Monday, October 31, 2011

Scary ICD-10 Thoughts – Late at Night

Before the night passed, I thought I’d build upon some of the craziness and silliness of ICD-10 codes. Who came up with these codes?  What was their reasoning?  Were they just daft? Am I just daft?  Or is it just you that's daft?

To be sure, you can search the following for all the 'scary' and 'silly' ICD-10 codes noted below:

Warning: If the following upsets you, be sure to follow me @ShimCode on Twitter for more of the same. And revisit this Blog of Mine where I'm almost certain to provide some more upsetting perspective on a regular basis! :)

“X17” - Contact with hot engines, machinery and tools

{The nightmare of every ‘Real Man” and ‘Way Cool Woman’}

“Y35.3” - Legal intervention involving blunt objects

{Make sure you pay off that loan you took out last week or you may get a visit from Guido and Annunzio}

“Y87.2” - Sequelae of events of undetermined intent

{Think about it! – “undetermined intent!  Has an “undetermined intent’ ever happened to you before?” Who’d know? And learn up on that new word: “Sequelae?”}

“Y02” - Assault by pushing or placing victim before moving object 

{Remember Jim Carrey & the Sliding Door in “Ace Ventura?” If not, watch here: }
#icd10 #Halloween #Bored

Too much sugar tonight? Eh?

Tuesday, October 25, 2011

ICD-10: Dual Coding vs. Double Coding – What’s the Value for Providers?

I stumbled upon the following post and comments about “Dual Coding vs. Double Coding.”  The post was a good clarification as to the difference between Dual vs. Double Coding; and the comments made some good points pro and con for each process. 

Here are my thoughts:

Indeed, which providers with current or future contracts impacted by ICD codes (which means many providers) wouldn’t put themselves into a better negotiating position by starting to “double code” their services?  So as to better understand the services they provide and negotiate more accurate contracts with their payers? I’m not suggesting all providers need to start double coding everything indefinitely – just start to sample and understand differences and potential differences between their current I-9 stats and their soon to arrive I-10 indications. 

Indeed double-coding is an added expense; albeit an expense that may not be as large as one may believe.  More and more vendors have products to assist with this and consulting service providers are starting to understand how they can assist. Recall the old saying: "Pay me now or pay me later?"  Providers don’t have to incur a large expense to double code and better understand where their typical services are targeted. Is it not true that a lot of providers services are targeted at a somewhat limited, number of categorized diagnoses groups?

Just a thought...not saying this applies to everyone but something most should consider..

ShimCode on Twitter

Also, I posted about the value of this topic a while ago: Financial Neutraility

BTW: I tried to comment at the actual site but had technical difficulties establishing an account; so I’ll post my reply here.  I suggest reading the above referenced post and comments; then consider the following as an additional comment from me.

Friday, October 21, 2011

10 Things Dr. Seuss Really Did Say About ICD-10? (Not kidding!)

I tip my hat to these sites of note => and => and offer thanks to those who thought my Dr. Seuss post worthy of note.  Here are a few more that Dr. Suess actually has really wrote!


1. Don't cry because it's over, smile because it happened.


{What many of us working on ICD-10 will feel sometime in late 2016}


2. Unless someone like you cares a whole awful lot, nothing is going to get better. It's not.


{What executives and others responsible for ICD-10 must take to heart}


3. I have heard there are troubles of more than one kind. Some come from ahead and some come from behind. But I've bought a big bat. I'm all ready you see. Now my troubles are going to have troubles with me!


{The attitude some ICD-10 project managers are going to need to take, if not already}


4. From there to here, from here to there, funny things are everywhere!


{What those assessing business processes and software applications are finding}


5. Think left and think right and think low and think high. Oh, the thinks you can think up if only you try!


{See # 4}


6. How did it get so late so soon?


{What everyone thinking about and/or working on ICD-10 is thinking TODAY!}


7. You can get help from teachers, but you are going to have to learn a lot by yourself, sitting alone in a room.


{What clinical documentation specialists are going to have to do}


8. They say I'm old-fashioned, and live in the past, but sometimes I think progress progresses too fast!


{Some physicians who are irked about ICD-10.  I know more than a few…}


9. You'll get mixed up, of course, as you already know. You'll get mixed up with many strange birds as you go. So be sure when you step. Step with care and great tact and remember that Life's a Great Balancing Act. Just never forget to be dexterous and deft. And never mix up your right foot with your left.


