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."

Comments

Sucked into jet engine, subsequent encounter

[art123]

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

Re:Sucked into jet engine, subsequent encounter

[Firethorn]

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.

Re:Sucked into jet engine, subsequent encounter

[Anonymous Coward]

Subsequent encounter refers to going to the doc a second time for the same ailment, not being sucked into an engine again. Still, this is ridiculous.

Re:Sucked into jet engine, subsequent encounter

[hajile]

The XD at the end of the URL made me think it wasn't real.... I should have known better

Re:Sucked into jet engine, subsequent encounter

[Gr8Apes]

And I'm wondering where the obligatory xkcd post is.

Re:Sucked into jet engine, subsequent encounter

[phantomfive]

Serious question......is it possible to survive that?

Re:Sucked into jet engine, subsequent encounter

[Bender0x7D1]

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.

What you describe is known as sequela which also has a code.

From Wikipedia:
In ordinary language it may be described as a further condition that is different from, but a consequence of, the first condition.

Disclaimer: I am not a medical professional, so I could be mistaken.

Re:Sucked into jet engine, subsequent encounter

[Firethorn]

Good point: http://news.aapc.com/initial-s...

Basically, the ER visit is the initial, subsequent encounters are for 'ongoing treatment', IE physical therapy and such. Sequela is for when new complications show up.

Re:Sucked into jet engine, subsequent encounter

[Firethorn]

Apparently yes. Note: Wearing a helmet seems to have been a survival factor.

https://www.youtube.com/watch?...

Re:Sucked into jet engine, subsequent encounter

[davester666]

It's just a flesh wound. I can keep working.

Re:Sucked into jet engine, subsequent encounter

[andyring]

I'd think this would be bad enough the first time, not to mention a subsequent encounter!

http://www.icd10data.com/ICD10...

Unspecified spacecraft accident injuring occupant, initial encounter.

Re:Sucked into jet engine, subsequent encounter

[chilenexus]

Almost, but not quite: A sequela (UK /skwil/, US /skwl/; usually used in the plural, sequelae) is a pathological condition resulting from a disease, injury, therapy, or other trauma. Typically, a sequela is, in medical language, a chronic condition that is a complication of an acute condition that begins during that acute condition.

If an initial encounter was for something like getting stitches for a laceration, a subsequent visit would be for getting those stitches removed. The sequela would be for treating a resulting infection. Where I work, we've had ICD-10 codes available for use by our clients for the majority of this year, though we just got database updates for changes in them that will be going into effect on the first. It's kind of a muddle right now because of all the foot-dragging in the required start date: the analytics packages have been requiring ICD-10 for a while to attest for MU, so a lot of people are more confused by the repeated postponements. That and they don't want to update until they have to, and still record some stuff in ICD-9.

Re:Sucked into jet engine, subsequent encounter

[hoggoth]

I think this video is clearer:

https://www.youtube.com/watch?...

Re:Sucked into jet engine, subsequent encounter

[Specter]

No the real benefit is going to be in scamming the system. A coding system this ridiculous is ripe for abuse. Surely there are many companies right now figuring out exactly how to plausibly code almost any mundane injury so that it generates the maximum reimbursement for the provider. Of course, as insurers get wise to the scam they'll change the rates for the scammed codes forcing the scam to move to another code and screwing the 1:1,000,000 people who actually did fall off their water skis while burning.

It will be a never-ending chase through the 10's of 1000's of useless codes.

And people wonder why health care costs so much.

My sister is a nurse

[Snotnose]

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?

Re:My sister is a nurse

[drunk_punk]

By the time the codes get to your insurance company, denied, sent back, recoded (hopefully), sent back to the insurance company, you be fine! And then the insurance company will sue you for fraudulently submitting a claim... Which will be processed within the week.

Re:My sister is a nurse

[PopeRatzo]

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?

You have to wonder why the insurance industry's lobbyists wrote the ACA this way, don't you?

Re:My sister is a nurse

[AK Marc]

Mostly the result of insurance companies and doctor's fraud. A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud.

Yes, the government does it by moving the cost of compliance to the user (the codes are on the doctor's side, the government just verifies), rather than the other way, where the government would be spending much more on fraud investigations and compliance.

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?

It's not going to cost the government much. Just like the IRS. All the complaints about the IRS being inefficient are about the cost to comply, not the cost of the IRS. The IRS is an order of magnitude (or more) cheaper than the same services from a private service. But partly because they push the cost to the person complying.

What I find funny is all the conservatives who hate ACA want the government to pay more (moving more compliance cost back to the government), rather than the smaller, more efficient government proposed.

Re:My sister is a nurse

[ShanghaiBill]

how in hell do they think people making 20k/year are going to do a good job at entering codes?

As a first step, they could try using a computer instead of a binder.

Re:My sister is a nurse

[Cornwallis]

a) It is going to cost a shitload of money

b) They'll do the best they can- most of them do care

c) You didn't ask for an option "c" but this is the most important: This is just going to make the whole thing worse. By a lot.

Re:My sister is a nurse

[NoKaOi]

This is only really an issue because all the big EMR products are flaming piles of crap. If the software was decent, there would be no reason to have to memorize so much stuff, the software should guide them through it in a matter of seconds. The folks who deal directly with insurance should be the only ones that have to memorize all that.

Re:My sister is a nurse

[jcr]

The codes make it easier to sniff out fraud.

More like, this Byzantine complexity makes it easier to delay payment and deny coverage.

The ACA was the insurance industry's wet dream. Obama, the dems in congress, and far too many of the republicans, handed it to them on a sliver platter.

-jcr

Re: My sister is a nurse

[BradMajors]

Republicans get blamed for an initiative of the World Health Organization that is being pushed by a Democrat administration. Meanwhile, congressional Republicans are trying to override Obama's decision to go ahead with ICD-10.

Facts don't seem to matter to Democrats.

Re:My sister is a nurse

[fahrbot-bot]

how in hell do they think people making 20k/year are going to do a good job at entering codes?

