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Doctors On Edge As Healthcare Gears Up For 70,000 Ways To Classify Ailments
HughPickens.com writes: Melinda Beck reports in the WSJ that doctors, hospitals and insurers are bracing for possible disruptions on October 1 when the U.S. health-care system switches to ICD-10, a massive new set of codes for describing illnesses and injuries that expands the way ailments are described from 14,000 to 70,000. Hospitals and physician practices have spent billions of dollars on training programs, boot camps, apps, flashcards and practice drills to prepare for the conversion, which has been postponed three times since the original date in 2011. With the move to ICD-10, the one code for suturing an artery will become 195 codes, designating every single artery, among other variables, according to OptumInsight, a unit of UnitedHealth Group Inc. A single code for a badly healed fracture could now translate to 2,595 different codes, the firm calculates. Each signals information including what bone was broken, as well as which side of the body it was on.
Propoenents says ICD-10 will help researchers better identify public-health problems, manage diseases and evaluate outcomes, and over time, will create a much more detailed body of data about patients' health—conveying a wealth of information in a single seven-digit code—and pave the way for changes in reimbursement as the nation moves toward value-based payment plans. "A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders," says Dr. Rogers. "ICD-10 will give us the precision to do that." As the changeover deadline approaches some fear a replay of the Affordable Care Act rollout debacle in 2013 that choked computer networks, delaying bills and claims for several months. Others recollect the end-of-century anxiety of Y2K, the Year 2000 computer bug that failed to materialize. "We're all hoping for the best and expecting the worst," says Sharon Ahearn. "I have built up what I call my war chest. That's to make sure we have enough working capital to see us through six to eight weeks of slow claims."
Propoenents says ICD-10 will help researchers better identify public-health problems, manage diseases and evaluate outcomes, and over time, will create a much more detailed body of data about patients' health—conveying a wealth of information in a single seven-digit code—and pave the way for changes in reimbursement as the nation moves toward value-based payment plans. "A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders," says Dr. Rogers. "ICD-10 will give us the precision to do that." As the changeover deadline approaches some fear a replay of the Affordable Care Act rollout debacle in 2013 that choked computer networks, delaying bills and claims for several months. Others recollect the end-of-century anxiety of Y2K, the Year 2000 computer bug that failed to materialize. "We're all hoping for the best and expecting the worst," says Sharon Ahearn. "I have built up what I call my war chest. That's to make sure we have enough working capital to see us through six to eight weeks of slow claims."
Here is my favorite.
As if being sucked into a jet engine the first time wasn't bad enough.
http://www.icd10data.com/ICD10CM/Codes/V00-Y99/V95-V97/V97-/V97.33XD
is now classified as "Ronnie Pickering".
That would be code 3973 "Rodent infested anus" not to be confused with code 10 "politician talking out his ass"
are doing this because they believe only the wealthy are entitled to healthcare.
I used to think she was exaggerating how people specialized in not medical training, but in translating doctor's diagnosis into something the government could grok. One day about 5 years ago she brought over a binder that converted ailments to codes, I couldn't believe it. It was about 300 pages of stuff on something minor, like stitches and shots. She works for Kaiser and said they had as many coders as they had nurses, coders being people who converted diagnostics into codes for the government.
I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
http://www.icd10data.com/ICD10...
It'll be nice to track trends of these particular three over time:
Y35811A Legal intervention involving manhandling, law enforcement official injured, initial encounter
Y35811D Legal intervention involving manhandling, law enforcement official injured, subsequent encounter
Y35811S Legal intervention involving manhandling, law enforcement official injured, sequela
http://gomerblog.com/2015/09/hospitalist-coding-query/
I have the sneaking suspicion that this is going to backfire massively. They'll have bad data hither and yon as overworked medicos end up entering the wrong codes (hey, it's a broken femur, who cares which side?) as often as the right ones. They won't get the supposed benefits of more granular data because the data will be so screwed up that they won't be able to draw any conclusions at all.
Nothing like an industry standard to screw things up on a grand scale.
A thousand pounds of wood moving at 300 feet per minute. Don't get in the way.
That is why they are doing this to us.
And the further down it goes, beyond the bottom of the graph
tl;dr of the report above: US is the worst and most expensive healthcare system in the modern developed world.
http://www.icd10data.com/ICD10CM/Codes/V00-Y99/X30-X39/X35-/X35.XXXA
Because I am sure there are not dozens of very different causes of injury from a volcano.. being burnt by lava, hit by flying debris and gassed in the ash cloud are all the same thing ;) Why would a doctor care about the differences?