{What everyone impacted by ICD-10 must remember today, tomorrow and the next 700+ days}


10. So the writer who breeds more words than he needs, is making a chore for the reader who reads.


{Evidently what those who came up with many of the ICD-10 codes were thinking when they created a few thousand of those ICD-10 codes?}


Ok, I will goof no more. Stay in tune with my blog to see what’s in store!


Hint: My thoughts on financial modeling using ICD-9 and ICD-10 codes.


Thursday, October 20, 2011

Computer-Assisted Coding for ICD-10

Note: I posted this on LinkedIn in response to a question from a fellow group member.  After I realized I spent more than a few mintues responding, I fugured I may as well post this here since I rarely post topics like Computer Assisted Coding that are largely in the realm of healthcare providers - as opposed to my payer bailiwick.

Here's what I posted on LinkedIn - Unadulterated:

I’m not real familiar about the functional details and better or less-better vendors in emerging computer-assisted-coding applications (CAC); mainly because I’m a payer-side, administration, financial and care management guy. But from what I’ve come to know about this topic via my natural curiosity over the last year, I'll offer this response for your consideration:

{For sure, I’m venturing just a bit outside of my bailiwick here so consider the following information subject to correction and due the payment I am requesting; nothing! :)}

Besides the anatomical and physiological capabilities that must be identified and processed by a CAC (or even a human for that matter,) I’ve learned the following “data points” are required for accurate ICD-10 diagnosis coding:

1. Type of encounter (initial or subsequent or sequelae?)

2. Applied specificity (did the patient lose consciousness?)

3. Acute versus chronic

4. Relief or non-relief (intractable versus non-intractable?)

5. External cause (was it caused by an accident? – i.e. Other Party Liability?)

6. Activity (what was the patient doing when ‘injured?’)

7. Location (where was the patient when injured?)

Many of these data points should be currently available in a provider’s EHR, medical records and notes. So a good NLP-based CAC application should be able to consistently, accurately identify and categorize all of the above data points into their clinical documentation process over the next 24 months – well in advance of the October 1, 2013 ICD-10 compliance date.

Integration and access to multiple data stores - structured and unstructured will be key features of any CAC application! But that's what NLP is all about, right?

Some vendors I’ve noticed in this emerging CAC space include - in no specific order or testament as to capability or value – include Quadramed, OptumInsight, 3M, Nuance, Ingenix, Wolters Kluwer, Precyse, and Dolbey. But I don’t know much about their detailed CAC capabilities. Again, I'm not focused on this topic - yet interested for sure!

And, to be clear, I don’t have any financial or emotional connection to any of the above vendors. Well, maybe Quadramed. :') I’ve just heard and/or read about all these vendors CAC efforts more than a few times lately; and all of them seem to be moving in the right/straight direction. (As opposed to a number of firms I’ve run across who seem totally lost and out of the ballpark.)

Here are some potential useful references that may be of use to you with your quest for CAC knowledge:

Top 10 Questions for CAC Vendors:

Evaluating Computer Assisted Coding Systems & ICD-10 Readiness:
{I’m not endorsing WK, I just think this is a pretty good, clear overview of CAC. I’d include the same info from other vendors if I could find such from their sites}

Wow! Isn't speech to text translation cool? I just rattled all this off in about 10-15 minutes (with, admittedly the majority of that time editing mistakes and inserting white space).

Take care Corrie,et al


My Thoughts on CAC and new ICD-10 data points:

Wednesday, October 19, 2011

Au Contraire, ICD-10 is NOT like the Mortgage Crisis of the Great Recession

This article recently published on has a catchy title and garnered a lot of exposure and RT’s on Twitter. After I read it a couple times, I became convinced the ICD-10 mandate will not create a financial upheaval similar to the mortgage crisis of the Great Recession.  To the contrary, I came away with just the opposite opinion: that opinion being, unlike the mortgage crisis that cost a lot of money, decimated the worth of many homeowners and shows no signs of improvement, I believe ICD-10 will have a net positive impact on the healthcare in the United States; albeit with some bumps at the start and hiccups along the way.

