Can Anyone Top This?

Gayle · Post by **Gayle** » Tue Sep 13, 2011 6:16 pm

Try to find today’s (9/13/2011) WSJ to read this front page article titled:

Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way
New Medical-Billing System Provides Precision; Nine Codes for Macaw Mishaps

Are we not now arriving at what has to be the absolute absurd with regard to Medical coding.

Personally I recommend everyone see their Doc to get all necessary care before this supposedly goes into effect in 2013.

In the future aren't we all are at risk for being coded as a R46.1 (which is the new code for “bizarre personal appearance”).

And really?, has anyone here ever experienced, or know of anyone whohas expereienced a Macaw bite? If so 1.) where (meaning the exact geographical location where the bite actually took place) and 2.) where (meaning the exact bodily site where the bite occurred). They don’t seem interested in the primary color description of the offending Macaw. Hummmm?

Gayle

Polly · Post by **Polly** » Tue Sep 13, 2011 8:13 pm

Hi Gayle!

This is unbelievable! My first thought is that it is one of those spoof articles you see on April Fool's Day. Is it really legit? It has got to be tongue in cheek..... please tell me it is someone's idea of a joke! Thanks for sharing!

Polly

sarkin · Post by **sarkin** » Tue Sep 13, 2011 8:15 pm

OK, I was thinking "bizarre personal appearance" might be a *goal* - if only I could get a doctor to pay sufficient attention to diagnose me with R46.1, I would know they were actually looking at me! HOWEVER - R46.2 is 'Strange and inexplicable behavior' - that sounds more like me!

Doctors will, of course, use whatever codes they already use, and/or those that they believe will up the odds of the patient's insurance agreeing to pay for tests, office visits, etc. As far as distinguishing between my knitting injuries, and those from other crafts... much less between those inflicted by a duck vs. a goose... well, thank goodness for medical professionals!

What fun...

Polly · Post by **Polly** » Tue Sep 13, 2011 8:31 pm

Actually, "bizarre personal appearance" is a more sophisticated way of saying "FLK". In peds we used that to mean "funny looking kid". Of course, we did not have a code for it.

It referred to a kid who had unusual features that may have been caused by a genetic problem/syndrome.

Post by **tex** » Tue Sep 13, 2011 8:34 pm

One thing we can be sure of, the odds of them actually having a code to uniquely identify MC are pretty slim.

Having to either remember, or look up a code in a list of 140,000, versus the existing list of 18,000 codes, should save doctors a lot of valuable time. Not!

Tex

mbeezie · Post by **mbeezie** » Wed Sep 14, 2011 5:55 am

LOL Polly, my BIL was an OB and he used to talk about FLKs. Apparently he did NOT think all babies are cute.

Sara, I see alot of R46.2 in my line of work:) I actually wish that were a real code I could use - could really simplify insurance billing.

Meanwhile, some illnesses, like the one I have, have no diagnostic code. Just ridiculous!

Mary Beth

Gayle · Post by **Gayle** » Wed Sep 14, 2011 9:19 am

Polly said:

My first thought is that it is one of those spoof articles you see on April Fool's Day. Is it really legit?

Exactly what I first thought. Still, can’t be totally sure? But would they really use the front page of the WSJ for an April fools joke in September?

I knew a Doc who actually used the FLK acronym on a patient chart. He was roundly upbraided by a Nurse Ratchett for his lack of professional judgement. He never did that again.

IMHO, one day R46.1 will become a frequently hurled pejorative term among medical professionals, mark my word.

If I were a Doc when/if this goes into effect, I would be tempted to get together with my cohorts and label all patients as R46.1 ……. and then watch the CDC come running in to try to understand and thwart this new epidemic of Bizzareness.

In the article, a Ms. Brooks say’s she is a Z73.1 (Type A behavior pattern). I really don’t think that is a correct self diagnosis. Rather, she manifests something between a severe personality disorder and frank psychosis.

And if this is true, this is an extreme example of our government running-amuck. (anyone really surprised?)

Any persons concerned about the possibility of there being no code(s) for MC, .... NOW is the time to make input into this project. Just think of all the subtypes one could conjure up, which might have to include the exact location of the water closet that was the receptacle of a specifically coded type of deposit. Give it your best shot everybody!

