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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."
Just to be a spoil-sport, "subsequent encounter" isn't that they've experienced whatever injury again, it's that a complication popped up after primary treatment, such that they need more medical care.
For example, you're sucked into a jet engine and survive. They patch you all up, then 6 months later they discover that there was a laceration in your small intestine that they didn't catch and it's now infected, inflamed, and such. That's a subsequent encounter.
I think that even things like physical therapy can carry that code.
I don't read AC A human right
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
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.
Posting as AC so as to not lose moderation above. I had this happen one time when my child went in for an annual checkup that is definitely covered. They denied the claim and said the wrong code was used.
I asked the doctor's office and they said "we think we used the correct code".
So I called the insurance company back and said "they think they used the correct code, you said they didn't, so you tell me what the correct code is." Front-liner said "we can't do that". I said "fine, you probably want me to speak to a supervisor".
Supervisor gets on and repeats that crap. I say "That's fine. Here's how we're going to proceed. You're in breach of contract. I'm going to pay the doctor and then sue your company in the local small claims court for the cost of the visit, which is around $150. I know that the contract has an arbitration clause but I will argue in court that because you've blatantly breached one part of the contract the rest of it is null and void. Even if I lose - which I won't, by the way, since I have home-court advantage and small-guy advantage - it will cost your company many times the amount of the doctor's bill just to send a couple of lawyers to court to defend your company and then lose. And you'll still end up paying the doctor's bill. Your call."
Supervisor says "The code they need to use is _______".
I see people saying "I'm going to sue!" and getting nowhere. I explain carefully that I'm dead serious about suing and I know the process, and I get results.