Wow, it blows even worse that I expected.
Since it’s a Death Code (see link to my post on Death Codes), it’s way over-represented with codes for fatalities, and under-represented with codes on non-fatal events. Leg ripped off by feral dogs? Will, the most important question – WHICH leg? Decapitated by chipmunks? Sure, we need a code for that.
The part that exasperates me is trying to code for actual real things, especially if they have actual real words that describe them.
Part of the “returning medicine to the people” movement involves dumbing down the vocabulary of medicine. I’ll give you that “epistaxis” and “nosebleed” are pretty much the same. But when it comes to describing a FRICKING RASH, there’s almost no use for the actual WORDS that describe a rash.
Many of the descriptive codes are avoided, and the definitive codes are present. Pseudopsoriasis due to a drug effect – I’ll bet that THAT exists somewhere, but not “drug rash.” Do I code for something that ISN’T present just to get the gist of what I’m seeing?
Diarrhea from Rotavirus. That’s codable. It requires a virology lab to prove it. Can I use the code if the patient just has explosive diarrhea? Nope. Ain’t rotavirus until you got a lab test.
Yesterday’s Rant was on duplication of inaccurate information. When you do that, you no longer have information, but sets of CONFLICTING information. The information becomes DEGRADED, not more precise.
Stage II of Meaningful Use also requires the use of SNOMED terms. SNOMED ® is a registered trademarks of the International Health Terminology Standards Development Organisation, another organization that’s getting a boodle of money, I’m sure.
The positive side of SNOMED is that it’s not a Death Code, so it has a broader range of real-life definitions. And that’s its drawback.
The quality of information is defined by its precision, not by its quantity. If you have three different systems to define a problem, and they are not coherent, you have just degraded the information.
Say, if you have a personal FBI file, and someone accidentally reports that you are under warrant for rape/murder in Idaho, does the system consider that it’s only one state out of 50, you’re a pretty good citizen? Nope.
Not only does information degrade, it emphasizes the most variant information, i.e. the wrong stuff. If you get an MI code in your file, then you’ve had an MI, pal. Try to get THAT off your insurance report.
(PS) I find that there are many critical categories that are missing, and that I have had to use intolerably inaccurate codes in describing a condition. As we drift into control of medicine by the fools, this inaccuracy becomes dangerously contrary to good practice.
I recall asking for an echocardiogram, for the stated diagnosis of new-onset right bundle branch block. It was denied. I called up the poor millenial trapped in a dead-end job of denying procedures at the insurance company. Acute heart attack – that’s a code that I could use instead. New-onset RBBB is not an authorized category. But to approach an acute heart attack with an outpatient echo only, is bad medicine. Fortunately, there was a code vague enough to simply mean “heart dysfunction.” That is correct – and nearly meaningless. We will advance – into global nonsense, I fear.