Category Archives: PhysBizTech

ICD-10 Essentials for Busy Physicians – Encounter codes from Chapter Z

By way of celebrating my last blog in this series, I am going to leave behind the old pattern of focusing on a few codes of interest to a particular specialty. Instead, we’ll look at a bunch of codes that can be used by all kinds of specialties and by no particular specialty. They are called encounter codes.

Encounter codes are often the first listed code on a claim and explain the reason for the patient visit. They are not considered diagnosis codes, though a diagnosis may be implied. They are decidedly unglamorous, but they are used a lot in physician practice. Their purpose is to state the essential reason the patient came to see you (e.g., the patient needs aftercare following surgery). Continue reading

ICD-10 Essentials for Busy Oncologists—Prostate and Breast Cancers, Leukemia

The ICD-10 neoplasm chapter documentation and coding changes come in three basic degrees:

  1. No change whatsoever
  2. A level of detail or two has been added
  3. Holy crap, that is a serious bunch of new stuff!

And the three most common cancers illustrate these degrees of change nicely: prostate cancer (men), breast cancer (women), and leukemia (children). Continue reading

ICD-10 Essentials for Busy Pediatricians—Bronchiolitis, Asthma, Otitis Media

This is my only chance to talk about the changes in ICD-10 for diagnosis codes that might be of interest to pediatricians. It is a pretty tall order for a specialty that covers the whole human body, one that just happens to be on the young side. I hope I chose well. I had some help.


Nothing here that would make page one of the Wall Street Journal. There are two acute bronchiolitis codes that specify the responsible organism:  RSV or human metapneumovirus. ICD-9 has an RSV code but no code specifying human metapneumovirus. (ICD-10 has unique RSV codes for pneumonia and acute bronchitis as well.) The acute bronchiolitis codes are shown below. Continue reading

ICD-10 Essentials for Busy Neurologists who would Rather be Doing Something Else – Alzheimer’s, Migraine, Neurologic Deficits

Chemists can dismiss all human physiology as just chemistry, and physicists might go even further—all chemistry is just physics. I find all human physiology pretty amazing and fascinating. The fact that we keep taking that next breath, that our heart beats one more time, that we pee at regular intervals—holy cow, the whole thing is incredible. But I have to confess, I find something extra intriguing and mysterious about the physiology of the brain and its associated wiring—maybe because one of its byproducts is what we call consciousness, maybe because at 50 my particular flavor of Charcot-Marie-Tooth Syndrome is starting to become interesting. I mean, the world needs proctologists, but neurology is extra cool.

Hopefully I have awakened all the old physician specialty rivalries, and I will get some interesting mail. Meanwhile, let’s talk about ICD-10. There is new stuff and reclassified stuff in ICD-10 for documentation and coding of neurological conditions. There are so many to choose from I feel like a kid in a candy store picking only three, but here are some purported biggies: Alzheimer’s disease, migraine, and neurologic deficits following a stroke. Continue reading

ICD-10 Essentials for Busy Physicians – Urology and Nephrology

I swear, I chose the three conditions I thought would best meet the 80/20 rule for urologists or nephrologists and the physicians whose patients end up seeing these specialists: treatment of urinary stones, an enlarged prostate, or management of chronic kidney disease.

And then I discovered that coding and documentation for these three conditions is the embodiment of “no big deal,” the kind of thing I have been saying all along. Or to put it a bit more Old World, here is a Catalan blessing from Stephen Maturin, my favorite (fictional) physician: May no new thing arise. There are practically no changes here. Enjoy. Continue reading

ICD-10 Essentials for Busy Physicians: Opthalmology

When a patient has a serious visual impairment, physicians of any specialty who participate in the care of that patient need to know about it. Hopefully that means you are all good citizens and get the information into the health record and eventually into the coded data, so that such impairments reflect the real cost of care and the tracking of outcomes. Or not. You all know what’s involved.

