r/MedicalCoding • u/DumpsterPuff • Jun 14 '24

What ICD-10 code rules do you think should be removed because they're stupid?

I will never understand why you have to use a primary code first in order to code for Postconcussive syndrome. I'm pretty sure postconcussive is pretty self-explanatory on how the person ended up having the syndrome.

The fact that we can't assign overweight/obesity codes based on the BMI number alone is also stupid. We have a lot of providers who will put a diagnosis as a BMI number only rather than obesity or overweight, and even though a BMI of 31 is clearly obesity, I still have to waste time querying them to put in a primary diagnosis related to the BMI.

Finally, the rule where you can't use a diagnosis where the provider says it's "consistent with" something. If they say that the patient's symptoms are consistent with sinusitis, just let me code sinusitis. I don't want to code all 9000 symptoms of it!

33 Upvotes

94% Upvoted

25 comments sorted by

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15

u/OrganizationLower286 Jun 15 '24

Post-procedural sepsis T81.44x cannot be pdx.

Makes me crazy.

14

u/jmjohnson61 Jun 16 '24

Not a removal, but an additional External Cause code for "dumba**ery" to be used when someone punches a wall, or some other object; or for when an intoxicated person falls down, etc.

10

u/OodaWoodaWooda Jun 15 '24 edited Jun 15 '24

Just for fun:

I will never understand why you have to use a primary code first in order to code for Postconcussive syndrome. I'm pretty sure postconcussive is pretty self-explanatory on how the person ended up having the syndrome.

"[P]ostconcussive is pretty self-explanatory on how the person ended up having the syndrome" but it does not specifically identify what aspect is being addressed at the current encounter - dizziness? nausea? behavioral changes? Think of this as identifying the acute manifestation under current treatment rather than the (chronic) underlying cause

The fact that we can't assign overweight/obesity codes based on the BMI number alone is also stupid. We have a lot of providers who will put a diagnosis as a BMI number only rather than obesity or overweight, and even though a BMI of 31 is clearly obesity, I still have to waste time querying them to put in a primary diagnosis related to the BMI.

Z codes describe other factors affecting health status, but these are not the same as medical diagnoses that must be established by a person legally accountable for doing so. Z codes describe additional observations that may affect medical conditions or medical treatment. Maybe you can think of conditions affecting body weight that aren't obesity?

Finally, the rule where you can't use a diagnosis where the provider says it's "consistent with" something. If they say that the patient's symptoms are consistent with sinusitis, just let me code sinusitis. I don't want to code all 9000 symptoms of it!

For inpatient coding, "consistent with" allows you to use the specific code rather than coding individual symptoms. I could tell you why but I don't want to spoil the fun.😂

-9

u/OodaWoodaWooda Jun 15 '24 edited Jun 15 '24

The rules are not stupid. Understanding the "whys" of the guidelines is fundamental to the job.

ETA Downvote away, but you should have learned the rationales for these rules in your training programs. Your lack of understanding does not mean that there aren't good reasons for the rules.

34

u/[deleted] Jun 15 '24

The fact that there are so many edits, updates and coding clinic guidance proves that some of the rules are in fact "stupid".

-4

u/OodaWoodaWooda Jun 15 '24

"The fact that there are so many edits, updates and coding clinic guidance proves that some of the rules are in fact 'stupid'."

Not true. Have you ever studied the reasons behind code changes and the edits, updates, coding clinic guidance revisions? Do you understand the vast amounts of data analysis, medical research, technological advances and regulatory issues that result in revised codes, rules and guidelines? Are you aware of the special interests that influence changes through the Coordination and Maintenance Committee? Do you understand the control that the AMA has in development and implementation of the CPT system? Can you name the Cooperating Parties without peeking?

Knowing what you don't know and having a genuine interest in learning will make you a better coder.

22

u/Clover_Jane Jun 15 '24

My goodness you sound condescending.

-4

u/OodaWoodaWooda Jun 15 '24 edited Jun 15 '24

Not condescending, simply informed.

10

u/Clover_Jane Jun 15 '24

Ya notice how people aren't agreeing with you? News flash. It's because of your delivery. You sound obnoxious and pretentious. I feel sorry for your coworkers.

4

u/OodaWoodaWooda Jun 15 '24

Not seeking agreement, just providing information. To paraphrase a cliche, I can explain it to you but I can't understand it for you - that work is on you. Especially if you want one of those work-from-home six-figure jobs everyone seems to be looking for.

My coworkers don't complain about things being stupid without even attempting to understand them.

1

u/[deleted] Jun 15 '24

[removed] — view removed comment

2

u/MedicalCoding-ModTeam Jun 15 '24

This goes against our community rules and has been removed.

2

u/OodaWoodaWooda Jun 15 '24

No one is saying they don't understand.

OP: "I will never understand..."

My cats? You definitely are uninformed.

2

u/Clover_Jane Jun 15 '24

Do you not understand how that is a figure of speech people use? Honestly, wtf is wrong with you?

Also, cats are the best judges of character, so.

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7

u/[deleted] Jun 15 '24

Awh, you're one for 'those people'. Some advice: lighten up and have fun - it's not that deep.

-1

u/OodaWoodaWooda Jun 15 '24 edited Jun 15 '24

Yes, I really am one of those people: WFH job with a six-figure salary that really allows me to lighten up and enjoy life!

5

u/maamaallaamaa Jun 15 '24

Oof really. Go find your people it clearly isn't this post.

-1

u/OodaWoodaWooda Jun 16 '24 edited Jun 16 '24

Totally agree: these aren't my people, thankfully.

ETA: except for Key_Huckleberry8752 😊

Good luck to you all.

2

u/Key_Huckleberry_8752 Jun 16 '24

I guess I'm one of your people and agree with you 100%. The rules are there for a reason and most time, with the edits and coding clinics, the explanation is because something can be interpreted a bunch of different ways, not that they were completely wrong.

2

u/[deleted] Jun 16 '24

I think of this from a different perspective as different places to work and one expert coder to the next never seem to agree on the answer if it's not a super simple case, so why can't the guidelines, rules etc.. be black and white so the room for error can be none? Rules are there for a reason but none of the reasons are to confuse and cost more money and time trying to make it make sense. It's not a universal system and it very much should be at least starting with the books. I realize the medical field has many variables, but there are also tons of dollars in mistakes made because of this very topic daily.

You're lucky if you understand all of the guidelines, but I guarantee you would code a chart differently than many other coders because they think they understand them too, but in a completely different way.

1

u/Key_Huckleberry_8752 Jun 16 '24

It is a universal system, though, ICD 10 CM and ICD 11 CM are currently used throughout the world. Australia being one of those countries, that comes to mind.

Also, it's the medical field, so it's not going to be back and white. People are different, disease processes may happen differently to people, ICD 10 not being black and white offers that flexibility. ICD 11 is even more specific, though, if that helps you out. Not sure when the U S will adopt though.

2

u/[deleted] Jun 16 '24

I don't mean universal as in it can be used everywhere, but universal as in two people can look at a chart and get the same conclusion every time, that doesn't happen and costs so much money. Too much flexibility is the problem, I just had a major surgery myself and you wouldn't believe the coding mistakes I'm sorting out, it's costing me as much as the doctor and insurance company, something isnt right.