I’ll get into why I think ICD-10 is unlike the recent and on-going mortgage crisis a bit deeper down in this post but first I’d like to identify a few key points made in the article that spurred my doubt and/or which I was unable to reconcile to the claim that implementing ICD-10 will cause a financial crisis similar to the current mortgage crisis of the Great Recession. I want to make these points so as to provide some background about why I disagree and also to provide others an opportunity to clarify, educate and/or rebut my position.  Indeed there are important points made and ideas presented with which I wholeheartedly agree.

Observations & Questions I Have

1.   What actually defines the mortgage crisis? And how large is it?

Freddie Mac and Fannie Mae controlled approximately 50% of the mortgage market in 2008.  Many believe it was actually the private sector that triggered the mortgage crisis. So, even if all of the other factors and assumptions used in the math are correct, the ICD-10 crisis would be only half what is stated; admittedly still a huge amount of money.

2.   What caused the mortgage crisis?

Is there a correlation between what caused the mortgage crisis and the ICD-10 mandate? I agree the mortgage crisis was about ethical failures in leadership, transparency, and poorly documented quality that led to higher than expected risk.

I also believe it was caused by individual/homeowner greed, mortgagor ignorance as to how certain mortgage products operate, and a government where one political party was demanding equal home ownership opportunities for all while the other party was not implementing enough control over sophisticated financial products, namely collateralized mortgage obligations. I’m just not able to match abstracts of those particular causes to parallels in ICD-10.

3.   Recent decision by HHS to rescind the part of healthcare reform known as "Community Living Assistance Services and Supports” (CLASS) program stating that it was actuarially unsound.

Is this comment intended to imply ICD-10 will create unsound, non-neutral funding and finances? 

Items of Agreement and How ICD-10 Might Cause Some Heartburn

The author states the following items are (1) partial causes for pending ICD-10 financial doom (2) items that may in fact ameliorate some of the pain; or even create value. 

1.   5010 issues will create delay and must be resolved to enable ICD-10

For a while now, I’ve been saying there will be 5010 issues – yet I think they’ll be resolved in Q1-Q2 of 2012 and not cause major disruption and/or the ICD-10 compliance date to be delayed.

2.   Radical shifts in healthcare IT software and solutions companies

We’re already seeing this and I think it’s a good thing and won’t exacerbate healthcare financial stability.

3.   Code Shifting Issues (DRG, HCC, Case Rate and Otherwise)

This topic appears to be the crux of the argument that ICD-10 may create financial loss similar to the mortgage crisis.  It really deserves a more detailed response on its own - and I intend to address modeling one day - but for now I'll say this:

Not all of the multi-trillion dollar healthcare economy will have to shift its reimbursement paradigm due to ICD-10 because not all providers are reimbursed based on ICD codes or related derivatives like DRG’s, Case Rates, and HCC’s, etc. So while a majority of institutional/facility and Medicare premium payments to payers are based on ICD’s and their derivatives, there are many that aren’t so ICD-10’s impact to these providers – typically “non-institutional” - shouldn’t directly impact their reimbursement; but admittedly cursory reporting requirements for ICD-10 codes may add some administrative overhead that will translate to some financial cost.  Moreover, the trend toward performing procedures outside of hospital inpatient institutional settings may further diminish the institutional providers most impacted by ICD-10.

I can appreciate the example about the cost shift of the DRG groupings but it was just that, one example and there may be others that counter or negate this example.  I will not argue there won’t be some potentially risky shifts and until a comprehensive modeling of the entire set of ICD-10 based DRG’s – which are not even out yet – is performed, we just don’t know enough to state either way.

4.   Introduction of Opportunities & Risks

No doubt that ICD-10 will introduce opportunities and risks!  And doesn’t all change introduce opportunity and risk? Yet merely pointing out risks without balancing them against opportunities makes for a lop-sided argument that ICD-10 will create a mortgage-like crisis.

Why I Think ICD-10 is unlike the Mortgage Crisis

1.   ICD-10 specificity will enable more realistically defined benefit plans for members, more accurate reimbursement to providers and more equitable cost-sharing among all healthcare constituents: payers, providers, and sponsors/employer groups. 

In my opinion and experience, some providers are underpaid for services and others are overpaid – due seemingly minor clinical, procedure and/or administrative variations.  The increased specificity of ICD-10 will address these inequities.

