Reason #41 Health Care is So Expensive: Medical Codes for Being Struck by a Turtle at the Opera

But no, I’m just kidding. There are separate medical codes for being hurt at the opera and being struck by a turtle.

The U.S. health care system is ramping up to implement a massive new coding system called ICD-10. It’s a bland name for a system capable of coding thousands of colorful injuries. A full 68,000 to be exact, as opposed to the 13,000 under the current ICD-9.

Take these, straight from ICD-10:

Hurt at the opera: Y92253

Stabbed while crocheting: Y93D1

Walked into a lamppost: W2202XA

Walked into a lamppost, subsequent encounter: W2202XD

Submersion due to falling or jumping from crushed water skis: V9037XA

This isn’t just a Dave Barry essay, it’s the cost of health care.

Medical coder is an actual profession and most places have them now. Quadrupling the number of codes means that more codes will be needed and that adds even more to the cost of health care.

Classification was supposed to make health care less expensive and more streamlined, but like most data initiatives, it just adds cost and complexity to the system.

And the people who benefit from that make money by adding complexity, which is the head of a medical coding consulting company (you can see how bad things are when there is a consulting company for the codes) tries to justify the absurdity.

Let’s say you’re in some kind of accident that involves an insurance claim — whether it’s a vehicle or boating accident, or even if you’ve been bitten by an animal. It’s not enough to say, “I was hit by a car” or “an animal bit me.” The insurance company needs to know exactly how that injury occurred so when they go back and look at how to pay out a claim, it helps the patient have their story told properly and allows for potentially better benefits and care.

Does anyone actually benefit from an entire profession that breaks down Injured in Animal Encounter to 600 categories of classification? Besides the people who make money classifying it. The bureaucracy expands and the cost of everything goes up.

NEWSHOUR: Flaming water skis. That’s another colorful one. When would that ever come into play?

HOLLY CASSANO: Well let’s think. Flaming water skis might occur if someone was trying to do some kind of a stunt in Hollywood (the movie “Yogi Bear” comes to mind). maybe they’re putting some kind of ignition fluid onto the water skis for a movie. If I was a coder in an emergency room in Los Angeles, it’s quite possible I’d see something like that.

Yogi Bear was an animated movie. But maybe there should be a code for animators hurting their wrists while moving around 3D sprites of a bear on flaming water skis. I know my wrists are hurting while typing this. Someone get me a code. Pronto!

By utilizing ICD-10 and being more specific about what has gone on with that patient, a doctor in Florida can help someone who was bitten by a rattlesnake out west a few months before. The patient is probably suffering some ongoing issues from the venom, so when another provider goes into their records, they can see: “OK, they were bitten by a rattlesnake, here was the severity of that injury, and let me see what I can do to treat them more specifically,” — which is a lot more helpful than dealing with the unknown.

Or the attending physician could just write into the medical chart. “Patient bitten by a rattlesnake.” But that wouldn’t add six degrees of complexity and ten degrees of expense to the process.

NEWSHOUR: This is a big change for doctors, hospitals and especially professional coders. Just how big is the lift here to implement this new system?

HOLLY CASSANO: It is a very big undertaking but I feel at this point it’s more from an IT (information-technology) standpoint, and it’s more or less of a challenge depending upon what type of office system a provider currently has. There actually are some providers out there who are still on paper, believe it or not. For those individuals, it’s going to be a huge undertaking because they not only have to convert all of that paper into an electronic health record system, they then also have to find one that can handle ICD-10. There are also vendors who you can outsource your coding to, if say, you feel you need assistance during the transition. There are companies that specialize in assisting providers, hospitals and other health care organizations with streamlining their coding operations. For organizations that have an electronic health record system of some sort — which is most — they need to assess and review the vendor’s ICD-10 implementation plan in order to determine if that vendor can handle transitioning ICD-10 into their current system.

If you can make it through that entire paragraph, you have some idea of Reason 41 of why your health care is so much more expensive than it used to be.

It may, prove to some degree, during the initial transition to have some hiccups on the provider side of things. But if they are armed with the proper coding tools out there, it should be somewhat seamless. Coding is not done from memory, so they will utilize the same types of coding tools they do now for ICD-9. If you have a tool like that, which is what I currently use, it’s not going to be that difficult. You just have to plug in “injured in opera house” and the code will pop up.

Here’s a crazy idea, what if we walked this back all the way to “Doctor writes stuff in chart, chart goes into medical record, physicians have access to medical record”?

Tragically the entire profession of coding might go up in a wisp of smoke and a doctor’s visit might end up costing 20 dollars less.

NEWSHOUR: Is there any part of you that thinks this may be going overboard, like distinguishing between an injury in a mobile home’s bathroom vs. the garden or foyer?

