paper coding book, like “bruise”, aka contusion, and any stupid “cut”, aka laceration, because the search sucks. I was trying to find prehypertension the other day. The electronic medical record lists it as “elevated blood pressure without diagnosis of hypertension”. Great. I have a coding book in each exam room. By October, I will have a massive pile of  coding books in each exam room.

The photo is my father and my wonderful office manager, at the clinic opening party in 2010. My father died in early June 2013. The clinic is due for our five year anniversary…..

Thoughts on the update from ICD 9 to ICD 10

I would be very interested in a tune for this poem. 

This poem was rejected by JAMA, the Journal of the 
American Medical Association. Of course, the American 
Medical Association writes the codes. I do not look 
forward to going from the present 14,000 diagnosis 
codes to 42,000. I think it's just another way for 
insurance to delay and refuse to pay physicians. I 
think our country now has a business ethic of "screw 
anyone you can" and I don't like it. 

Thoughts on the update from ICD 9 to ICD 10


They say ICD 9
Just isn't so fine
Not enough codes to choose
To keep us fungking confused

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liar liar liars
Pants on fire fire
Noses as long as telephone wires

They are liar liar liars
Fungk ICD 10
And let me tell you fungk them
Fungk starting over again

ICD 9 is now 34
Oh what a bore
They say it's too old
I'm older and gold

They say engage a team
Establish a plan
Get focused training
Learn that sh-t from the man

They say what does your practice
See and learn just those codes
Fungk ya'll but wise
I see everything that goes

I do family practice
I'm a rural doctor
The point of the codes
Is insurance don't pay, suckers

They say ICD 9
Just isn't so fine
The rest of the world
Uses ICD 10, word

But they are liars liars liars
Pants on fire fire
Noses as long as telephone wires

I know my ICD 9
Forwards and backwards, up and down
I can code pregnant
by four circus clowns

I can code pulmonary
embolus past
I can code gerbil inserted in the a--

ICD 10
is starting again
Code left or right or other
Those sh-ts would fungk your mother

ICD 10 is starting again
Code where it happened
Or insurance won't pay
Fungkers make my day

They say champion the change
I say channel the rage
Take a book from my page
Incinerate the fungking change

Fungk ICD 10
Fungk ICD 10
Fungk ICD 10
Fungk it again.