As a first step, they could try using a computer instead of a binder.

Get the guy who created that 1000 key emoji keyboard to help out.

Re: My sister is a nurse

[fahrbot-bot]

Facts don't seem to matter to Democrats.

He said as if facts matter to Republicans.

Re:My sister is a nurse

[LynnwoodRooster]

Just curious - which Republican voted for the ACA?

Re:My sister is a nurse

[flink]

ICD-10 has been in the pipeline for years and years, long before the ACA was a twinkle in Obama's eye.

Re: My sister is a nurse

[kwbauer]

Ah, yes. The Republican ruled AMA that supports Obamacare and gun control. Got it.

Re: My sister is a nurse

[pslytely psycho]

Yes, we destroy families by feeding them, housing them, and providing health care.
Yes that is sooooo fucking evil isn't it.
As far as the ACA, written originally by the Heritage Foundation (including Mitt Romney), Did not get passed by congress back in the early 90's (IIRC, not Googling for a AC retort)
Adopted by Dems, because true single payer would never get passed, so now it's evil.

"Please cite ONE instance where the republicans have in the least gotten the better of the most transparent(ly corrupt) administration in history."

TPP and Fast Track. You voted in lockstep and Obama supported it.

Re:My sister is a nurse

[BradMajors]

I have had that problem. My doctor gave me a valid ICD diagnosis. My doctor prescribed me a standard drug for my condition. My insurance company says that my drug is not prescribed for my ICD diagnosis. They are OK with my drug being prescribed for some other ICD diagnosis codes.

Re:My sister is a nurse

[Tablizer]

A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud.

I wonder if they did a cost/benefit analysis of the cost of insurance fraud versus the cost of detailed encoding.

Also, I wonder if there's not a way to phase it in gradually, one limb at a time or something, or only patent's with ID numbers that end in 3 and 7, or the like. One-Big-On-Switch launches are disasters in the waiting.

Re:My sister is a nurse

[Solandri]

Yes, the government does it by moving the cost of compliance to the user (the codes are on the doctor's side, the government just verifies), rather than the other way, where the government would be spending much more on fraud investigations and compliance.

That's what makes it dangerous - you're decoupling the cost of compliance from the benefit of compliance.

Picking a number out of thin air, lets say 10% of medical transactions are fraudulent. The extra work of learning these codes and looking up ones you don't know (nobody is going to memorize all 70k) incurs a cost. For simplicity, let's say it's $1 worth of labor per transaction. Since only 10% of transactions are fraudulent, there's a 10:1 ratio of labor cost per fraud detected/prevented. That is, for each incident of fraud prevented by these codes, the cost of detecting that fraud is using the codes 10x, or $10. Now say the codes are successful and reduce fraud to 0.1%. Now the cost per fraud detected is entering the code 1000x, or $1000. The labor that involves probably far exceeds the cost of the average fraud it's preventing.

Somewhere between those two points is a trade-off point, where the cost of entering those codes begins to exceed the cost of the fraud it's preventing. If the cost of compliance and the benefit of compliance both rest in the same entity, like the government, then that entity will be aware of when that cross-over point happens, and take measures to change the system before it crosses that point in order to reduce costs.

But when you decouple the cost from the benefit, you destroy the mechanism by which such inefficiencies are eliminated from the economy. The hospitals and medical offices complain that the additional labor of having to use all these codes is monumentally wasteful. But all the government sees is the benefit of fraud prevention, and none of the costs associated with that fraud prevention. So they continue to enforce a system which is now costing the economy more money than it's saving by preventing fraud.

Other examples of where costs are (were) decoupled from benefit are:

• Pollution - everyone bears the cost but only the polluter benefits.
• Overfishing - the entire fishing fleet bears the cost, the lone fisherman exceeding his limit gets all the benefit,
• Credit card security - the merchant bears the cost of credit card fraud, the credit card company gains the benefit (they make money even if the transaction was fraudulent because they've made the merchant bear the costs). This is why the state of credit card security is so pitiful.
• Mortgage-backed securities - the person buying the security is tricked into bearing the cost because the risk of the subprime mortgages wasn't disclosed, the broker who originally sold the subprime mortgage got the benefit of the fees for selling the mortgage.

Decoupling costs from benefits is in general a really, really bad idea. The few places where it does work (insurance) generally involve robust feedback loops where high or low costs eventually get sent back to the party which can benefit from reducing said costs. I don't see any provisions for feedback loops with these codes.

Re:My sister is a nurse

[Dr_Barnowl]

Ding! You hit the nail on the head.

The International Classification of Diseases was originally for compiling WHO statistics, but has been embraced by the pen-pushers in health care. You might think the US insurance industry likes it because it affords manifold opportunities to deny someone a claim (code not covered / wrong code assigned, sorry, bad claim), I couldn't possibly comment.

The UK is ahead of the USA using ICD-10 ; we've used it for years. We also use a somewhat more limited set, of around 14,000 codes, having heavily audited all the codes that arise from combinations of suffixes and decided that many of them don't make sense.

Re:My sister is a nurse

[Dr_Barnowl]

And "dug up three months later and recycled as firelighters"

Re: My sister is a nurse

[Dr_Barnowl]

TPP?!?!?

TPP isn't getting "the better". TPP is surrendering your sovereignty to giant international corporations.

I mean, the USA was pretty much that way anyway, but TPP really makes it official, and unfortunately (along with TTIP) drags a lot of the rest of us along for the ride.

Re:My sister is a nurse

[Dr_Barnowl]

It's a great way to deny claims.

Wrong code? Sorry, fraudulent claim. You can bet that the insurance industry will have more skilled coders than the hospitals.

Gerbil up the arse with *fire damage*?? Sorry, we only cover gerbil up the arse, lubed.

Re:My sister is a nurse

[RKThoadan]

The doctor's and nurses don't need to know any of the codes. However, they do need to document things much better than they have been doing so far in order for the coders to categorize things correctly.

