Struck By a Turtle? Crushed By a Merchant Ship? There’s a Code for That

BY Jason Kane  March 4, 2013 at 11:56 AM EDT

Struck by a turtle lately?

No? Then surely you’ve been smacked by a raccoon, chicken … or at the very least, a nonvenomous lizard.

Well, regardless, starting in 2014, your doctor will be prepared when animals, lightning, or even unpowered watercraft strike, burn, bite or injure you in just about any other way.

The U.S. health care system is ramping up to implement a massive new coding system called ICD-10. It’s a bland name for a system capable of coding thousands of colorful injuries. A full 68,000 to be exact, as opposed to the 13,000 under the current ICD-9. The codes are intended to help health care providers keep track of what happened to you, how much it should cost and what follow-up care you need.

Take these, straight from ICD-10:

  • Hurt at the opera: Y92253

  • Stabbed while crocheting: Y93D1

  • Walked into a lamppost: W2202XA

  • Walked into a lamppost, subsequent encounter: W2202XD

  • Submersion due to falling or jumping from crushed water skis: V9037XA

Even with the new descriptive phrases at their disposal, many health care providers strongly oppose the coding system. In December, the American Medical Association, 42 state medical organizations and 40 medical specialty groups, wrote a letter to the Centers for Medicare & Medicaid Services to cancel implementation of the ICD-10 code set.

Not only do they say it will “create significant burdens on the practice of medicine with no direct benefit to individual patient care,” they also say ICD-10 will distract from other upcoming health information initiatives, including major ones tied to the health care reform law.

The complaints about the new coding system are just the latest in a mounting list of gripes doctors have with the federal government these days — particularly the Centers for Medicare and Medicaid Services. On Monday’s PBS NewsHour broadcast, senior correspondent Ray Suarez takes an in-depth look at why the largest health care groups in central Texas decided to drop all new Medicare patients. Tune in.

In the meantime, let’s delve a little deeper into the intrigues of ICD-10 — including how often the medical profession is likely use the code “Burn due to water-skis on fire, subsequent encounter” — with someone on the front lines of its implementation. Holly Cassano is the CEO of a Florida-based medical coding consulting company ACCUCODE Consulting and blogs regularly on the upcoming ICD-10 changes for MedicalBillingandCoding.org.

NEWSHOUR: Holly, thank you so much for joining us. Let’s start with the basics. Why should a normal patient care about the coding system and this change?

HOLLY CASSANO: This system is much more specific, which can be good. Let’s say you’re in some kind of accident that involves an insurance claim — whether it’s a vehicle or boating accident, or even if you’ve been bitten by an animal. It’s not enough to say, “I was hit by a car” or “an animal bit me.” The insurance company needs to know exactly how that injury occurred so when they go back and look at how to pay out a claim, it helps the patient have their story told properly and allows for potentially better benefits and care.

NEWSHOUR: Speaking of being bitten by an animal, some of these codes are so specific they’re funny.

HOLLY CASSANO: I live in Florida and there’s a lot of wildlife here – all great to see from a distance. But some people kind of take it to the next level and they want to have a more tactile encounter. That’s where these codes come into play. You’ll find codes for alligator attacks, which are easy to imagine. But let’s look at some of the others. “Struck by a pig, initial encounter” or “struck by a dolphin” — things that seem hardly feasible but you’d be amazed how often crazy things happen. That being said, when I worked in an ER, I never saw anything like a dolphin bite or someone struck by an orca or turtle or parrot, but bites while fleeing from river otters, panther and bear encounters along with mild shark bites, were a frequent occurrence and there are codes for all of those things just in case.

NEWSHOUR: Flaming water skis. That’s another colorful one. When would that ever come into play?

HOLLY CASSANO: Well let’s think. Flaming water skis might occur if someone was trying to do some kind of a stunt in Hollywood (the movie “Yogi Bear” comes to mind). maybe they’re putting some kind of ignition fluid onto the water skis for a movie. If I was a coder in an emergency room in Los Angeles, it’s quite possible I’d see something like that.

NEWSHOUR: They may be funny, but the hope is that these hyper-specific codes can also be very helpful. How?

HOLLY CASSANO: Absolutely. Living in Florida here, we get a lot of people from up north that come down and so they’re seeing different physicians while they’re here. But part of health care reform is making it possible to access a patient’s electronic medical records nationally. By utilizing ICD-10 and being more specific about what has gone on with that patient, a doctor in Florida can help someone who was bitten by a rattlesnake out west a few months before. The patient is probably suffering some ongoing issues from the venom, so when another provider goes into their records, they can see: “OK, they were bitten by a rattlesnake, here was the severity of that injury, and let me see what I can do to treat them more specifically,” — which is a lot more helpful than dealing with the unknown.

NEWSHOUR: This is a big change for doctors, hospitals and especially professional coders. Just how big is the lift here to implement this new system?

HOLLY CASSANO: It is a very big undertaking but I feel at this point it’s more from an IT (information-technology) standpoint, and it’s more or less of a challenge depending upon what type of office system a provider currently has. There actually are some providers out there who are still on paper, believe it or not. For those individuals, it’s going to be a huge undertaking because they not only have to convert all of that paper into an electronic health record system, they then also have to find one that can handle ICD-10. There are also vendors who you can outsource your coding to, if say, you feel you need assistance during the transition. There are companies that specialize in assisting providers, hospitals and other health care organizations with streamlining their coding operations. For organizations that have an electronic health record system of some sort — which is most — they need to assess and review the vendor’s ICD-10 implementation plan in order to determine if that vendor can handle transitioning ICD-10 into their current system.

NEWSHOUR: There’s been quite a bit of backlash against switching to ICD-10. Why?

HOLLY CASSANO: I think initially there was a lot of fear, as with anything new, and a lot of it is because people don’t fully understand how it’s going to work. But honestly, on the physician side, for coders and for health care providers in those settings, it’s really more simplified due to programs that help you “crosswalk” to ICD-10. It may, prove to some degree, during the initial transition to have some hiccups on the provider side of things. But if they are armed with the proper coding tools out there, it should be somewhat seamless. Coding is not done from memory, so they will utilize the same types of coding tools they do now for ICD-9. If you have a tool like that, which is what I currently use, it’s not going to be that difficult. You just have to plug in “injured in opera house” and the code will pop up.

NEWSHOUR: Is there any part of you that thinks this may be going overboard, like distinguishing between an injury in a mobile home’s bathroom vs. the garden or foyer?

HOLLY CASSANO: Well, yeah (laughing). I think that some of these codes really may or may not be necessary. But part of the problem with ICD-9 is annually, due to various strange incidents or new disease processes, the governing bodies and decision-makers in health care — the Centers for Medicare and Medicaid Services, the American Medical Association, the American Hospital Association and others — are tasked with looking to create new codes from providers and others requests in the health care community in order to report these strange and/or new incidents and diseases. Which is one of the areas ICD-10 will assist with and cover more of the bases.

NEWSHOUR: Is there a takeaway here?

HOLLY CASSANO: The takeaway for coders and providers is to continue to educate yourselves. Don’t wait for your facility or office to take the lead — lead with both feet and embrace this as any other changes in health care reporting requirements. Look at how it will affect your specific specialty, not the entire health care community, and it makes it more palatable and easier to digest. It’s like the age old question: “How do you eat an elephant? One piece at a time.” And they will probably have a code for that too in the near future. So be careful out there and watch out for those charging river otters.


Holly Cassano is a Certified Professional Coder (CPC) and the CEO of ACCUCODE Consulting in Leesburg, Fla. She has worked in the health care industry since 1993 and currently serves as the blog host for Medical Billing and Coding.