Federally-Mandated Medical Coding Gums Up IT Ops

Lucas123 writes "The change over from a medical coding system in use since the 1970s to an updated version that adds more than 50,000 new 7-character codes is being compared to Y2K as an IT project that is nearly impossible to complete on time. ICD-10, which replaces ICD-9, adds far more granularity to medical diagnosis and treatment. For example, ICD-9 has one code for a finger amputation. In contrast, ICD-10 has a code for every finger and every section of every finger. An 'unfunded mandate,' the change over to ICD-10 codes is a multi-year project for hospitals, state Medicaid organizations, and insurance providers. The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records."

Comments

Structured data makes this easier

[Mjec]

Surely if the specification lists the data in a structured way, they don't need to be hard-coded. Can't you just stick them all in a database and do lookups? Can't the authority give that the requisite structure?

Re:Structured data makes this easier

[Anonymous Coward]

They're versions, not digits. ICD-9 diagnosis codes (for some reason the International Classification of Diseases also has a set of procedure codes) use up to 5 digits in the form [0-9VE]##.##. ICD-10 is of the form X##.###X, except for some codes that have a "placeholder" to pad the middle of the code out to seven digits.

The real problem here is that insurance claim submission is real design-by-committee bullshit of the highest degree. It's an ANSI standard, a submember of ASC X12 so half the shit in there is unused crap needed for the other things X12 is used for, like wholesalers restocking their shelves or boats reporting their cargo, because apparently code reuse is so damn important to these people that the claim form has a section (completely unused for claims) for reporting credit card details. Of course, the insurance companies all took this design under advice and did their own shit with it. There's a code that identifies whether the insurance company is blue cross, medicare, medicaid and so on (that you have to put on the claim just in case blue cross forgot, and they apparently forget a lot, since if the clinic forgets to set this code properly, the insurance company uses every excuse possible to refuse to pay). Simple enough, right? Well when I started, we had an insurance company that used blue cross's servers for processing claims, so even though they weren't blue cross, this code had to be blue cross or BC's servers would shit themselves. Setting that aside, there's a completely separate code for what kind of provider ID you're sending (blue cross, medicare, medicaid and so on) because of course people are going to bill blue cross using medicaid IDs. Fortunately, the NPI did away with that bullshit (for the most part... medicaid here still demands provider IDs for checkups because they refuse to give up any hoops for doctors to jump through, and one of those was that the doctor had to use a different provider ID for checkups versus treating someone sick. Their computer system apparently cannot sort these claims out themselves... and yet if you bill a checkup on the wrong provider ID, the computer system can easily reject it. Hmmm...)

Ahem.... Anyways, instead of just adding a code to identify whether the diagnosis in question is using ICD-9 or ICD-10 (in the box the committee already created for the purpose of identifying the code being used), the committee got together and pretty much rewrote the whole damn thing. This is where IT got gummed up (it's getting better now). And believe me, you can talk about "legacy equipment" and other stuff til you're blue in the face, but claim submission is how doctors and hospitals get paid, that's where IT has been spending all of its time freaking out.

Cry me a river

[Enry]

ICD-10 has been out for nearly 20 years. There was a 5 year timeline to get ICD-10 implemented, and there was likely a few years of discussion with major Medi* billers before that to let them know this was coming along.

Much like the FCC and HDTV, health care companies must have ignored the mandates until it was too late, whined and cried about how they couldn't meet such a strict deadline and pretty please can we extend it for another 5 years. Repeat until our health care records system is completely unusable.

Though, wow, I would have thought VistA would have ICD-10, but it's being bolted on now. Strange.

Re:I bet you anything

[jhoegl]

True.
As an IT guy who worked for a medical billing company I got to see the inner workings of the coding world.
It is interesting to see that it requires another human being to code from a doctors notes. And then many things came into play, such as alife medical, a EMR system that codes based off of what it reads. They even converted TIFFs with OCR so they could read it. Now with things like NextGen you can put it all into the system and let the system do it for you. No more "interpreting" what the doctor wanted to say. However, with this system it will be tough to find doctors who overbill or put in information that is untrue.
I would watch coders detect these things by finding a doctor attempting to charge for a procedure that did not even involve the issue. Can an EMR system do that? Hopefully, but it will probably be an after thought to the new coding.
And what about these certified coders? Do they have to retrain and re-certify? Probably.

That job was an eye opening experience into the Medical billing world. It was very interesting and I helped develop some of the very first medical billing methods.

Total Bullshit

[Saerko]

As pretty much everyone else has already said, if you don't have a system that can quickly and easily update from ICD-9 to ICD-10, you're so far behind the IT implementation curve that you should be drug out into the street and shot.

It's 2011. They've had many, many years to upgrade, and now they're poised to paid by the government to do so. Hell, my employer stands to gain $50 million dollars over the next couple years from implementing key portions of the HITECH provisions in ARRA. For those reading, that's more than half of my (quite large and well-funded) health system's annual budget.

For our part, we just slapped down a couple hundred thousand for a product that hot-swaps our ICD-9 coding for ICD-10, and also tosses in a problem list that physicians can use that's tied to these coding schema, potentially improving efficiency and accuracy as well. The only excuse, and I mean ONLY excuse for ICD-10 being a problem is poor IT leadership within the health system/hospital--a failing which is incredibly, unbelievably common.

I'm lucky, I work in an IT shop that actually has its shit together.