As far as the software goes it varies a bit by vendor, but I expect that the real slowdown part is in tracking down the documentation in the record, not assigning the codes. We are slowly moving away from free-form dictation by doctors into more data-oriented documentation which makes this part a bit easier.

It's just insane how long it's taken us to do this. My wife learned to code ICD-10 in college because they didn't think ICD-9 would be around much longer. This was 20 years ago.

Re:My sister is a nurse

[ThosLives]

You have the correct thesis, I think, but some poor examples:

Pollution - everyone bears the cost but only the polluter benefits.

Overfishing...

Not exactly; the people who pay low cost for the goods/services provided by the polluter/overfisher also benefit.

The examples of credit cards are better. MBSs, I'm not so sure - I don't think there was "tricking" there so much as an artifact of booking rules associated with unrealized gains and losses. Add to that the hot-potato nature of financial instruments, and it's unsurprising, really.

Insurance is a different beast - I've come to realize that insurance isn't about reducing total societal costs at all but it really is about socializing the cost. So large pools of people pay a total higher cost for potentially lower out-of-pocket costs per individual. Insurance by itself cannot ever reduce costs, especially health care costs - the providers have all the power, because sick people are basically willing to pay whatever it costs to be made well.

So the only way health care costs can come down is if people are more healthy, there are more providers, or there is regulation imposed to cap prices (e.g., all the recent hoopla about pharma companies buying rights to drugs and increasing prices because "that's what the market will bear").

The current regulatory framework almost guarantees fewer - not more - providers, so there is really very little hope for reduced health care costs from that aspect. So the only hope is that the socialized preventive care really does effect the desired increase in overall population health - but we won't know that for probably a decade or two.

Re:My sister is a nurse

[xanthines-R-yummy]

Not only do doctors and nurses not need to know ICD9/10 codes, the vast majority do not know them. It was not taught to me ever in 4 years of med school and 3 years of residency. If a doctor ever uses a code, it's from the CPT set.

Re:My sister is a nurse

[sribe]

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?

It's pretty ridiculous to have the 20K/year person translating to codes. The doctor should choose the ICD code. Before anybody argues with that, I write EMR software, and work directly with doctors, nurses, techs, clerks, and billing people. I've seen what a mess happens when the 20K/year person chooses codes, and I've seen how little up-front time it takes for doctors to figure out what codes they should be using, and also that over the long-term it's *0* extra time for them to do it right to start with, rather than trying to have someone else do it and clean up the mistakes.

Of course, some places still insist on doing it wrong ;-)

Re:My sister is a nurse

[meta-monkey]

It has been being phased in slowly. Many institutions have been dual-coding for years now. Now is just the mandatory switch. Kind of like how there was HDTV for years before the day everyone officially stopped broadcasting in SD.

Re: My sister is a nurse

[JackieBrown]

As far as the ACA, written originally by the Heritage Foundation (including Mitt Romney), Did not get passed by congress back in the early 90's (IIRC, not Googling for a AC retort)
Adopted by Dems, because true single payer would never get passed, so now it's evil.

The bulk of Republicans that were for that were not in office when this thing got passed. Assuming the current crop of republicans want what the republicans wanted in the early 90's makes zero sense. If they wanted it, they would have passed it during Bush's time.

Re:My sister is a nurse

[bugs2squash]

I would have thought it would be easier for one business to recover fees from a few solvent businesses than from thousands or millions of individuals. There must be billing savings that are worth consideration.

Re:My sister is a nurse

[Captain Damnit]

Good certified professional coders working in a non-HMO setting can make north of $25 an hour if they are productive. They are also very difficult to find. Since the job that coders do determines whether or not your facility gets paid for a $20K procedure, most places tend to err on the side of caution and spend the extra cash on a good one.

The reason that Kaiser doesn't pay as much for their coders is because the only time Kaiser submits claims to an external entity is for certain subsets of Medicare patients. Otherwise, they are both the insurance company and the provider, which means that they don't have to spend lots of time and money convincing an insurance company to cough up the requisite payment. They will occasionally outsource care to a third party lab or surgery center, but that's the exception.

Re:My sister is a nurse

[gzuckier]

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?

not to mention the large market for software that takes the list of diagnoses and procedures pertaining to a particular patient, and assembles the bill for insurers that will return the largest $$$.

Re:My sister is a nurse

[gzuckier]

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?

You have to wonder why the insurance industry's lobbyists wrote the ACA this way, don't you?

the ICD10s were coming down the pike since before anybody ever heard of Barack Obama, and the ICD9s were here for decades before that.

Re:My sister is a nurse

[PopeRatzo]

the ICD10s were coming down the pike since before anybody ever heard of Barack Obama, and the ICD9s were here for decades before that.

You are absolutely correct. These 70,000 classifications are entirely the creation of the insurance industry.

The only part I blame Obama for in this is that when he pushed for health care reform, he didn't just go ahead and destroy the insurance industry altogether. It is an embarrassing artifact of corporatism that we even have "health insurance companies".

Re:My sister is a nurse

[gzuckier]

Mostly the result of insurance companies and doctor's fraud. A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud. Yes, the government does it by moving the cost of compliance to the user (the codes are on the doctor's side, the government just verifies), rather than the other way, where the government would be spending much more on fraud investigations and compliance.

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?

It's not going to cost the government much. Just like the IRS. All the complaints about the IRS being inefficient are about the cost to comply, not the cost of the IRS. The IRS is an order of magnitude (or more) cheaper than the same services from a private service. But partly because they push the cost to the person complying. What I find funny is all the conservatives who hate ACA want the government to pay more (moving more compliance cost back to the government), rather than the smaller, more efficient government proposed.

there are two kinds of diagnosis codes; there's the ones featured here; "collision with space station" etc. which describe the event, and the ones that say things like "fracture of distal left phalange", that describe what is actually wrong with the patient. Obviously, the second variety are a good indicator to what should be being done to the patient, whereas the first variety don't tell you anything whatsoever about what procedures need to be done.