Gayle

Zizzle · Post by **Zizzle** » Wed Sep 14, 2011 9:43 am

I worked for an OB/GYN in grad school and noticed the FLK on patient charts, especially after they gave birth, in regard to their offspring. Of course the doctor never told the person they or their child should be evaluated for a genetic syndrome, so what was the point of the FLK designation?? Is the expectation that the pediatricians will notice it and follow-up? I encourage everyone to get a copy of their medical records after they stop seeing a doctor. It's amazing how much you can learn about yourself and about how judgemental your doctor is!!

Post by **tex** » Wed Sep 14, 2011 10:04 am

It's amazing how much you can learn about yourself and about how judgemental your doctor is!!

I'm just so proud that we've never stooped so low as to be judgmental of our doctors.

Tex

Zizzle · Post by **Zizzle** » Wed Sep 14, 2011 10:37 am

OK FOLKS...I'M SERIOUS ABOUT THIS....WE NEED TO MOBILIZE ABOUT THIS RIGHT NOW. I'M ASKING EVERYONE HERE TO SEND FEEDBACK TO CMS, SIMILAR TO THE MESSAGE I JUST SENT. THIS ICD-10 SYSTEM IS NEW AND THEY ARE ALWAYS LOOKING FOR FEEDBACK FROM THE PUBLIC. Beleive it or not, the public rarely weighs in on this kind of stuff. I work for various HHS agencies and I know how to get their attention. This is how we start, and then we follow-up, for as long as it takes, until we get what we want.

PLEASE, send a message to CMS about the new ICD-10 codes at the following link: https://questions.cms.hhs.gov/app/ask/p/8,11,981

Here is the message I just sent. Feel free to copy and edit to make your own.

Subject: Why no code for Lymphocytic or Collagenous Colitis (aka. Microscopic Colitis)??

Section: Medicare, coding, ICD-10

Message:
I examined your new medical coding system in shock and disbelief. You have hundreds of codes for strange animal encounters, watercraft injuries, etc. and yet again, not a single code for Microscopic Colitis, a disease that is growing exponentially, especially among Medicare recipients. How did this happen? Can Microscopic Colitis, or more specifically, Lymphocytic Colitis and Collagenous Colitis be added? This disease is growing in prevalence and affecting people's quality of life and ability to work and raise their families. Without proper diet and treatment, sufferers can experience dehydration, malabsorption, malnutrition, and triggering of other autoimmune diseases. Without a proper diagnosis code, researchers, insurers and medical providers can't quantify the extent of the population affected. Please let me know how I can advocate for inclusion of this important disease in the diagnostic codes. Thank you.

WE CAN DO THIS!!

JLH · Post by **JLH** » Wed Sep 14, 2011 10:46 am

Gayle · Post by **Gayle** » Wed Sep 14, 2011 11:00 am

Zizzle said:

I worked for an OB/GYN in grad school and noticed the FLK on patient charts,

Oh yes, the acronym FLK gets used, not infrequently … as something of a quick conversational shorthand. This may, or may not, be being used as a pejorative. In conversation it may really mean that there is something amiss that doesn’t look quite right – does anyone else notice this? I don’t recognize, is this of concern? What do you think? Voice and facial expressions usually tell others how this term is being tossed about. But this type of communication does NOT translate on paper.

A patient chart is a permanent legal document, which puts using such a term in a chart in a different light.

Just as one really wouldn’t say to a parent that “you have one funny looking kid here”, using such a term on a patient chart could turn out to be at the health professional’s own peril. The dialogue of a Chart gets taken very literally. The judgement, and call-out, made by the Nurse Ratchet type, sighting --- lack of Professional Judgement --- was aimed directly at this fact.

Liked your send to the CMS about the new ICD-10 codes. Will follow up.

Gayle

Zizzle · Post by **Zizzle** » Wed Sep 14, 2011 11:22 am

Gayle,
The "FLK" was always written on the manila inside portion of the chart, not on the notes themselves, which means if a patient requested records, they would never see the FLK, as the notes on the manila folder are never copied.

Post by **tex** » Wed Sep 14, 2011 12:26 pm

Zizzle,

You forgot to point out that MC is at least as prevalent as Crohn's disease.

I can locate a legitimate reference, if you need one.

Tex

Zizzle · Post by **Zizzle** » Wed Sep 14, 2011 12:32 pm

Tex,
You should include that fact in your email to CMS!!