2.   “ICD-10 is an Innovation & Quality Improvement Program as Well as a Regulatory Compliance Effort”

To me, this statement validates the likely potential that ICD-10 will not create financial havoc. Besides the above referenced increased accuracy of for benefit plan and provider reimbursement, ICD-10 will enable additional, innovative care programs and opportunities. I mentioned some of these in a recent blog post.

3.   A few other insightful considerations listed in the article seem to argue against the premise that ICD-10 will cause a mortgage crisis:

a.     Firms are upgrading aging and brittle transaction systems – often not maintainable – to new systems; often COTS products with superior functionality and TCO measures.

b.     In many cases, business process are being improved and streamlined as part of the remediation process.
c.     Redundant or contradictory business functions and data systems are being eliminated or consolidated.

d.     All of the above should bode well for cost savings, improved care management processes and and overall improvement to our healthcare system. Surely there will be cost and pain associated with developing, implementing and smoothing out the ruffles associated with these improvements.  But, unlike, the mortgage crisis, those costs should be considered investments; not money spent just to get back to where we once stood with our homes.

So I do agree with a lot of what was stated in the article; just not wholeheartedly with idea that ICD-10 will have a huge financial impact similar to the mortgage crisis of the Great Recession. It’s been several years now since the mortgage crisis started and there have been many failed government “mortgage assistance” programs. From what I read and have personally experienced, things are not looking better and I’m not aware of any in-process or proposed plans to make the mortgage crisis better. But I’ve witnessed and participated in making positive steps toward compliance with the ICD-10 mandate that will pay dividends when delivered and into the future.

Note: The above comments, thoughts and ideas are mine only and do not represent those of any of my employers or clients – past, present or future!  :’)


Thursday, October 13, 2011

Going Beyond Simple ICD-10 Compliance – Think Strategically!

I suspect many, if not most, healthcare payers will struggle to meet the October 1, 2013 compliance date.  But there will be a small percentage of payers initiating other programs in tandem with their migration to ICD-10 – similar to how some providers may bundle their movement towards meaningful use with their ICD-10 compliance activities.

Here are some strategic initiatives that forward-thinking payers may undertake with their ICD-10 assessment and compliance project – if not simultaneously as they march toward the compliance date – certainly shortly thereafter.

1.      Improve care management programs
2.      Improve business intelligence and data analytic capabilities
3.      Creating provider contract models and consider re-negotiating certain contracts
4.      Reconfiguring member benefit plans
5.      Creating new payment models based on performance and value (like P4P, VBR, etc.)
6.      Deploying or enhancing patient portals and member engagement tools
7.      Designing new member wellness and lifestyle programs

All of the above are enabled by the increased specificity of ICD-10 codes. In my estimation, items number 1, 2, and 3 can provide huge returns for payers approaching ICD-10 in a more strategic manner.

What other programs and improvements do you think will be enabled by ICD-10?

Monday, October 10, 2011

What Dr. Seuss Might Have Said About ICD-10

These last few weeks have wrought a lot of fun and silliness about definitions of the new ICD-10 diagnoses codes. Ya gotta admit there's been a lot of coverage and funnin' about it all. The site sponsored by 3M - and a few other ICD-10 sites - have posted quite a few funny and informative posts about ICD-10 diagnoses and related humor.

So yesterday was Fall Break. One of my kids brought up the wisdom of Dr. Seuss in a round about way and I thought: How apropos! Who might provide some terse insight and humor? Dr. Seuss!  Of course!

So what would Dr. Seuss (God rest his soul) have thought about all this ICD-10 joking/craziness?  Most surely something witty and wise? Of course he would!

Permit me to take a guess and make up a few Dr. Seuss-Ism's. (Indeed, I honor Dr. Seuss and only wish I was 1/1,000,000,000 as witty as he was)

What Dr. Seuss Might Have Said About ICD-10

1. "Will ICD-10 succeed? Yes indeed, yes indeed! 98 and three-quarters percent guaranteed!"

2. "ICD-9 has been truer than true. ICD-10 is newer than new. And deeply known by only a few."

3. "Don't shed tears for ICD-9 passing away, go with the sway, give a cheer - ICD-10 is coming our way!" 

4. "ICD-10 is not a diagnostic count down!  ICD-10 is a healthcare reform count up! ....ICD-7, ICD-8, ICD-9, ICD-10 and perhaps ICD-11? Oh, the ICD versions you can think!"

Oh the places we're all going!

All due respect