Re:My sister is a nurse

[gzuckier]

The codes make it easier to sniff out fraud.

More like, this Byzantine complexity makes it easier to delay payment and deny coverage.

The ACA was the insurance industry's wet dream. Obama, the dems in congress, and far too many of the republicans, handed it to them on a sliver platter.

-jcr

the insurers are required to pay within 45 days, icd10 or no icd10. and they're doing a lot better at that now than they were doing a couple of decades ago.
there isn't as much pressure to deny claims to save money these days, either, since their overhead (including profit) is capped; big insurers have to spend 80% of their premium income directly on medical payments and the other 20% is the max they can keep for overhead, whereas in the past they could squeeze that down to 75/25 or even better sometimes. if they're spending less than 80% on medical expenses, they have to refund the excess income to their customers until they meed the requirement.

Re:My sister is a nurse

[gzuckier]

A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud.

I wonder if they did a cost/benefit analysis of the cost of insurance fraud versus the cost of detailed encoding.

Also, I wonder if there's not a way to phase it in gradually, one limb at a time or something, or only patent's with ID numbers that end in 3 and 7, or the like. One-Big-On-Switch launches are disasters in the waiting.

It was originally supposed to go live like 4 years ago (maybe even earlier) but has been delayed at the providers' and insurers' requests multiple times.

Re:My sister is a nurse

[gzuckier]

Not only do doctors and nurses not need to know ICD9/10 codes, the vast majority do not know them. It was not taught to me ever in 4 years of med school and 3 years of residency. If a doctor ever uses a code, it's from the CPT set.

yeah, there's an office full of "medical coders" in the basement of every hospital, or there's a person in the office staff of a practice who is expert on the arcane art.

Re: My sister is a nurse

[gzuckier]

Perhaps they would have had more success trying to override Bush's decision to go with the WHO's decision in 1994 to adopt it.
"What? Who is this Bush you speak of? I was so happy under Reagan, then I woke up the next day and there was the black guy president and the country was in a big mess"

Re:My sister is a nurse

[AK Marc]

Most single payer systems pay a lot of attention to causes of cost. Then, the government tries to minimize harm to people (measured by costs). The US already does it with seatbelt laws and the like. But if they use the cause codes the way they should, they could better reduce harm by actual measures, rather than assumptions, like seatbelt and airbag laws.

Re:My sister is a nurse

[Lendrick]

My wife is a nurse practitioner at a hospital and they're already switched over to ICD10. She tells me things are going relatively smoothly.

Also, the way they enter codes they don't already know is that that the computer asks them questions until it narrows down on the correct code. She doesn't go through gigantic binders, nor are there other people at her hospital that do. The additional overhead from it is minimal.

Mind you, I'm not calling the parent a liar. I'm sure there are some places out there that handle these codes very inefficiently, but using computers to aid with the process is clearly the way to go.

Re:My sister is a nurse

[Lendrick]

And as someone else noticed, the codes are intentionally designed to make no sense. Why is all the information in a binder and not a computer?

This is false. My wife works at a hospital that switched over to ICD10 months ago, and their EMR (electronic medical records) program asks them questions and looks the code up for them if it's one they don't already know.

Burn due to water-skis on fire subsequent encouter

[BradMajors]

http://www.icd10data.com/ICD10...

lives matter so let's track them

[Anonymous Coward]

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

Bad data is worse than abstract data

[mhkohne]

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.

Re:Bad data is worse than abstract data

[Oligonicella]

The problem with granularity is the same one as the problem with trying to describe each grain of sand.

Re:Bad data is worse than abstract data

[quantaman]

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.

I suspect you'll be right for the first five years and there will be a lot of ugly news stories. Then people will figure out how to work with the system, fix the bugs, and then things will get better.

Re:Bad data is worse than abstract data

[AK Marc]

How will it backfire? There'll be bad data? It'll be found, and the doctor charged with the cost of finding and correcting it. It's a self-correcting problem, and not one that will cause medical care problems.

Re:Bad data is worse than abstract data

[Anonymous Coward]

FWIW, United States is one of the last countries to move to ICD-10 (from version 9). Not saying it will be hiccup-free (are always things to iron out), but as far as the world goes, this isn't anything new.

Re:Bad data is worse than abstract data

[Okian Warrior]

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.

It won't backfire, it'll work perfectly.

The insurance companies sit between the doctor and the patient, view medical care as an expense, and seek to avoid paying by any means.

Having an enormously complicated system of classification gives them many more ways to deny claims, leaving the patient on the hook for the bill.

I've had personal experience with this: for a procedure which was 100% covered, the anesthesiologist put the wrong diagnosis code in his notes and the insurance company wouldn't reimburse him for that reason (but everyone else - doctors, nurses, hospital - was OK).

It took 2 1/2 years and about half a vertical inch of paperwork to straighten it out, and was a nightmare. Some tidbits:

1) The insurance company could tell the doctor that he used the wrong code, but wouldn't say what the right code was.
2) The med techs swore up and down that it was the right code (in fact, the *only* code), the insurance company stated with equal strength that it was not.
3) Since it is a mistake with either the doctor or insurance company, nothing the patient can do will help - they are completely helpless.
4) A doctor can't "just change" their notes, even when they've made a clear and unarguable mistake.
5) If you resubmit a claim, the company will deny it based on the previous denial, even if the mistake has been corrected.

#3 above is the most frustrating. The patient has to convince someone else to spend time and effort to fix something which is not their problem.

This new system is just a bureaucratic boondoggle that lets insurance companies avoid payments.

It's saying, in effect, that they care more for paperwork than they do about providing health care.

Re:Bad data is worse than abstract data

[AK Marc]

So if the doctor does a bad job, the doctor's costs go up. You obviously don't know much about how business works. Businesses try to minimize costs, and bad coding is a cost, to the doctor will have a financial incentive to make sure the coding is correct.

You are insisting that having the doctors do a good job with documentation treatment will "backfire". Yet you can't explain how it will backfire.

