BACKTALK
Ginseng and Jet Engines Bill Benda, MD, Associate Editor
T
here has been a significant push by unconventional professions, most notably naturopathic medicine and chiropractic, to gain inclusion into our insurance industry, both private and public. Blue Cross, Blue Shield, Medicare, Medicaid, and a plethora of other black holes of regulation and exclusion criteria apparently are desirable fruit as we all compete for a bite of health care reimbursement in this country. Speaking of fruit, I think you are all nuts. As a 40-year veteran of conventional medicine, there has been no disease, diagnostic quandary, or moral or ethical dilemma as infuriating as dealing with the insurance industry. I’m not saying that it is evil—the pharmaceutical and medical device trades have earned that designation—but dealing with insurance regulations and requirements is like catching Ebola, except that you never die. Think I am exaggerating? Let’s peruse the upcoming ICD-10-CM code book, soon to supplant the despised ICD-9-CM tome. These volumes of tiny print are basically page after page of listings of codes (16 000!) that you must get right when you fill out your forms if you expect to get paid the fraction of your charges the patient’s insurance will reimburse. The basic structure of the code is as follows: characters 1 to 3 (category of disease), character 4 (etiology of disease), character 5 (body part affected), character 6 (severity of illness), and character 7 (placeholder for extension of the code to increase specificity). In other words, character 7 is a sort of asexual reproductive capability that can extend the actual code designation indefinitely. Let’s take a look at a few of these gems: W5621XA: Bitten by orca, initial encounter. V96.00XS: Spacecraft crash injuring occupant, initial encounter. W5612XA: Struck by a turtle. S30867A: Insect bite (nonvenomous) of anus, initial encounter. V91.07XA: Burn due to water skis on fire, initial encounter. V97.33XD: Sucked into jet engine, subsequent encounter. Z63.1: Problems in relationship with in-laws. W61.62: Struck by a duck.
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Integrative Medicine • Vol. 14, No. 2 • April 2015
And of course, the all-important Y34: Unspecified event, undetermined intent. For anything missed by the previous 59 999 codes. You laugh? None of the above is a joke. Miss one of these babies and you are not getting paid for sewing up that orca bite. So in the spirit of unconventional therapies meet conventional insurers, the following are a few potential codes you may find yourself swearing over in the next couple of years: A42.91P: Retained acupuncture needle, unspeakable location, initial encounter. H22.43E: Second-degree burn from healing energy. JW20.15: Irrational hatred of medical doctors, chronic. U43.87FC: Injured by droppings from unicorn jumping over rainbow, subsequent visit. H33.20OC: New onset diabetes secondary to excessive homeopathic remedies. PL32.46: Addiction to platitudes regarding healing potential of love. JG14.01: Inability to spell ginseng correctly, repeated visits. OZ66.0BS: Believing anything Mehmet Oz says, whatsoever. So to those of you chomping at the bit to stay 2 hours late at the office each day playing with this alphabet soup of absurd lunacy, your day is almost here. And you can add in the countless local and state and national codes and restrictions and exceptions and weekly revisions. Its fun! OP43.00: An optimist believing people are doing the best they can. PSS61: A pessimist fearing this is true.
Benda—BackTalk
Ginseng and Jet Engines Bill Benda, MD, Associate Editor
T
here has been a significant push by unconventional professions, most notably naturopathic medicine and chiropractic, to gain inclusion into our insurance industry, both private and public. Blue Cross, Blue Shield, Medicare, Medicaid, and a plethora of other black holes of regulation and exclusion criteria apparently are desirable fruit as we all compete for a bite of health care reimbursement in this country. Speaking of fruit, I think you are all nuts. As a 40-year veteran of conventional medicine, there has been no disease, diagnostic quandary, or moral or ethical dilemma as infuriating as dealing with the insurance industry. I’m not saying that it is evil—the pharmaceutical and medical device trades have earned that designation—but dealing with insurance regulations and requirements is like catching Ebola, except that you never die. Think I am exaggerating? Let’s peruse the upcoming ICD-10-CM code book, soon to supplant the despised ICD-9-CM tome. These volumes of tiny print are basically page after page of listings of codes (16 000!) that you must get right when you fill out your forms if you expect to get paid the fraction of your charges the patient’s insurance will reimburse. The basic structure of the code is as follows: characters 1 to 3 (category of disease), character 4 (etiology of disease), character 5 (body part affected), character 6 (severity of illness), and character 7 (placeholder for extension of the code to increase specificity). In other words, character 7 is a sort of asexual reproductive capability that can extend the actual code designation indefinitely. Let’s take a look at a few of these gems: W5621XA: Bitten by orca, initial encounter. V96.00XS: Spacecraft crash injuring occupant, initial encounter. W5612XA: Struck by a turtle. S30867A: Insect bite (nonvenomous) of anus, initial encounter. V91.07XA: Burn due to water skis on fire, initial encounter. V97.33XD: Sucked into jet engine, subsequent encounter. Z63.1: Problems in relationship with in-laws. W61.62: Struck by a duck.
64
Integrative Medicine • Vol. 14, No. 2 • April 2015
And of course, the all-important Y34: Unspecified event, undetermined intent. For anything missed by the previous 59 999 codes. You laugh? None of the above is a joke. Miss one of these babies and you are not getting paid for sewing up that orca bite. So in the spirit of unconventional therapies meet conventional insurers, the following are a few potential codes you may find yourself swearing over in the next couple of years: A42.91P: Retained acupuncture needle, unspeakable location, initial encounter. H22.43E: Second-degree burn from healing energy. JW20.15: Irrational hatred of medical doctors, chronic. U43.87FC: Injured by droppings from unicorn jumping over rainbow, subsequent visit. H33.20OC: New onset diabetes secondary to excessive homeopathic remedies. PL32.46: Addiction to platitudes regarding healing potential of love. JG14.01: Inability to spell ginseng correctly, repeated visits. OZ66.0BS: Believing anything Mehmet Oz says, whatsoever. So to those of you chomping at the bit to stay 2 hours late at the office each day playing with this alphabet soup of absurd lunacy, your day is almost here. And you can add in the countless local and state and national codes and restrictions and exceptions and weekly revisions. Its fun! OP43.00: An optimist believing people are doing the best they can. PSS61: A pessimist fearing this is true.
Benda—BackTalk