Red tape 101 - if it makes sense, fix that immediately!
I always figure that a code is in the book because somebody, somewhere actually got hurt that way. The thought is amusing.
I don't read AC A human right
Now instead of using big data to identify trends and pattern, doctors will need big data to figure out which code to use when they fill the forms. Good news is, with the right instance type on AWS and a latest build of mahout, locating the right code for any disease should take less than an hour.
lucm, indeed.
They're going to get a false sense of accuracy. I predict if you look into it, the accuracy of diagnostic codes will nose-dive after this change. Doctors or nurses will look up "turtle" and aren't going to worry about whether you were bit or struck.
Personally, when filing bugs, if Bugzilla has more than a few dozen products or components, I'm more or less guessing which one gets the bug. At least with bugs, eventually the owner will forward it to the right place. I really don't think doctors have a huge incentive to make sure their diagnostic codes are accurate.
I also wonder how exactly this will improve health outcomes. I'd personally pay my doctor to get training on the latest treatments, not the latest billing codes.
a hillbilly making minimum wage can look up a car part out of tens of millions in about 3 seconds, with 3-4 questions, using a green screen terminal connected via dialup
your nurse sister has a binder
I don't think the number of codes is the problem
I bet this will be about as useful as most ticketing systems. Users put data in that isn't true (overly complicated), and managers make decisions based on the imaginary clarify. Dr's struggle keep up with new relevant treatment practices, but I guess keeping up with how to extract cash is needed more. Coding = getting paid.
Pay or die... uhg
Is there a similar standard/public database for medical procedure codes? Will help us all with deciphering medical bills!
From the website:
Suggest a feature or send your comments to feedback@icd10data.com.
Here's the feature I suggest: stop putting LSD in the water cooler at your office.
lucm, indeed.
and in 2016 when the gop system kicks in and now you have 70K new ways to get black listed.
A complete medical report including dictated audio, and imagery, is maybe 50 MB, or 400 megabits, in size.
Let's just cut the crap, and use 2^(400 million) medical codes, each of which maps to one such report. Then the insurance companies may review than as they like.
or not.
Every country but the U.S. Has been using iCD10 for a long time. If you happen to need medical care in another country, say Canada, it would be nice for then to be able to see what medical procedures you have had in the past and understand them. It would also be nice for the doctor to know that the screws holding your arm together are in your right arm, not your left, and ICD 9 codes are not that specific.
I have a better idea. Fire all the people, buy a Watson computer and let it read/listen to all the medical reports and patient conversations.
The change to ICD10 has nothing to do with obamacare, it was something else entirely. iCD10 was originally proposed in1989, and the American Medical Association has been fighting it ever since, because the AMA made lots of money off of their copyright on codes that will now be obsolete. I think Canada started using icd10 in about 2000, and the UK a couple years earlier.
The main problem for doctors is the huge amount of money software companies are charging for the icd10 update, which has caused some doctors I see to join a group of doctors so they can spread the cost of the software update over a larger group of doctors.
Feels like a push to robotize health care.
Or at least make it impractical enough to justify increased spending to "improve" efficiency.
Idiocracy Medical Coding
https://www.youtube.com/watch?...
That's what we need.
It won't solve anything. It will just make things more unwieldy and increase cost. You can bet that cost will come out of our pocket The bureaucrats who support it will get a raise and a promotion.
I used to work on a project like that, where the bean counters ran amok and tried to create accounting codes for the minutest detail of the job. I pissed them off by entering all my time under "Development" or "Debugging."
I do not fail; I succeed at finding out what does not work.
Talk about 50 years behind the times. This whole idea (ICD-9, but much moreso ICD-10) is predicated on the twentieth-century idea that you can assign a numeric code to every possible state of the human condition.
How could we be forced into using this untested system so quickly! We should start using it only after it's been used in other countries for 20 years!
Oh wait.
Yes, three times:
Foreign body in anus and rectum, initial encounter
http://www.icd10data.com/ICD10CM/Codes/S00-T88/T15-T19/T18-/T18.5
Foreign body in anus and rectum, subsequent encounter
http://www.icd10data.com/ICD10CM/Codes/S00-T88/T15-T19/T18-/T18.5XXD
Foreign body in anus and rectum, sequela
http://www.icd10data.com/ICD10CM/Codes/S00-T88/T15-T19/T18-/T18.5XXS
Yea, because we know that HIV and AIDS are really cheap and inexpensive to treat.
I think I'm just not going to go to the doctor again, unless it's one that only takes cash, and can remember my first name.
No sympathy.