Re:Bad data is worse than abstract data

[AK Marc]

Won't need as many doctors anyway.

We have more doctors than almost anywhere else. This results in higher cost, but not better outcomes. More efficient delivery of care can only be a good thing.

Re:Bad data is worse than abstract data

[AK Marc]

quality of care will go down as doctors spend more time trying to figure this out than treating patients.

You do know that the people that code are usually not the ones that treat patients, right? Care will go down because the admin in the doctor's office spends more time on paperwork? She was bored anyway. The hospital administrators will hire more into the already existent coding teams.

It's only the dumb or the liars that think this would impact care.

Re:Bad data is worse than abstract data

[Jeremi]

In a sane world, Google or IBM or someone clever will come up with a program where you type in a rough English description of the injury and it returns the set of codes that are likely to match that description, and then guides you interactively towards choosing the correct code from that set.

I'm going to be naively optimistic and assume that this has already been done, at least to some extent. :)

Re:Bad data is worse than abstract data

[dcw3]

You obviously don't know much about how business works. Businesses try to minimize costs

You obviously don't know much about how businesses that deal with insurance work. Those businesses try to maximize costs in order to maximize profit. Witness this at any auto body shop. My kid, the insurance adjuster, can tell you all about this crap.

Re:Bad data is worse than abstract data

[Anonymous Coward]

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.

Re:Bad data is worse than abstract data

[anjrober]

try Intelligent Medical Objects, IMO
i don't work for them, just know about them.
they do exactly this.

Re:Bad data is worse than abstract data

[gzuckier]

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.

It won't backfire, it'll work perfectly.

The insurance companies sit between the doctor and the patient, view medical care as an expense, and seek to avoid paying by any means.

Having an enormously complicated system of classification gives them many more ways to deny claims, leaving the patient on the hook for the bill.

I've had personal experience with this: for a procedure which was 100% covered, the anesthesiologist put the wrong diagnosis code in his notes and the insurance company wouldn't reimburse him for that reason (but everyone else - doctors, nurses, hospital - was OK).

It took 2 1/2 years and about half a vertical inch of paperwork to straighten it out, and was a nightmare. Some tidbits:

1) The insurance company could tell the doctor that he used the wrong code, but wouldn't say what the right code was. 2) The med techs swore up and down that it was the right code (in fact, the *only* code), the insurance company stated with equal strength that it was not. 3) Since it is a mistake with either the doctor or insurance company, nothing the patient can do will help - they are completely helpless. 4) A doctor can't "just change" their notes, even when they've made a clear and unarguable mistake. 5) If you resubmit a claim, the company will deny it based on the previous denial, even if the mistake has been corrected.

#3 above is the most frustrating. The patient has to convince someone else to spend time and effort to fix something which is not their problem.

This new system is just a bureaucratic boondoggle that lets insurance companies avoid payments.

It's saying, in effect, that they care more for paperwork than they do about providing health care.

Again; the insurers are now required to pay 80% of their premium out again as direct medical expenses, or refund the overage. So it does them no good to routinely deny claims, since they can hit this target honestly.

Re:Bad data is worse than abstract data

[gzuckier]

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.

i got caught in a similar hotbox between MRI and insurer regarding the doctor not having preauthorized the MRI, the insurer not paying anything not preauthorized, and the MRI place saying I need to pay them, and if it was the doctor's fault, I should go after the doctor.
luckily, i'm familiar enough with the biz to point out to all three that my member agreement says very specifically that if I go to a participating provider (which the doctor was) I'm not liable for any additional costs for anything he orders, so go work it out amongst yourselves, boys.
the funny part is that the doctor and the MRI were both part of the same Big Med School here, and are like ten feet apart in the same hallway, despite their apparent inability to find each other.

Re:Bad data is worse than abstract data

[Lendrick]

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.

It'll fail in some places and be highly beneficial in others.

I'm guessing it's going to be the worst in heavily-trafficked primary care offices, where there will be a very large variety of issues (particularly those in poorer areas, which see more patients for less money and the staff is spread very thin). It'll be a lot better in hospital wards and specialist offices, where there's more staff and they people are (generally) working with a much narrower set of codes.

But a volcano can only do one thing to you..

[thesupraman]

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!

Re:Burn due to water-skis on fire subsequent encou

[Firethorn]

I always figure that a code is in the book because somebody, somewhere actually got hurt that way. The thought is amusing.

Quite optimal

[lucm]

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.

Re:Quite optimal

[zlives]

thats what billing departments will be for :) optimize the bill.

And the unintended consequence will be...

[Anonymous Coward]

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.

state of healthcare

[Osgeld]

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

Re:state of healthcare

[Mr D from 63]

There is absolutely no ambiguity in what any particular car part is. Classifying medical conditions is far from being so black and white.

Re:state of healthcare

[bistromath007]

I can't decide which of you guys to give "+1 Insightful." I went to a tech school to study insurance coding, and you're both completely right.

Re: state of healthcare

[robi5]

It doesn't work like that. Sometimes numerous sets of codes can be alternatively describe the medical situation. From that point on it's a matter of optimization to figure out which set results in the highest reimbursement. Sometimes it's an NP-hard problem, and sometimes there are differences in the risk of rejection.

Re:state of healthcare

[Dr_Barnowl]

I worked on some of the tools for ICD-10.

Aside from the data being rather horrible (it takes quite a chunk of code to parse it correctly - and most users haven't written that code properly), I also worked on tools for defining conversions of SNOMED CT to ICD-10.

If you think ICD-10 is scary, wait until you see SNOMED CT ; 70,000 codes? Try 400,000, which you can use in combination with each other (codes qualifying codes), with 1.5M descriptions.

Re:state of healthcare

[sribe]

...it takes quite a chunk of code to parse it correctly - and most users haven't written that code properly...

WTF? The format of the data is dead simple. Parsing it took me almost no time at all.

