Wet Read: Billing 401

When at last we are sure, You’ve been properly pilled, Then a few paper forms, Must be properly filled. So that you and your heirs, May be properly billed.

—Dr. Seuss

Dr. Seuss should be required reading in medical school. Without a doubt.

Today is trivia day, kids! There is a book that names and numbers disease. I’m sure you and/or your billing staff are well aware of it. It’s currently called the International Classification of Diseases-Version 9. I’m relatively certain you and yours are working to get ready for the latest innovation in billing and reimbursement—ICD-10. I thought I would share some observations with you from what I’ve been able to glean about this so far.

The history of this whole classification thing is pretty interesting, actually. It was initially a means to catalogue death (that “d” stood for something a little different, it seems). Something along this line has been in existence since 1900. The diseases, injuries and other health problems got mixed into the stew later.

ICD-9 was confusing, bizarrely complex and organized by someone who plainly did not want you to be able to communicate with anyone regarding the disease you had identified. So, plainly it needed fixing. Just like someone thought the same for ICD-1 through ICD-8. This time, however, it seems that they went to a big fix. The whole enchilada, as it appears. As big a revision as when the “Black Death” was changed to bubonic plague. ICD-10 is a shake-up of near-Biblical proportion.

So, when to introduce this new system? How about 1999? Nope? How about 2010? Nope? How about 2015? There are billing staff who have learned it, forgotten it, relearned it, had second families, and relearned it again.

The push is toward more explicit descriptors and precise terminology. So, 17,000 codes to over 155,000 codes. Now there is a proper code for the accidental injury when you are run over by a cart that is being pulled by a 4-legged beast weighing no more than 250 pounds that crushes your big toe. And for God’s sake, don’t bill it incorrectly. You know for a fact that this was done for a single purpose, right?


Wow, am I smart, or what?

“What’s the reason for this denial?” you will ask innocently.

“Improper coding” they will reply. And there will be crying, and gnashing of teeth, and ultimately, despair.

All the best, my friends. Don’t abandon hope. Hire really bright coding staff.


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Wet Read: Billing 401.  Appl Radiol. 

By C. Douglas Phillips, MD, FACR| March 09, 2015

About the Author

C. Douglas Phillips, MD, FACR

C. Douglas Phillips, MD, FACR

Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.

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