HOLLY CASSANO: Well, yeah (laughing). I think that some of these codes really may or may not be necessary. But part of the problem with ICD-9 is annually, due to various strange incidents or new disease processes, the governing bodies and decision-makers in health care — the Centers for Medicare and Medicaid Services, the American Medical Association, the American Hospital Association and others — are tasked with looking to create new codes from providers and others requests in the health care community in order to report these strange and/or new incidents and diseases. Which is one of the areas ICD-10 will assist with and cover more of the bases.

As Ancient China could have told us, bureaucratic complexity is the enemy of getting anything done.

Making health care cheaper requires wiping out 90 percent of the bureaucracy that acts as the middle man between providers and patients.

  • Edward Cline

    This column is spot-on. Has anyone noticed the proliferation of ads on the Internet that direct you to courses for a medical code billing career, such as the one that appears in the right-hand column of this article?

    "Medical Coding. Find 2013 Medical Coding & Billing Courses Near You – Apply Now!"

    I suspect that most of these courses, regardless of the venue (actual classroom instruction or online instruction) can be paid for with government education grants. Most private teaching-a-trade schools, such as ECPI, are extensions of federal and state education rackets, supported by government grants to their students. Perhaps ICD-10 Code No. 68,004 will be: "Trauma induced by belligerent student loan bill collectors."

  • Mary Sue

    Getting hit by a turtle at the opera (yeah, I know it's a joke) is about as likely to happen as seeing Shredder, Rocksteady and Beebop fight Splinter, Leonardo, Michaelangelo, Donatello, and Raphael at the Opera House.

  • Ar'nun

    Is there a code for "Progressives make blood shoot out of my eyes"?

    • Daniel Greenfield


      • Mary Sue

        Code for accidental consumption of "hash brownies" by 2 people:


      • Daniel Greenfield


  • figment

    my question, will there be any doctors left to implement any type of care?

  • Jay

    The economies of scale has made it too difficult now for smaller physician practices to operate independently. Many are being bought by hospitals as a result. Physicians are shifting from being independent business owners of their own practices to employees at hospitals more and more. As a result you are going to see a political shift where it makes more sense for physicians to unionize like nurses have.

    ICD-10 was adopted 23 years ago. It is only now being implemented in the US. The purpose of ICDs:

    “The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems.

    It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. It is used for reimbursement and resource allocation decision-making by countries.

    ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. The 11th revision of the classification has already started and will continue until 2015.”

  • Jay

    More on the political shift by the New York Times in doctors when they switch from being independent business owners in their practices to employees of hospitals

    ” …There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.

    That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

    Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.

    Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs. ..He said that in his experience, conservatives prefer owning their own businesses.

    “People who are conservative by nature are not going to go into the profession,” he said, “because medicine is not about running your own shop anymore.” ”

  • Edge Kingston

    Definitely for a common man health care systems are now being very expensive that they are not able to afford any kind of health care programs. Since from last few year we have witnessed that President Obama almost take every precaution to deliver better health care facility to American public. But due to lack of proper utilization we are suffer from worst health care programs and facilities.
    urgent medical care

  • Holly J. Cassano

    What a shame that when you broke down the article – you didn't have all your facts. I have worked in the healthcare industry since 1996 and am a home grown coder who has been writing professionally for more than 7 years. I have worked as a practice manager for 11 years prior to obtaining my CPC in 2006, amongst other accomplishments and just launched my company last June. If you checked me out on Linkedin before you trashed the article, you would have seen my areas of expertise and credentials.

    It is a shame that you truly don't understand our profession and why it is necessary – I have personally helped many providers over the course of my career as an employee and as a consultant. I have several physicians in my family and have always been an advocate for them.

    I do a lot of gratis work and help employ a lot of independant contractors. I believe in the greater good for our healthcare system's future is better served by a team approach, as there is no "I" in team and working together collectively and harmoniously is the best approach to resolve.

    I hope that in the future, you can cast a more objective review of others in my profession.



    • Paul

      “The greater good” and “collectively”? This explains the main impetus behind Obamacare. It’s hardcore socialism plain and simple. The individual has to sacrifice for the society’s greater good. And like all good bureaucracies, their main job is to justify their existence and not provide service. And that goes for the parasitic groups that always seem to pop up in the private sector to take advantage of the overcomplexities. The Utopia these people think will be achieved is nothing but a dream-but the reality they dumped on us with the brute force of the federal government is truly a terrifying nightmare in the making.

  • coder1

    it’s too bad that you can’t comprehend the fact that medical coding came AFTER the coding system was developed and was born out of necessity due to the red tape governed by insurance plans and other powers that be who constantly try to reduce, delay or deny provider reimbursement, as well as limit member coverage.