Re:state of healthcare

[gzuckier]

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

well, that's what all those links provided in all those posts upthread are; search for a keyword, get the related ICD10s.

Re:state of healthcare

[Dr_Barnowl]

Ah, you've been using the DSV table files.

The UK tools are based on the XML format, ClaML. This introduces all sorts of nice things like transitive inheritance of suffixes, but does include all the descriptions in the proper places and the text of the entries in addition to the full code descriptions from the books, which you could consider useful for the job of being a clinical coder.

Incidentally, the official DSV tables have plenty of errors in them, including some nasty encoding boo-boos and quite a number of rows that should / shouldn't be there.

As far as I can make it, the historical method of editing the data has been to take the files they use to publish the books and transcribe it to other formats manually. It's only recently they've been aspiring to a toolchain that starts with a structured format and publishes everything else from there. The official data is (was, when I was still working on it, maybe they accepted my patches) riddled with transcription errors, encoding errors, etc, many of them precisely the sort of thing you'd expect from manual transcription or copy/pasting from Word (including the infamous left/right leaning quote characters instead of single quotes / apostrophes).

Re:state of healthcare

[sribe]

The UK tools...

That explains the difference. In the U.S. the CMS (Centers for Medicare and Medicaid Services, a Federal government agency) makes available for download the master source files from which everyone else (EMR vendors, the AMA, all the book/disk/training vendors) starts. And those files are absolutely simple: a few fixed-length space-padded fields followed by a single variable-length field for the unrestricted-length description.

Although admittedly we're focussed on a specific sub-sub-speciality, we have found no errors.

Feedback

[lucm]

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.

Re:Feedback

[jonnythan]

To properly bill this LSD poisoning (initial encounter), we need to know whether it was accidental, intentional self-harm, assault, or undetermined:

http://www.icd10data.com/ICD10...
http://www.icd10data.com/ICD10...
http://www.icd10data.com/ICD10...
http://www.icd10data.com/ICD10...

Re:Feedback

[rsclient]

Yes....and no. There are four codes like you say -- T40.8X1, .8X2, .8X3 and (no surprise) .8X4.

But you know what? Each of the drug overdose sections includes the same subtypes, and using the same codes (except that actually LSD is an outlier; the other ones in the same section include items for "Adverse effect" and "underdosing".

Doctors (and intake nurses) who use electronic patient records (which should be most by now) should find that their software will guide them through the codes as they enter the patient data.

and in 2016 when the gop system kicks in

[Joe_Dragon]

and in 2016 when the gop system kicks in and now you have 70K new ways to get black listed.

To its logical conclusion.

[DoofusOfDeath]

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.

if you like your code, you can keep your code.

[turkeydance]

or not.

Re:Even more complex and expensive!

[AK Marc]

It's been that way for decades. It's only now that people are beginning to believe the people who have been saying it for years.

Just ask Watson

[transfire]

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.

I used to work on a project like that

[msobkow]

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."

Re:I used to work on a project like that

[msobkow]

Oh. And "Meetings". There were always meetings... with free doughnuts at least. *burp*

Re:I used to work on a project like that

[BradMajors]

But for some reason they never included a billing code for filling in the forms that the bean counters require.

Re:I used to work on a project like that

[msobkow]

Actually, this project *did*! "Preparing Supporting Documentation" *LOL*

Idiotic

[blach]

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.

Panic! Panic!

[bperkins]

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.

Re: expands the way ailments are described from ..

[Anonymous Coward]

yea but do they have "gerbel up the ass" yet???

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

OMG -- We only had ten years to get ready

[sandbagger]

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.

Re:OMG -- We only had ten years to get ready

[RKThoadan]

ICD (all versions) are not about insurance. Yes the insurance companies use them, but the primary push comes from the World Health Organization and they aren't the least bit concerned about insurance companies. It's generally been adopted much faster in countries with socialized or single-payer systems.

Re:OMG -- We only had ten years to get ready

[mrchaotica]

This was a well publicized deadline

Not only that, but the original deadline was last year! It's already been pushed back once because of people whining that they're not ready.

Hate how they do the codes

[CanadianMacFan]

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}.

Re:Hate how they do the codes

[jwymanm]

Hierarchies are terrible. Indexed terms with descriptive results you can search through quickly are much better. However, providing both options is a good way for people to be exposed, initially, to what terms are available. The web is a good example of this... of course it would have to be designed to be user friendly.

Re:Hate how they do the codes

[CanadianMacFan]

Well the problem is that there are so many entries. There are almost 2600 entries just for fractures. Who knows how many entries are going to going to be pulled up when you search for femur. Or are you going to force the user to search for 'fractured left femur' just to limit the number of results down to a manageable number.

I forgot to mention this in my previous post but they are trying to capture everything is a single code. So if they give a patient a dose of charcoal to deal with a poisoning there are a number of possible codes for the treatment depending on the cause (accidental, suicidal, unknown, etc). I think that this is wrong too. You only need one code here to deal with the actual treatment. Then you have another code with the case that specifies the reason for the treatment. This would cut down on a lot of codes. There has to be a lot of duplication of codes because they are trying to capture the reason for the treatment in with the treatment itself. So for the ways that a person would try to commit suicide those treatment codes would be duplicated. They would have added suturing the forearm due to a suicide attempt along with other common causes such as accidental.

Re:Hate how they do the codes

[gzuckier]

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}.

like this https://en.wikipedia.org/wiki/... ?
it's the same way the ICD9s have been organized for decades, just finer grained. i.e. different codes for left arm vs right arm, instead of the ICD9s which only had a code for broken arm. etc.

So ... 10 years behind?

[questioner]

Canadian hospitals switched to ICD-10 in 2001-2003. Welcome to the 21st century.

70,001

[fahrbot-bot]

70,001 - Stress induced from working with 70,000 medical codes.

How would we code ...

[PPH]

... tearing the arm off the politicial that thought of this mess and beating him/her over the head with it? Do we search under brachium or cranium?

Re:How would we code ...

