Crabby 

 Pier stretching into the ocean at sunrise. 
October 1st, 2015 

The diagnostic codes for doctors, the way we communicate with insurance companies about what the hell is wrong with you, changed yesterday. After decades of using what is called ICD-9 all physicians in the US were required to change to ICD-10. 

ICD-9 worked just fine, it seemed. Now it is this confusing jumble of letters and numbers and designations arranged into “chapters” that have left me wondering what was wrong with the old way anyway? Still, I am sure there was a good reason. The government always has a good reason….

Hospitals and some outpatient practices have been so terrified about the disruption that they have taken out loans in the millions, expecting insurance companies will be delaying or refusing payments for months as we all sort this out.

Staff still needs to get paid, you know?

So, there is the change itself. Change is always hard. It is magnified 2,000 times, however, when your electronic health record does not have a clue what it is doing: tons of errors, system crashes, and three times the work to get the correct code. Seriously. You would not believe the stupidity we have to go through for each patient and each problem on the list. Colossal waste of time. 

I was lucky that yesterday was my half day. Today? Not so much.

The thing that really gets to me, though, is that it was not like this was a surprise. It has been looming ahead for years. So why can’t they/we be adequately prepared for it? 

Sooooooo….. If you are in the US and you are visiting your doctor in the next few weeks or months, give them a few words of encouragement. We are terribly sorry if you have to wait longer for your appointment or if you get incorrect bills or if everyone in the office seems crabby and disconnected. 

Pardon me…. my left eye is twitching…

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130 thoughts on “Crabby 

  1. Oh, you’ll master it Victo – and likely will never know why they changed it. When I was in transportation they changed the hours of service rules (log books) for the first time in 20 years – it was about 100 pages of new rules, much in lawyerese. Royal pain in the ass. We had a hard time getting a consensus on the interpretation of some rules even from the officials whose job it was to enforce them. They were not rewritten to make them easier to use. I will dust off the Serenity Prayer and roll it out:

    God, grant me the serenity to accept the things I cannot change,
    The courage to change the things I can,
    And the wisdom to know the difference.

    😀

    Liked by 3 people

  2. I’m sorry, I hate how they are always changing everything. I worked doing medical filing twice and that was hard. (I was also a CNA for a few years). doctors, nurses, and CNAs don’t get paid enough for all the work they do and crap they have to deal with. My prayers go out to you. I hope the kinks get worked out soon and that it’s a really long time before they change things again.

    Liked by 1 person

  3. The government never has a good reason for doing anything and like that evil man who invented facebook, the axium “if it ain’t broke, don’t fix it” never applies because they always fix things on a daily basis just to piss us off. Okay, so that’s, as my wife would say, the conspiratorial side of me coming out. I know that change is necessary but give people too much change and not enough hope to prepare for it and you end up with a confused society of people who are wondering “what the hell is it all good for” feeling like we no longer have a foundation because some official or manager or executive decided that it would be a good idea to change something, not knowing, maybe not able to know the domino effect of that change.

    Liked by 1 person

  4. Hm. I took Moo for shots yesterday, and we didn’t get MY nurse, we got stupid new nurse, and stupid new nurse isn’t actually stupid or new at all, but she’s not MY nurse and MY old, wonderful nurse couldn’t do Moo’s shots because she said, “I got stuck doing computer things.”
    Now I wonder if this was involved.
    Anyway, sorry. I’m sure you’re very adaptable, but it must be tiring to always be adapting to one professional clusterduck after another!

    Liked by 1 person

  5. Perhaps you need to put up a sign in the waiting room. If it gets really crabby in there (or in back with you and the rest of the staff) a copy of ICD-10 with a large rubber hammer will probably come in handy.

    The research part of my company does a lot of research in insurance databases — that depend on those codes. My guess is there will be some interesting studies in the next year or two.

    Liked by 1 person

  6. Tis but a shame that the govt must stick its nose into things in which it does not understand. The only way to get it fixed-hackers on the deal web. If the can hack CIA, FBI, Interpool and so on, EHR and their BASIC lack of working ability shall be cake for them. I bet they would even have fun showing how “tight” their “security” is.
    And you are a great doctor! Keep up the wonderful work!!

    Liked by 1 person

  7. Oh, OK this makes some of my friends’ posts on FB make more sense now. Like, their new favorite code in the book that wasn’t there before. Hours of fun. Not.

    Liked by 1 person

  8. No worries, we are selling tons of services to help you guys out with all the number jumble troubles. 🙂
    And I remember the days when my mom bring me to a doctor, and the receptionist pulled out a worn out little Soviet folder with all my papers inside of it. Mine was super fat, because I was always a sick kid. Or better yet, we would call the doc, and the doctor would visit sick children at home. Miss those days.

    Liked by 1 person

  9. I live in Canada and I’m not in the medical care profession, but I assume this is the type of crap that goes on here too.
    I consider this post a public service announcement. You have my sympathies.

    Have a bottle of wine, a couple of chocolates and hopefully you’ll feel better in the morning 😉

    Liked by 2 people

  10. I got certified as a medical coder a couple years ago so I’m trained in both ICD -9 and 10. Would you believe I never could find a job as a coder bc of my lack of experience? Ugh. Just lost my certification bc I didn’t use it. 😔 Sorry, just went on a tangent about my own life.

    Liked by 1 person

  11. So why the change? Well it’s like this. Every organisation has a development department that is staffed by wet nosed little graduates who feel the need to justify their existence. In retail it might be as simple as changing the packaging on a product and the retailer then has to explain to the customer that ‘it really is the same as you bought last time’. The fact that they have totally stuffed up your system is irrelevant – what is important is that they feel important and ‘all growed up’.