ICD-10 has added quite a bit of detail for describing some of the diseases and disorders of the eye. Others are essentially untouched beyond the ability to specify which eye is affected. Blog space being by definition a virtual cubbyhole, I will just touch on a few of these: glaucoma, cataracts, and general codes for characterizing level of vision. Continue reading

ICD-10 Reaction from My Favorite Busy Physician

Finally—a final final rule from CMS declaring that we will switch to ICD-10 after all, on October 1, 2014. Good for them, good for us. In this age where democratic dialogue has become a contact sport, it seems miraculous when anything at all like progress actually occurs.

At the time the announcement was made, I was as far as you can get from Beltway politics, hiking to one of the minor peaks that form the rim of Crater Lake, in Oregon. For the first time in five years, I actually left it all behind—no cell phone, no email alerts, just putting one foot in front of the other and breathing, stopping to take in the amazing views in every direction. How fantastic is it that I chose that week to be off the grid.

In July, I spent the weekend in a similar place, stopping in at a family reunion in Mt. Shasta, California. The whole mob of us were trailing along the McCloud River to a grandkid-friendly waterfall. I ended up walking for awhile with my nephew, Josh, a doctor in private practice and a first-rate human being. He runs his ophthalmology practice from a smallish town in the inland West, just him and his office support team. He is only a few years out from his residency and doing well enough that he could discontinue the periodic visits to satellite towns if he wished, but he can’t bring himself to do it. He fears his glaucoma patients would not get the care they need. Continue reading

ICD-10 Essentials for Busy Physicians – Spinal Stenosis, HNP, Vertebral Fractures

As promised last time, I am going to show you what’s up in ICD-10 when it comes to documentation and coding for spine diagnoses that can end up being treated surgically by an orthopedic  surgeon or neurosurgeon, but may be seen by many other primary care physicians along the way. The family of diagnoses I am going to cover briefly are: herniated nucleus pulposus (commonly called a ruptured disc), spinal stenosis, and pathologic vertebral fracture.

Disc herniation or degeneration, spinal stenosis

Diagnosis coding and documentation of disc herniation (aka displacement), disc degeneration, and spinal stenosis are not that much different for ICD-10 . It is simply a variation on the theme I have been repeating all along, especially for musculoskeletal system codes: there are more codes mainly because there are unique codes for anatomic sites not specified in ICD-9. Sometimes there is more clinical detail as well. Continue reading

ICD-10 Essentials for Busy Physicians who would Rather be Doing Something Else – Arthritis and Back Pain

This blog is nominally for rheumatologists. They are the ones who end up treating long-term sufferers of painful musculoskeletal conditions, especially those with autoimmune origins. But since a significant number of people suffer from arthritis or back pain, and most of them see most of you for various reasons, this basic ICD-10 information may be of interest.

Arthritis — Rheumatoid et al

It is still fashionable to get worked up about the number of ICD-10 codes, stating that, contrary to every other aspect of the information age, more is worse. People who have jumped on this bandwagon tend to use examples of codes that are statistically rare and of no relevance whatsoever to most physician practices (external cause codes for exotic animal bites and wildly improbable boating accidents, etc.). They leap blithely from their favorite silly ICD-10 code to the conclusion that ICD-10 contains no new clinically relevant detail. Continue reading

ICD-10 Essentials for Busy Physicians who would Rather be Doing Something Else—Substance Abuse

The double entendre in the title is pure dumb luck, and I left it there for fun. Some days we might all prefer imbibing something that messes with our brain chemistry to thinking about ICD-10. It would be nice to just wake up when the crazy ICD-10 politics are over, to a steaming mug of coffee and a more rational world. That is not the world we live in at the moment, however, and there is work to be done in the meantime. So let’s look at how substance abuse codes are classified in ICD-10.

Substance use, abuse and dependence codes in ICD-10 are both more precise and more practical. For thirty years you have had to put up with ICD-9 substance abuse codes that ask about the patient’s pattern of use—episodic, continuous , or unspecified—and ICD-9 doesn’t define these subjective terms. So you did what anyone in your situation would do, you didn’t use these words in your documentation and the pattern of use that got coded was the unspecified code, as in 304.00 Opioid type dependence, unspecified. Continue reading