[Bob the Super Hamste]

I think you actually need to search under rectum.

How Much?

[sycodon]

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.

Re:How Much?

[dcw3]

As with any overly complex system, people will find codes that are generic enough to reuse, or some such workaround, The data that the proponents claim will be more useful, will not be accurate. The only other solution is as you suggested, training someone in every Dr office, ER and Urgent Care, to properly code new patients. My money is on doctors seeing this as a waste of time/money. I'm betting that the "proponents" are really the insurance companies, who want to know every little artery that gets stitched up.

Re:How Much?

[Daetrin]

There are generic codes and work arounds, but insurance companies are threatening not to pay up if they decide the code for an incident is "too generic."

And yes, the doctors and the people responsible for filling out the forms are _not_ happy with the new system and think it's a waste of time, but it doesn't seem like they feel they can push back against the insurance industry on this.

Re:How Much?

[Captain Damnit]

Depends on whom is calculating the costs.

Insurance companies profit every time you need healthcare, and can find a plausible reason to ration it or deny it completely. Most insurance companies now do pre-authorization for services based on the diagnosis codes. By making diagnosis coding more granular, they have more of an opportunity to save money prior to dispensing care, or by denying your claim after the fact, by saying "You had diagnosis X, which our contract with your provider does not cover for procedure Y". Conservatives refer to this process as a death panel. Liberals refer to it as "bending the cost curve", which has a more pleasant ring to it, even if the net effect is that you don't get treatment in a timely manner, if at all. Please select your preferred side of the political spectrum and rage accordingly.

Providers' costs will probably be a wash. Most providers already have someone who is a Certifier Professional Coder on staff, or they contract it out to a third party coding company. Strangely, these people refer to themselves as Coders, which tends to confuse the hell out of the IT staff. This individual is tasked with reading the pre- and post-procedure diagnosis and procedure report, and assigning a set of CPT and ICD codes to the encounter. These are, in theory, used for clinical purposes, but the main reason procedure and diagnosis codes exist is that they form the terms of the contract between payer and provider. This coding process tends to have the same precision as a group of witches divining the future from cat entrails, because of a wonderful little concept called "unbundling". Let's say that an anesthesiologist is performing a spinal block in which they inject narcotics and steroids into multiple levels in your back. Some combinations of spinal blocks are issued their own procedure codes, whereas other spinal blocks can be billed for separately. If a coder fails to group the separate procedure codes into a proper bundle, or fails to justify the code with the correct diagnosis, CMS and an entire army of subpoena-wielding acronyms will crawl up their butt screaming "FRAUD!!!", because frequently the total of several individual codes will pay much more than a single bundled code. With a more granular coding system, the coder may need to spend a bit more time per report finding the right level of detail, but in theory the number of unpaid visits and claim denials will go down, because they and the insurance company now have a more accurate agreement on what diagnosis will justify the treatment they are providing. ICD-10 covers the diagnosis portion of the coding system, but rest assured, the AMA will soon be confusing the hell out of us with an equally arcane set of new procedure codes.

Incidentally, the procedure codes can and do create some perverse incentives in healthcare. For example, if an orthopedic surgeon is performing a knee procedure with an MCL repair and doing it laproscopically, she is actually paid MORE if she makes two incisions than if she makes one. Reason? There is a single code for "Knee arthroscopy with MCL repair", and separate codes for arthroscopy and MCL repair as their own procedure. Medically, it's safer if you do both procedures with a single incision because of lowered infection risk and less bleeding, but the the difference between the bundled code and the unbundled code is that second incision. So the coding system actually creates a financial incentive to perform a second incision. This is especially true if the procedure is done in an outpatient facility that the surgeon happens to have ownership in.

Universities, research companies, EMR vendors, and biotech firms using big data analysis to perform studies will consider this granularity a godsend, because they won't have to squint as hard at the data to tease things out. Whether you, the patient, want your record to be teased without your knowledge or consent is a debate for the future, but the medical benefits of being able to data-mine everyone's record will likely far o

Re:How Much?

[Specter]

"Universities, research companies, EMR vendors, and biotech firms using big data analysis to perform studies will consider this granularity a godsend..."

-1 Disagree

It will be a godsend only if you happen to worship a particularly cruel and vengeful god. The data that's collected is going to be absolute s**t outside of a few 1000 commonly used (and reimbursed) codes. (Which is going to vary wildly among providers and insurers.) Everything else is going to be filled with errors and statistical outliers and the real white whales you're searching for are going to be buried invisibly in those commonly used codes.

Re:How Much?

[gzuckier]

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.

The thing is that any given doctor does 90% of his/her work within maybe a dozen codes. Your garden variety family practitioner will have little use for accidents due to weightlessness or burns from flaming waterskis, and will go on coding office visit new patient, office visit returning patient, immunization, annual checkup, etc. The biggest addition will be for things like fractured toe where the body has multiple choices, they will now have to code which toe, etc. but since the code is pretty standardized about what suffixes serve for these across all the different limbs, it won't be that bad.

Do you own stock in insurance companies?

[damn_registrars]

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.

Re:Do you own stock in insurance companies?

[gzuckier]

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.

Oh, Medicare Part D was WAAAY bigger handout to corporations than ACA. And I suspect both of them together wouldn't make a dent in your average military contract handout,

Re:Do you own stock in insurance companies?

[damn_registrars]

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.

Oh, Medicare Part D was WAAAY bigger handout to corporations than ACA.

I disagree. Medicare Part D only allows Medicare users to purchase prescription coverage, but does not force it. Some people opted not to buy it for any number of reasons. The ACA, however, makes every living American an obligate consumer of the health insurance system and most of us have no option but to buy it from a for-profit company. Couple that to the fact that it gives them even more power over the consumer than they already had (which was not easy to do, but congress found a way!) and it is hard to see how anything could ever be a bigger handout.

Re:Do you own stock in insurance companies?

[gzuckier]

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.

Oh, Medicare Part D was WAAAY bigger handout to corporations than ACA.