This was a well publicized deadline with plenty of infrastructure money provided up front. Oh -- your HMO or physician practice spent all that money on something else. I guess that must be the evil federal government's fault.
---- The above post was generated by the Turing Institute. Maybe.
I think that capturing the data is a good thing but how they are doing is going to have a lot of errors entered. One big list of every possibility is terrible for usability. Instead of a long list I would have created a hierarchy. The major problems would be up top such as fractures, poisoning, surgical and then the valid options would be given to the user as they drill down. For example fracture -> {bone name} -> {side of body} or surgical -> suturing -> {artery name}.
Canadian hospitals switched to ICD-10 in 2001-2003. Welcome to the 21st century.
70,001 - Stress induced from working with 70,000 medical codes.
It must have been something you assimilated. . . .
Have gnu, will travel.
Will costs increase because doctors now have to hire more people to encode patient's charts? They already have at least one, very expensive, employee dedicated to that now. This is a typical government response to a fake problem...more rules, more crap, more costs.
When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
You should. If there is anything you can count on, it is that this will lead to more revenue and profit for them. Just as the Health Insurance Industry Bailout Act of 2010 (more commonly called "The Affordable Care Act" or "Obamacare") was the greatest corporate handout in the history of government, you can count on the insurance industry making plenty of money off of this as well. The longer an insurance company can deny payment for services, the greater the chances are that they won't have to pay it at all.
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
With classifications like that I think they got the abbreviation wrong: it should be OCD-10.
I'm curious enough how they came up with these exact codes that I'm going to try and find out.
Some of them are specific enough (waterskiing while on fire, for instance) that they must have actually happened, but in that case you'd think they'd have one for getting hit on the head by a falling coconut, which they don't. (Incidentally, falling coconuts account for a single confirmed death in the US, in 1973).
Maybe they chose a particular year as the cutoff for injuries, although I'd imagine at least a few more Americans have been *injured* by falling coconuts after 1973.
I am offended! Look! JUST LOOK AT THIS!
Oh sure, there's code for being struck by a raccoon, or bitten by a pig, or "other contact" with a horse (I won't judge), but what about bears?
Yeah, that's right. We bears are shoved into the "other" category. I am so sick of the micro aggressions of the medical patriarchy that is trying to marginalize the needs of the ursine community.
Well I'm not going to take it anymore!
No garbage can will be safe, nor all the salmon in any river. We will break into your homes and eat your pies, and we will smash down your fences to eat your bird seed, we will wage a war on your apiaries and your cries of anguish from a lack of honey will only drive us deeper into rage.
You've been warned!
Love sees no species.
This patient seriously needs to move away from San Francisco.
Give them an IDE with intellisense, no problem? Life is complicated. Let's not QQ on the quantity of information. We have methods to address these types of concerns. Categorize them, use intellisense, profit?
the only reason for that is to leak personal, medical history to all the layers of the system. from your health provider, employer and credit card company.
there's no reason any of this would help a physician.
in America, with or without this, you will still be at the only "first world" country were a visit to the ER will only warrant any procedure of your bowels are exposed. for more than 3 inches.
Congratulations, your new coding system will weed out $x billion in fraud but cost $4x billion by creating unneccessary paperpushing jobs, wasting doctor's time etc. Your government will lose money and more of your patients will have worse outcomes (including death) because everyone is wasting money trying to save it. I would say that's your problem, except that the rest of the world tends to follow your stupidity!
Hey, why not use a slightly larger code, and have each person have his or her own code. That way you'd be able, with an ICD-gagillion, specify exactly.
1-39171-114351-2312381328741234-1234121 = Jim stubbed his left pinky toe when he was 13, causing a 3.2 mm diameter bruise roughly in the shape of Africa, just distal to the first joint, lateral aspect, of yellowish, bluish color initially on presentation, with pain indicated 3 of 10, aching and dull, not stabbing, aggravated by pressure, (TTP positive,) palliative effect noted on application of ice.
Each person and each incident would have its own code. There. FTFY.
Holy Cow! Better order a LOT more 3x5 index cards for next year.
Pretty sure that's a thinly veiled request to visit the tenderloin district.
I just checked our use here in Norway and the total number of valid codes here is less than 20.000. However, there are a couple orthogonal codes bring the number of combinations way up, like in accident codes there's a code for the cause of injury (16 codes) * location (11 codes) * industry/activity (16 codes) that together is 1000+ combinations but many are non-sensical. And they are orthogonal to the medical codes describing the actual medical injury.
