ICD-10: One Small.... This is Going to be a Pain the Ass

This post is more geared toward fellow physical therapist or healthcare professionals. If you regularly read this blog for more general fitness or injury advice, may I suggest perusing my articles page for other topics I've written on. Likewise, if you have fitness or injury questions feel free to contact me.

So, with October 1 fast approaching, us healthcare providers (in the United States at least) have to prepare for the switch from ICD-9 coding practices to the ICD-10 system. I'll admit, it seems a little daunting and it's going to be a pain in the ass... for a couple weeks. I think after that it'll become common place and we'll wonder how we ever used that archaic ICD-9 system for 30+ years. That's right, ICD-9 was introduced in 1979. I think it's high-time for an update. Here's some things that happened in that amount of time:

Michael Jacksons Thriller album
The Fall of the Berlin Wall
The end of the Cold War
The Blue Jays won the 2 World Series
The Montreal Canadien won 3 stanley cups
Phase out from Vinyl to Cassette to CD to MP3
A plethora of Microsoft and Mac commercials
Planking (what the hell was that fad about)

Anyway, you get my point. A lot of stuff has happened in 36 years. A lot of stuff has changed in 36 years. It's high time we change along with it.

So what does that mean for us as physical therapists?

From what I can gather it means we can be a lot more specific about treatment diagnosis. It will also help with tracking what patients seek treatment for. For example, if someone is referred to physical therapy for medial epicondylitis of the right elbow there are a number of things that we can now chose under our diagnosis to be as accurate as possible for treatment and billing. See below for a comparison.

726.31 (medial epicondylitis)
719.42 (pain in joint: elbow)
782.3 (edema)
719.53 (stiffness of joint, forearm)
728.87 (weakness)

M77.01(Medial epicondylitis: right elbow)
M25.521 (Pain in right elbow)
M25.421 (Effusion in right elbow)
M62.81 (muscle weakness) OR M62.531 (muscle wasting or atrophy of right forearm)
M25.631 (Stiffness of right wrist)
Y93.53 (cause: golfing)

As you can see there's more specificity with ICD-10 coding, with the ability to chose the side of the body effected, the exact joint with swelling, where the weakness and loss of ROM occurs, and what the cause of injury was.

This all seems a little daunting, especially for those of you still using paper charting. However, with an intuitive EMR system (I personally use webpt) the transition should be fairly easy. Some things to note are that anyone currently being seen in your practice must have their codes switch over to the ICD-10 system in the first session of October, and you cannot switch to codes prior to that date. Also, there is a distinction in coding for initial encounter (A), subsequent encounter (D), and sequela (S). My understanding of it is this: If you are in a direct access state and the patient is seeing you without a referral and it is their first time seeking medical attention for the injury then you would be tack (A) onto the end of your coding, if you're seeing a patient who is referred to you then (D) and if the condition is chronic then (S).

Good luck to all you fellow healthcare professionals out there over the next couple of weeks! We're all in the same boat, and it's going to be a bitch for a while. 

A Brief History of Time

I haven't kept any of you abreast of how work is going for me. I guess now is as good a time as any to fill you in on what's what.

When I first moved to New York a little over a year ago I was bouncing around a little bit from different nursing homes in every borough of NYC. A week in staten island, a couple weeks in Manhattan, Queens, Brooklyn. I spent a couple months last summer in a nursing home in the Bronx, and I even had a couple trips out to long island. It was exhausting, but it also gave me a really good idea of how the American health care system works. It's bonkers, but I won't go in to it right now.

After last summer I started working full-time in paediatrics. I was working in the school system and in an after school clinic. That was another experience in itself. Really fun (for the most part) and also, really exhausting. I've been working with children for as long as I've been able to work really, so somehow these positions always fall into my lap. This is the first time I've worked with them as a physical therapist. It can be terribly interesting, but it can also be terribly... terrible. If there are any other physical therapist reading this who work with kids I'd like to hear your opinions.

Now with the school year being over I'm finally FINALLY working in an outpatient clinic full time. With any luck this will stick. I'm working in the setting I'm comfortable in and I'm learning a lot from the clinic owner. Life-long learning for the win!

Oh, just so you know, I'm not a bad physical therapist. I'm not bouncing around all of these places because I suck and get fired. I'm employed by a staffing agency and as such I end up doing a lot of coverage or things like that.

So that's a brief summary of the past year-or-so. I'm hoping this outpatient gig is where I stay for the remainder of my contract.

Cheers folks. I'll get back to more science-y type posting soon. I think.

Blarg, Do Not Get Fitness Advice From Vogue

Right, so to ease myself back into blogging I'm actually just going to reblog this nugget from Tony Gentilcore (awesome name, even awesome-er blog, go follow him now). Apparently Vogue magazine recently published an article about foam rolling that was... less than factual. Tony does a great job picking it apart over on his blog so I'm not going to do that here. I'm just going to point you towards his article.

