Rants from the Crib

An Ob/Gyn gone mad

Medical Coding Made Easy

Many of you may wonder, how is medical billing done?  How are your unique ailments translated into standardized format, to be recognized as payable by the insurance company?  Or, more likely, NOT recognized as payable to the insurance company.

The first coding category is ICD-10 code.  Translated into English, this category encompasses Shit That Is Wrong With You.  For example, gonorrhea is 098.0, which encompasses the following conditions and more:  acute gonorrhea, gonorrhea of the vagina, gonorrhea penis, gonococcal urethritis and acute Bartholin’s gland gonorrhea.  However, something slightly different (and you may be provided hours of entertainment trying to visualize how this was transmitted), gonococcal infection of eye is 098.4.  There are codes for every possible disease, illness, deformity, even one for High Risk Sexual Behavior.  I have this one memorized.  The digits in front of the decimal point usually delineate the main category of the disease, whereas the 2 digits after the decimal point delineate more specific details.  That fifth digit (the second one after the decimal point) is added only where extreme differentiation is required, say as in 607.83 (edema of penis) and 607.84 (impotence of organic origin).  In my opinion, many codes for Shit That Is Wrong With You have been excluded.  It would be very useful, for example, to have an ICD-10 code for Skank Ass Ho.  This would immediately trigger payment by insurance for things such as testing for STDs, multiple pregnancies, and chain smoking.  You could add a fourth digit, after the decimal point for Skank Ass Ho Who Lives In A Trailer Park, and a fifth digit to delineate Skank Ass Ho Who Lived In A Trailer Park But Got Thrown Out On Her Ass For Screwing The Guy In The Trailer Next Door.  See how useful this would be?  Also there could be one for Neurotic Middle Aged Woman, which would cover any number of ills, which I will not go into here for fear of being lynched.  Another highly useful code would be for PITA (which physicians all know stands for Pain In The Ass).  That code should cover all sorts of tests that the patient demands for ailments that he doesn’t really have, and allow higher billing, because the visit will be interminable because of all the whining and complaining.  The ICD-10 codes are changed almost annually, to numbers that are frequently completely different, by the Powers That Be,which are most likely owned by Big Insurance Companies.  The changing of the codes occurs in hopes that some hapless doctor will accidentally use last year’s code, which is now obsolete, and then they can weasel out of paying. 

The second category is the E Codes, which in English mean Bad Shit That Can Happen To You, basically from an external force.  These are numerous and extremely specific, such as Slipped On Deck Of Yacht While Walking In Swim Fins.  I believe this one actually exists, although I seldom have cause to use it.  The ones I use are usually tragic, things like Spousal Abuse, or Rape, Alleged.  You gotta love it.  Even medicine is biased against the sexual assault of women.  There is no Rape.  There is only Rape, Alleged.  I am totally surprised that they don’t have an E Code for:  Rape, But The Bitch Totally Had It Coming.  They have numerals that differentiate between Jumped and Was Pushed.  I shit you not.  There are some E Codes that would be extremely useful but do NOT exist, such as Had His Ass Kicked In A Bar Parking Lot After Talking Smack To Some Gangsta Guy.  Now THAT would be useful.

Then there are CPT codes, which translated into English are Shit That The Doctor Does To You, which covers most surgeries, treatments, and other medical interventions, or a badly needed bitch slapping.  We use these to cover Normal Spontaneous Vaginal Delivery, Primary Cesarean Section, Total Abdominal Hysterectomy, and Oopherectomy (removal of the ovaries), just to name a VERY few.  The insurance companies like to “bundle” these codes, which is to ensure that we are paid as little as possible.  For example, you are paid so much for just a Total Abdominal Hysterectomy.  If you remove the ovaries at the same time, these two codes are bundled, because they are frequently done together.  If you had removed only the ovaries, you would have been paid for that, but for both together, you just get paid the one reimbursement, usually the lower of the two costs.  They bundle some rather unlikely things, to make sure that we don’t get too big for our britches and do “unrelated” stuff.  Also, let’s say you do two procedures, with two different surgeons.  The specialist OB/Gyn does a hysterectomy, and a sub-specialist Urogynecologist does a bladder lift procedure, during the same surgical episode.  Typically only the sub-specialist is reimbursed, for both procedures, because they are considered capable of doing both, and sub-specialist outranks specialist.  I consider this outrageous, because it deters physicians from seeking specialized care for their patients, because if we bring in a sub-specialist, we don’t get paid for anything.  Thus, patients may be subjected to two different procedures at two different times, so that reimbursement will be given to both parties.  Now tell me how that optimizes patient care?

There is another coding system, for psychiatrists, which I believe is now DSM-4.  They change that up a lot, just like the CPT codes.  New diseases are added and removed with each revision.  For example, Female Hysteria was finally fortunately removed .  See?  We are making progress.  Psychiatrists code things on Axes (plural for Axis), in which one axis might be physical (like psychosis induced by lack of sleep), or biochemically induced bipolar disorder.  Another axis might be external, such as psychosis triggered by drug ingestion.  My friend, with a PhD in psychiatry insists that they should add a whole other axis, “The Axis of Evil.”  She also states they should be better reimbursed if it is invoked.

So let’s see how all this works.  A patient presents to the ER, bashed up and ranting and raving.  ICD-10 codes might be Acute Alcohol Intoxication, Chronic Alcoholism, Oppositional Defiant Disorder, Nausea and Vomiting and Opioid Addiction, Other.  E-codes might be assigned for Had His Ass Kicked In The Parking Lot Of A Bar After Antagonizing Some Dude Named Vinnie and Blunt Force Trauma To The Head, .  CPT codes for Shit The Doctor Did might include codes for Gastroesophageal Lavage (stomach pumping), four-point leather restraints, skin suturing, CT scan of the Head, and Adminstration Of A Rapid Paralytic Agent To Settle The Guy Down And Shut Him The Hell Up.  See how neatly that works?

I hope that this quick guide has helped you to a deeper understanding of the inner workings of the world of medicine.  If it does, I’ll send you a bill.  ICD-10:  Eyestrain, and Complete Incomprehension of Medical Procedures, E-Code:  Spending Too Much Time Reading Blog Posts, and CPT code:  Administration of basic information needed to comprehend the complexities of the medical world.  That’ll be $1,349.53, of which your insurance will cover $135.  Any further questions will cost you extra.

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