background image
A man walks into a lamppost,
¡®subsequent encounter¡¯
No, he didn¡¯t walk into the lamppost a second
time, but he did follow up with his doctor for
subsequent care, after the ¡®initial encounter¡¯,
where he was diagnosed with a contusion to
the head, also known as code S00.03XA, now
associated with code W22.02XD for walking
into a lamppost, subsequent encounter. It
seems calling it a follow up visit for a ¡®bump
on the noggin¡¯ just won¡¯t fly and providing
medical care without the right code doesn¡¯t
Currently, in order to get paid by insurance,
doctors have to choose from about 17,000
various codes to go with the reason for the
visit. We can make a brilliant diagnosis and
provide exceptional care, but if we don¡¯t code
the diagnosis just right we don¡¯t get paid.
Now the world of coding is about to get even
more complex as next month we adopt a new
system with over 160,000 codes. Just what
you want your doctor focusing on, huh?
The International Classification of Diseases
(ICD) version 9 has been around since about
1979 and pretty much includes every known
disease on the planet. The ICD9 book is
about 2 inches thick and many years ago
I flipped through the entire thing page by
page, intrigued with all the possible diagno-
ses. It is truly a compendium of differential
diagnoses. So how, and why, do we need to
increase our coding responsibilities almost 20
times over? Are there 140,000 new diseases?
Ostensibly, according to the Center for Medi-
care and Medicaid Services (CMS), the new
ICD10 coding system is required to provide a
more accurate means of tracking and gather-
ing data, doing research, clarifying risk and
severity, reducing fraud and lowering costs.
That sounds good, but let¡¯s take a closer look.
If you break your left arm, then let¡¯s code it
as a left arm fracture. Nope, not enough, we
need to know how you broke it and where
2015 November
Pg 6 - The Sunshine Express
Health & Nurturing
Drowning is serious business and apparently it
matters what kind of watercraft one has fallen
from prior to drowning. Does drowning due to a
fall off sailboat, fishing boat, canoe, kayak, mer-
chant ship or passenger ship, really make a big
difference in the type of care one might receive?
I question how you can use the ¡®subsequent en-
counter¡¯ code after the initial drowning.
There are codes for injuries sustained while
sewing, knitting, and crocheting. According to
CMS officials, getting the correct data on these
injuries is supposed to have an impact on public
health and safety. Of course, as we are always
seeing stab wounds caused by those darn knit-
ting needles! Somebody needs to start a knitting
needle awareness
group. Not to be
confused with the
¡®crochet needle injury
foundation¡¯ or the
¡®seamstresses for
safety¡¯ club.
Some codes seem
rather harsh. What
doctor would risk
putting the codes
R46.1 ¡®bizarre per-
sonal appearance¡¯, or
R46.0 ¡®very low level
of personal hygiene¡¯
into a patient chart?
That¡¯s not likely to go
over well when the
patient gets a copy of
their medical records.
Heck, that could be
considered discrimi-
natory. Next thing you
know the ACLU will be
after you for making
such a diagnosis. Are
these medical diag-
noses or observations
made while people
watching at the mall?
With millions and
millions of pieces
of healthcare data
streaming back and
forth between offices,
hospitals and insur-
ers, I wonder if this
expanded coding sys-
tem will lead to less
errors or more errors.
Will it lead to bet-
ter care? Will it lead
to physicians having
more time to spend
with their patients?
Will it steady the
surgeon¡¯s hands or improve the internist¡¯s wit?
I¡¯m feeling anxious from this stress, which would
be code F45.8 for ¡®anxiety, associated with
I want my doctor to put forth all energy and focus
on being in the present and listening intently to
my story, while using the full capacity of their
brain to solve the problem. I don¡¯t care how they
code it. I¡¯ll gladly pay for a service and a solution
no matter how it¡¯s coded. There should be a code
for ¡®being sick of increasing healthcare costs¡¯,
subsequent encounter of course.
(Scott Rollins, MD, is Board Certified with the
American Board of Family Practice and the
American Board of Anti-Aging and Regenerative
Medicine. He specializes in Bioidentical Hormone
Replacement for men and women, thyroid and
adrenal disorders, fibromyalgia, weight loss and
other complex medical conditions. He is founder
and medical director of the Integrative Medicine
Center of Western Colorado ( and
Bellezza Laser Aesthetics (
Call 970.245.6911 for an appointment or more
you were when you broke it. We need
to know if it is a visit to treat the break,
monitor the healing, or deal with some
problem later that was caused by the
initial break. We need to know if the
break was in the closest, middle, or far-
thest part of the bone. The current sys-
tem has a single code for a badly healed
fracture, while the new system will have
about 2,500 codes to choose from.
Bitten by a bird? We need to specify
whether it was a macaw, duck, goose
or parrot, because that really matters
when trying to categorize risk and se-
verity. There¡¯s a code for getting ¡®bit by
a turtle¡¯ versus ¡®struck by a turtle¡¯. I¡¯m
curious, how does one get struck by a
turtle anyhow? Would this be from the
infamous ¡®Ninja¡¯ box turtle or the high-
flying ¡®Judo¡¯ snapping turtle?
One of the more concerning new codes
is V91.07XA, which involves a ¡®burn due
to water-skis on fire¡¯. Seriously. Under
what circumstances would water-skis
catch fire? The coding experts were
slacking on this one as they didn¡¯t think
to include whether the fire occurred on
fresh-water or salt-water, because that
could make a difference you know. And
really, it lacks attention to detail not
including the brand of ski. As there is
no code for a ¡®burn due to snow-skis
on fire¡¯ I want to know what the coders
have against snow skiers.
In Harmony
by Scott Rollins, M.D.
Sandy Lauzon
We Only had One Thanksgiving
My parents were considered to be a ¡®mixed mar-
riage¡¯. Mom was Roman Catholic and French Ca-
nadian, 2nd generation, American for sure. Dad
was Ukrainian Orthodox, Ukrainian, 1st genera-
tion, American for sure.
I was fortunate to celebrate two of each Christian
Holy days. Two Christmases, two Easters, two
Pentecosts, but only one Thanksgiving. What a
dilemma! Where would the Thanksgiving turkey
be carved?
You would think that this would be a no-brainer
because Mom¡¯s only living relative was her moth-
er, who lived alone. Why can¡¯t Memere come to
Bounia¡¯s with us all for the holiday? The problem?
My two grandmothers did not like each other. Nei-
ther one spoke English very well, so they argued
in their own native language, French/Ukrainian,
each shouting louder than the other. ¡°This food
wasn¡¯t included on the menu¡±, and ¡°we had that
the last time¡±, and ¡°Claire (my Mom) always
bakes all the pies¡±. (Memere¡¯s point)
The grandchildren would seem to be the equal-
izer, but that would be an incorrect assumption.
Bounia won that score hands down. I was the
first granddaughter on both sides, so both Me-
mere and Bounia won that point. My brother was
born next, just ahead of Billy, the first grandson,
so another tie. Then my Uncle and Aunt chimed
in with first Billy, then Jean Marie for my Uncle
Willie, and then Joey and Michelle for my Aunt
Anne. Bobby came along long after the score
keeping. Memere had no other children to