I've said it before, always read articles and appraise them for what that are. If something sounds too good to be true, it probably is. Media targeted at women uses buzzwords like "toning" or "long and lean," which are vague and appealing. Anyway, go over to his blog and read his take on the vogue piece. Here's a handy-dandy link.


My How the Year Has Flown

Hello Blogosphere.

It's been a while. How've you been? I have been busy and out of touch with this side of things for a while. I'm finally getting settled into a bit more of a stable routine here in New York, so I think I can ease myself back into writing a little bit. If I ever get the chance I will finish writing up my NPTE sample exam. Thank you for the responses to my sample questions, it has become the most read article on my blog. RIght now I have to get back to treating patients, cheers!

Exercise an Important Aid in Addiction

The following is a contributed post and does not necessarily reflect the views of exercise basics. 

Contributed by Jen Pooley

The benefits of exercise have long been hailed in scientific literature; various studies prove the existence of a link between a physically active lifestyle and a lesser risk of obesity, Type II diabetes and heart disease. Recent findings, however, also indicate that exercise has an important role to play in mental conditions like anxiety and depression. It is also an important part of many rehabilitation programs at leading centers in the US, owing to its ability to help stave off addiction. These are just some of the most interesting findings on the link between exercise and addiction:
  • Exercise keeps the youth smoke-free. A study published by scientists at the University of Michigan showed that teens who engaged in regular sport where less likely to have smoked cigarettes or abused marijuana. Statistics have remained stable similar since the mid-1990s. Preliminary studies also indicate that exercise effectively decreases the demand for nicotine in laboratory animals.

  • Exercise curbs drug abuse during the stages of initiation and maintenance. Exercise also prevents drug abuse from escalating and lessens episode of bingeing. A study published in the journal, Frontiers in Psychiatry (Mark Smith et al, 2011), explains that the extent of addiction is often dependent on what takes place during various stages of consumption. There is a link, for instance, between the rapid transition from initial drug experimentation to regular patterns of drug use, and later problems with abuse and dependence. Laboratory studies have shown that rats that were initiated to an addictive drug and engaged in exercise, self-administered significantly lower rates of the addictive substance than sedentary rats. In the same way, rats who were physically active opted for lesser amounts of the addictive substance during the ‘maintenance’ phase (i.e. the post-initiation phase). Those that exercised also had less dramatic escalation of drug use and less bingeing episodes. The latter in particular is of great interest, since drug binge episodes are associated with higher overdose rates.

  • Exercise can aid in combatting depression. A study carried out by M Babyak et. al. set out to assess the effect of aerobic exercise, sertraline therapy, or a combination of exercise and sertraline therapy, in 156 adult volunteers suffering from major depression. Scales of depression were measured via the Diagnostic Interview Schedule and the Hamilton Rating Scale for Depression, as well as through self-reporting via the Beck Depression Inventory. After four months, participants in all three groups showed significant improvements in depression; however, after 10 months, subjects in the exercise group had significantly lower relapse rates that those in the medication group. Those who engaged in physical activity during the follow-up period also had a lesser chance of being diagnosed with depression after follow-up. This led researchers to conclude that exercise can play an important role in the treatment of depression.
Activities like yoga and Pilates, in particular, have been used successfully to combat depression and anxiety, which is why they are often used as complementary treatments in top rehabilitation centers in the U.S. A recent study on Pilates showed that depressed women in a residential center for abused women who did 20-45 minutes of Pilates a day, three days a week, had significantly higher levels of serotonin and a 34 per cent decline in depression.
  • Exercise reduces stress. When addicts are in the process of rehabilitation, they are forced to face acute episodes of stress as they are forced to control carving and as worry begins to set in about the effects of their addiction on their relationships with others and their future. Studies on women undergoing radiotherapy for breast cancer have shown that yoga significantly reduces cortisol levels and lessens fatigue.
Behavioral/psychological mechanisms that contribute to the beneficial effects of exercise: M Smith et.al. (2011) note that there are various reasons why exercise can be so efficient in dealing with addiction. Firstly, the fact that exercise can decrease the self-administration of drugs can decrease the “relative reinforcing strength of the drug when both are concurrently available.” Secondly, since exercise decreases depression and anxiety, it reduces risk factors for abuse/relapse. Finally, the positive effects of exercise on our well-being and self-esteem result in a lower likelihood of substance abuse. Interestingly, “accumulating evidence shows that exercise influences many of the same signaling molecules and neuroanatomical structures that mediate the positive reinforcing effects of drugs.” As the Mayo Clinic notes, exercise is beneficial for everyone: “The health benefits of regular exercise and physical activity are hard to ignore. And the benefits of exercise are yours for the taking, regardless of your age, sex or physical ability.”