So multiple leg fractures would be S827, a not transported related fall injury W0n, construction area goes under "9 Other" as location as work injuries are typically classified by industry and construction industry is b, so in total "S827 W0n9b". If you sustain the same injury as a pedestrian in a road traffic accident it'd be V0n, location 1, activity usually r Other (everything but work, education, sports and exercise) so "S827 V0n1r". They usually wrap the accident codes up on a single A4 page to choose from, I've actually seen that in the ER room. And of course "Unknown" are options on both. Same thing with the medical codes, instead of multiple fractures you can code each fracture in detail using supplemental codes. It's as complicated as you want it to be.
Live today, because you never know what tomorrow brings
Jesus, some people just don't learn do they...?!
I had a dream, bright and carefree, but now there's doubt and gravity
I had an ER visit early in the summer. They were able to calculate my responsibility and display it through my insurance provider in a week or so. The hospital didn't bill me, despite me giving the address *and* box, which the PO requires to deliver mail. They also botched my middle initial somehow. Result? It got sent to a collection agency. Fortunately the agency said they wouldn't report it to credit bureaus unless I failed to pay by a date in October. The collection agency was actually able to format my address properly so that the PO wouldn't bounce it.
Now really, a lot of this is on the PO for requiring a box number and an address when the address ought to be enough. It's not the first time this has caused me problems, and probably won't be the last; but the hospital also ought to know that some POs require a box number along with an address. It can't be *that* unusual.
So. We can't even get all these stupid fucking corporations to properly handle something as simple as an address w/box combination. In theory we can mine that medical data, yes? But in practice you know some crappy software is going to default something, say... all those arteries, just default them to left. Either that or people will be pressed for time and they'll click-through. That expanded data will be shit. I can almost guarantee it.
The rest of the world has been using ICD-10 for years. The transition will be a nightmare but it allows for significantly more accurate differentiation between diagnoses(laterality and region). Things like upper outer quadrant of left breast rather than just the icd-9 code of female breast cancer.
Rectum the first time. Must have killed him the second time, surely!
Human Rights, Article 12: Freedom from Interference with Privacy, Family, Home and Correspondence
This is what is going on in my neck of the woods in Orlando, the MASSIVE Florida Hospital has made a grab for every medical provider and service in the state, and now this...
[From Orlando Sentinel]
In what's considered one of the largest health-care-fraud settlements involving physician referrals to hospitals, Adventist Health System is paying the U.S. government and four states, including Florida, a $118.7 million settlement.
A large portion of the settlement amount — $47 million — is based on allegations involving Florida Hospital Medical Group, which is owned by Adventist, and nearly three dozen Florida Hospitals in the state. That includes the Florida Hospitals in Orlando, Altamonte, Apopka, Celebration, east Orlando, Kissimmee and Winter Park. Physicians were not named as defendants.
"We alleged Adventist's hospitals paid doctors outrageous sums and offered overly generous benefits and lax billing oversight as part of a corporate strategy to capture and control physician referrals for inpatient and outpatient services near its hospitals," said Peter Chatfield, an attorney with Phillips & Cohen, which represented three of the four whistle-blowers.
The lawsuits also allege that the health system submitted false or fraudulent claims based on these referrals to obtain millions of dollars in Medicare and Medicaid reimbursements.
In response to a request for comment, Adventist Health System released a statement saying that "it regrets these oversights, and while some of its hospitals had no violations, the organization has improved monitoring and business practices system-wide as a result of lessons learned from this experience so that it can continue to uphold the highest standards of compliance with regulations."
Adventist also noted that a Department of Justice statement says that the settled claims are allegations only, and no liability has been determined.
The allegations stem from two whistle-blower lawsuits filed in 2012 and 2013 by three employees and a now-former Adventist Health systems senior health-care executive who alleged that financial relationship between the hospital and doctors violated the Stark law and the False Claims Act.
The Stark law limits the financial relationships between hospitals and doctors who refer patients to them. It aims to prevent overuse of government services such as Medicare and Medicaid.
The False Claims Act, enacted during the Civil War, gives the government the ability to recover losses due to fraud against it.
"Adventist is a very successful company, so this is not a settlement that will impact them financially," said Susan Gouinlock, an attorney with Wilbanks & Gouinlock, which represented one of the whistleblowers. "However, $118 million is a lot of money, and taxpayers deserve to get back what they lost in fraud."
The complaints allege that Adventist initiated a corporate policy that directed its hospitals to purchase physician practices and group practices or employ physicians in their surrounding areas in order to control all patient referrals in those locations.
