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.

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

[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

[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

[fahrbot-bot]

Facts don't seem to matter to Democrats.

He said as if facts matter to Republicans.

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

[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 ;-)

Burn due to water-skis on fire subsequent encouter

[BradMajors]

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

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

[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

[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.

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: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...

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.

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.

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.