    Liked by 2 people

  12. I am so friggin tired after this week of IDC-10 nightmare. We have been dual coding since 8/3….well, let me say this, we were supposed to dual code….now we have the issues at recert, because they were not coded correctly and well…. I could go on and on….but I am too tired. Working in healthcare is not for the weak of heart.
    I send you a sympathetic and understanding hug. Saw my PCP today and we lamented over this as he struggled with his documenting.

    Liked by 2 people

  13. The US code just expanded to 70K. Includes some beauties such as: walking into a lamp post, bitten by a cow, burned because of a fire on a surfboard. Just to make the physicians day a little more fun! I understand that hospitals and practices have invested millions and millions training coders in the last year.

    Liked by 1 person

  14. It all boils down to the Insurance Companies making billions of dollars on this. They love those golden parachute parties held at the 5 star hotels. How do I know this? My husband was a Chef for over 30 years in all the big hotels. The working class are nothing but a number to them. Now they have included the doctors, it truly sucks.

    Liked by 1 person

      • You wouldn’t believe some of the stories he has to tell. Some go right to the top of the pyramid, it is scary. The sad part is it continues election after election.
        There is no regard for the elderly, sick, poor and now the middle class, Trouble is who do we elect, there has not been one person that is truly for the people for quite some years. It like shoveling shit against the tide. :o)

        Liked by 1 person

  15. Similar disruptions were caused by changes in the DSM for psychologists and psychiatrists. The reason for the changes there was not just changing codes, but also changing the meanings of diagnoses and new decisions about what was a disease and what wasn’t. Did that also happen with the ICD-10? That would add yet another level of difficulty to the change.

    Making these changes is a big problem for everyone. Software has this problem everywhere and there have been many unsuccessful attempts to solve it. The bottom line is that it is a hard problem.

    Liked by 1 person

  16. The government always has a good reason….like the emperor must have his new clothes. I’ve been hearing about going to “F codes” Oct 1 at the agency I work for. I didn’t worry too much about it, because I’ve found that sort of worry to be bad for my health. I was off yesterday and today….guess I picked a good time.

    Liked by 1 person

  17. Something else to interfere with what you and your colleagues are supposed to be doing–treating patients.

    One would hope that this change wasn’t invented by bureaucrats without the advice and counsel of physicians–the people who will have to deal with it on the ground. But if so, it wouldn’t surprise me.

    Best wishes as you navigate new waters.

    Liked by 1 person

    • I believe the codes were first developed by the World Health Organization. But of course the US had to “tweak” them a bit. The codes themselves are not the biggest problem. It is how the EHR is wholly and completely unable to handle it. I wonder if the EHR has been as big of a problem for other systems. THAT I don’t know yet.

      Like

    • We cannot search the names in our EHR in ICD-10. I have search for them in ICD-9 and the use that code to search ICD-10 to get what I need. I am sure this is a unique problem for our record system and for everyone else who uses that company, but that is what makes like so challenging. You have a patient with 5-10 problems and you have to do this for each one…

      Like

  18. I’m with you in spirit, Doc. This appears to be another case of changing just because you can, not because it’s needed. They’ll say it’s because of advancements in technology, right? That’s always a great stirrer of the pot.

    Liked by 1 person

  19. This is so weird because, yesterday, my daughter and I went to see the pediatric ophthalmologist because she has juvenile arthritis on 1 joint, and a positive ANA result, so she has to have her eyes checked for inflammation, and the doctor came out into the waiting room after the appointment, while we were settling up with the receptionist, and asked which knee was affected, citing this code change as the reason he needed to know. I told him I was sorry he had to worry about such nonsense when he provides such wonderful care to his patients.

    Liked by 1 person

    • Ha! For specialists, they get to know a subset of codes in great detail. Primary care involves them all potentially and that is just impossible without an effective way of navigating. Sigh. I am glad your daughter is plugged into a good care team, though!

      Like

  20. somewhere in a dark part of the planet, someone awaits to see as soon as everyone is comfortable with a particular system, that’s their que to change things and unleash havoc when it comes to new technology.

    Liked by 1 person

  21. F958 Other tic disorders
    Z566 Other physical and mental strain related to work
    Z579 Occupational exposure to unspecified risk factor

    All that because your eye was twitching!

    Yes, I’m a Coder, Healthcare Consultant, Educator, and Designer Extraordinaire of ICD-10 Education Classes. Personally, I was banking on one more delay from the Government, but alas, we are here. Much like you, it has been a negative revenue producing week and I can’t wait to see what tomorrow holds. My hope is that when the denials start rolling in, I will be paid AGAIN for work that my company already coded and make up for the losses the I am experiencing.

    Unfortunately, that causes me a bit of guilt because the ONLY ones making money in this are the software companies, consultants, and staffing services. Oh, and the coders – which I am starting to hear numbers in the $90.00 per hour range – ridiculous! The ones paying for it are you – the physicians and us (you included) the taxpayers.

    Slippery slope. WAIT! Hey, I have an idea! Let’s stop using the ICD for re-imbursement and use it for its intended purpose. Lets make 3M pay back all the money they received for devising that Fibonacci Code they call ICD-10-PCS, lets funnel all the meaningful use money that is left into healthcare, and then, lets pay you guys to be Doctors and take care of us to the best of your abilities, without worrying about what you might get paid for!

    Never mind, that’s way to simple…

    Liked by 1 person

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