ICD-9 Fun! Coding Questions...

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Neuropsych Ninja
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15+ Year Member
Oct 7, 2006
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I have a coding question, so instead of making my own thread for it, I thought I'd make a general thread to help people who have questions about ICD-9 coding.

For students who have no idea what I am talking about when I mention "ICD-9 coding"....this is one of those things they teach you NOTHING about in graduate school. You learn the DSM-IV, but for anyone working in a medical setting that is only marginally useful for day to day practice.

The ICD-9 is a coding system that allows you to classify most health conditions (injury, disease, etc), and it is the primary way that billing is handled in hospitals. It was originally developed/implemented by the World Health Organization so that diseases can be classified, tracked, and information can be more easily shared across the world. That is all well and good, but it isn't the easiest system to navigate.

With billing being based off of ICD-9 coding, we are pretty much forced to learn the basics, though it can be less of an issue if you are dealing strictly with psych Dx's. For those dealing with co-occuring medical issues and/or a medical dx as a primary dx...well, you will learn to love the ICD-9 system!

So....feel free to post your questions/comments/other about the ICD-9 and coding in this thread. We can share in the misery!

ps. If you are completely lost...please feel free to post questions too, because I'm guessing most other people don't know either. They have whole listservs & websites dedicated to this stuff!

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Eh, nevermind. I think i figured it out...though I wish there was a cleaner way to capture the actual injury.

As an aside, I totally understand why so many people use NOS & "Unspecified" modifiers when they need to code something and they don't want to waste time. However, it drives me nuts because there can be LARGE differences in what I'm looking for with one Dx to another, particularly if the primary Dx is medical and not psych. When at all possible I try and add all of the correct specifiers/modifiers because no one likes digging through old records to try and figure out what "Unspecified" really means. If you do not provide a specifier when one is required, it will get kicked back (either by your billers or by the insurance company), which is why people default to "unspecified". They are acceptable billing codes, even though their clinical relevance can be limited.

I wish they taught this in medical school and/or residency for physicians because it would help SO MUCH when trying to correctly bill something. Okay...back to billing. :(

For people out there working in medical settings...how picky are your billing people/dept about this stuff?
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Personally, I wish they would give up on the absurd revisions proposed for DSM5, (particularly the way they want to mess with Axis II) and just get everyone on board with ICD10. And yes, it should be covered in grad school! I like the whole concept of a world-wide system to improve communication and they did need to develop a more specific system for mental disorders but now the APsychiatricAssociation has gotten themselves in a soap opera of a conflict so I"m ready to go with the global ICD...:)
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For people out there working in medical settings...how picky are your billing people/dept about this stuff?

I don't think most people working in medical settings (docs, nurses, accounts folks) have any idea what codes they should be billing/coding either. They simply circle a description/code on a sheet that they think looks best, perhaps based upon what they've been told by that office or what they've been told by others in the past. Aaand then it's sometimes wrong, wrong, wrong. Hopefully the accounts folks or the billing/coding folks catch it. But, oftentimes, there is nothing to key them in that there is nothing amiss.

I became quite unpopular at my doc's office because I knew they were billing codes incorrectly (thank you insurance background!), and I challenged them on it multiple times. It wasn't the folks in the billing/coding office screwing up. They thought the services were being rendered. They weren't. It was the providers in the office. Then, when you go to speak to the "accounts" folks about (b/c you just know it's an oversight, right?), they have no idea what you're talking about because they only have some limited knowledge of coding anyway--but they have enough so when people come to complain, most of them will go away with their tails tucked b/w their legs (i.e., and they don't give a damn to check with anyone else b/c they just want the money anyway).

Of course, once the billing/coding office was clued in that the office wasn't being paid extra, they did become quite diabolical with adding extra bullsh*t codes & modifiers to make sure they received more money for their claims in the future.

I still sometimes think that I should have stuck with the insurance gig. It paid oh, so nicely and had some awesome benefits. :love: On the downside, I'm sure I would have either killed someone or had a heart attack by now. :laugh: At least I've managed to push those off by a few years . . .