"To convince doctors to sell their practices to Adventist hospitals or to become hospital employees, Adventist hospitals allegedly provided excessive compensation, perks and benefits to the physicians," according to the Phillips & Cohen complaint. "The hospitals were willing to pay doctors more compensation than considered fair market value and absorb persistent losses in those deals because of the revenue the doctors' stream of referrals generated for Adventist from government healthcare programs and elsewhere."
The complaint listed a number of ways Adventist allegedly rewarded doctors, including leasing a BMW and a Mustang for a surgeon; a $366,000 base salary for a family physician because of his high level of referrals for X-rays and blood tests; and a bonus of $368,000 for a dermatologist who worked only three days a week.
To conceal thi
Four codes, actually; the last for mis-spelling the foreign body.
Ever been to a water ski show? A common act they used to do was jumping through fire on a ramp. It would be pretty easy to get some of the fuel on your skis and get burned.
not it's bulk (that's the biggest problem), but that it doesn't so much classify by condition, it classifies by cause. Knowing the cause (for example "fall off bicycle) does nothing to enhance treatment.
Foreign body in anus and rectum
But what if it's a domestic gerbil?
Not invented here syndrome? The rest of the civilized world has been using ICD10 for a while now.
V05.01XA Pedestrian on roller-skates injured in collision with railway train or railway vehicle in nontraffic accident, initial encounter
Tiller's Rule: Never use a word in written form that you've only heard and never read. You will end up looking foolish.
That's 70,000 opportunities fro insurance companies to reject claims due to "improperly coded" billing technicalities.
Suck it peasants!
Only because it was squashed.
The commonwealth report on healthcare lists all the developed countries healthcare systems . All of the others are better and cheaper than the US and they all use ICD-10. So the cost argument doesn't hold. Diagnosis coding systems need granularity to allow you to record , assess and intervene, ICD10 was built for better granularity ( even Botswana uses it) don't confuse diagnosis codes with treatment codes.
Was this monstrosity designed by the people who brought us poop emoji?!
- For the complete works of Shakespeare: cat
From reading the comments it seems a lot of people think that the ICD set is something new and don't realise that ICD9 has been in place since the late 70's - and for younger readers that was a time when computers weren't used as much as they are now.
ICD10 was supposed to be used in America by 2013 (over 10 years later than the rest of the world) then pushed back a year, then another year.
Sol if any clinic still has problems then it's something they've brough on themselves.
IDC-10 codes are just for the diagnosis. The real problem will be the corresponding billing codes (CTP codes). There was a well established translation set between IDC-9 and CPT codes, so that everyone would know that if the diagnosis was flu, the doctor or ER could not bill for doing an appendectomy. This is understandable and reasonable. However, this is all about to change, as IDC-10 turns into an approximately 6-for-1 translation of the new IDC-10 codes to align with the allowable billing codes.
And the real catch? Medical institutions run software to "optimize' the billing so that they are billing for the greatest allowable number of codes per diagnosis, and are using the codes that have the highest reimbursement rates; while the insurance companies run the counterpart software to validate the diagnosis-to-billing code combination in order to deny services, and thus not have to pay the bill, or at least deny some of the line items. An example of this is a hospital doing a tubal-ligation with a secondary appendectomy, and the hospital bills for two surgical trays when only 1 is really needed--unless there are complications which should have been noted by multiple DX's, but some software programs only look at the primary DX code and ignore the secondaries. This is done in the name of "optimization" and "contractual adherence" but can absolutely be administrated as deliberate delaying tactics.
Let's all welcome the USA to the rest of the world! We have been using ICD-10 for a long time and nothing has crashed, no end of the world meltdown has occurred and better stats are indeed the order of the day.
No, have a look at the structure, there is a code for external death, a sub-code for that cause being by water vessel, and a generic sub-sub-code for the vessel type, and a final suffix for primary, secondary or teriary cause. every code and subcode is available, no matter how plausible the event is.
sadly to me it seems unlikely someone in a tragic water-ski fire.
(actually maybe its not so sad).
RE: "Others recollect the end-of-century anxiety of Y2K, the Year 2000 computer bug that failed to materialize." This scare was perpetrated by people holding positions of power without the expertise to hold that job. People with NO CLUE! Just a knack for nay-saying. I think we have this syndrome in many other positions throughout government AND industry. Surely, politics has a very heavy hand in this major issue. How about we, the people, come to our senses and work to put the properly qualified folks in those critical positions? Shall we devise codes for those positions?
Self-importance and self-indulgence is the root of ALL evil.
So basically it's just a ridiculous combination of codes and not an actual deliberate code that someone had to explicitly enter.