I disagree. Medicare Part D only allows Medicare users to purchase prescription coverage, but does not force it. Some people opted not to buy it for any number of reasons. The ACA, however, makes every living American an obligate consumer of the health insurance system and most of us have no option but to buy it from a for-profit company. Couple that to the fact that it gives them even more power over the consumer than they already had (which was not easy to do, but congress found a way!) and it is hard to see how anything could ever be a bigger handout.

But Medicare D specifically prohibits the government from bargaining with drug manufacturers over drug prices; while medicare haggles with doctors, hospitals, even the pharmacists themselves over their fees. The result is hedge fund managers buying up rights to a drug and jacking the price up to $750. The result is that US residents pay more for their drugs than any other country. The result is Americans sneaking into Canada or Mexico to buy drugs they can't afford; or getting suckered in by ads for "Canadian pharmacies" on the internet. According to the 2013 Medicare trustees report (“General Revenue”, Page 111), through 2012, Medicare Part D added $318 billion to the national debt; and Medicare Part D will add $852 billion to the debt over the next 10 years.

Wrong Abbreviation

[Roger W Moore]

With classifications like that I think they got the abbreviation wrong: it should be OCD-10.

Re:Wrong Abbreviation

[andyring]

No, it seems to me that many of these need to be listed as ID-10-T abbreviations/codes.

Re:Burn due to water-skis on fire subsequent encou

[Lendrick]

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.

ICD10 is SPECIESIST

[KermodeBear]

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!

Re:ICD10 is universal

[kwbauer]

If the TSA can tell that you have pins and screws in your arm, I'm sure the fine doctors in Canada can figure it out as well. I've heard rumors that Canadian doctors have slightly more sophisticated imaging technology than the TSA.

Re:ICD10 is universal

[sc0ob5]

ICD-10 has also been used in Australia for well over a decade, it was in use before I started working the health sector in 2003.

Re: expands the way ailments are described from ..

[Applehu Akbar]

This patient seriously needs to move away from San Francisco.

we want information

[nazsco]

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.

Re:Republicans just want us to die

[Jeremi]

It is the Democrat administration that is pushing this. Congressional Republicans are trying to stop it.

The beauty of the above two sentences is that you can reuse them for just about any political news story, ever.

Re: expands the way ailments are described from ..

[idbeholda]

Pretty sure that's a thinly veiled request to visit the tenderloin district.

Re:ICD10 is universal

[Dr_Barnowl]

ICD-10 does not describe medical procedures, it only describes (as the name implies) medical ailments.

In the UK we have a separate coding system (OPCS) for describing medical procedures.

The one-code-system-to-rule-them-all is SNOMED CT, which almost no-one implements thoroughly because it's such a monster.

Quite exaggerated

[Kjella]

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.

Re:Quite exaggerated

[ChrisC1234]

It's not quite as simple. There are actually different code lists for different countries. To my knowledge, it's based on the same structure, but the US version may possibly have more codes. Also, there are many "unknown" and "unspecified" codes. But take something like S68.119 - complete amputation of unspecified finger. There's a very good chance that will be rejected by an insurance company because if you are the physician and you actually saw the patient, then YOU KNOW which finger it was, so it needs to be coded. So that turns into a separate code for each individual finger (and then even a code for "other" finger.

Re: expands the way ailments are described from ..

[Oxygen99]

Jesus, some people just don't learn do they...?!

Re: expands the way ailments are described from ..

[RuffMasterD]

Rectum the first time. Must have killed him the second time, surely!

Four times

[ThatsNotPudding]

yea but do they have "gerbel up the ass" yet???

Yes, three times:

Four codes, actually; the last for mis-spelling the foreign body.

Re:Burn due to water-skis on fire subsequent encou

[tomhath]

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.

The 2nd Biggest Problem With ICD10 is

[BECoole]

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.

Re: expands the way ailments are described from ..

[Motard]

Foreign body in anus and rectum

But what if it's a domestic gerbil?

ID10T codes

[trevc]

Not invented here syndrome? The rest of the civilized world has been using ICD10 for a while now.

Re:Burn due to water-skis on fire subsequent encou

[Muad'Dave]

V05.01XA Pedestrian on roller-skates injured in collision with railway train or railway vehicle in nontraffic accident, initial encounter

Re:Not connected with ACA

[mrchaotica]

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.

What did you expect? At the medical billing software company I used to work for, we had an entire team (of maybe 10 people) devoted for several months to implementing the damn thing!

Re:Burn due to water-skis on fire subsequent encou

[hoggoth]

Was this monstrosity designed by the people who brought us poop emoji?!

The real problem will be the translation

[prgrmr]

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.

Welcome!

[TheRealLifeboy]

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.

Re:ICD10 is universal

[gzuckier]

ICD-10 does not describe medical procedures, it only describes (as the name implies) medical ailments.

In the UK we have a separate coding system (OPCS) for describing medical procedures.

The one-code-system-to-rule-them-all is SNOMED CT, which almost no-one implements thoroughly because it's such a monster.

In the US we have a couple of procedure coding systems. There are CPT codes, used to describe procedures on outpatients, and ICD9 (soon to be 10) procedure codes, for inpatient procedures. It wasn't until getting inspired by this /. topic to investigate this stuff further that I learned that these ICD procedures are not actually part of the basic WHO ICD9 or 10.
as are not the ICD10CM, the "clinical modifications" which are the 70,000 codes being mourned herein; the central basic WHO ICD10 itself has only 15,000 codes.

Re:Republicans just want us to die

[gzuckier]

It is the Democrat administration that is pushing this. Congressional Republicans are trying to stop it.

The beauty of the above two sentences is that you can reuse them for just about any political news story, ever.

Except wars.

Who's in charge? What is the position code?

[martinfb]

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?

Re:Burn due to water-skis on fire subsequent encou

[Lendrick]

So basically it's just a ridiculous combination of codes and not an actual deliberate code that someone had to explicitly enter.