The U.S. health care system is ramping up to implement a massive new coding system called ICD-10. It’s a bland name for a system capable of coding thousands of colorful injuries. A full 68,000 to be exact, as opposed to the 13,000 under the current ICD-9.
Take these, straight from ICD-10:
Hurt at the opera: Y92253
Stabbed while crocheting: Y93D1
Walked into a lamppost: W2202XA
Walked into a lamppost, subsequent encounter: W2202XD
Submersion due to falling or jumping from crushed water skis: V9037XA
This isn’t just a Dave Barry essay, it’s the cost of health care.
Medical coder is an actual profession and most places have them now. Quadrupling the number of codes means that more codes will be needed and that adds even more to the cost of health care.
Classification was supposed to make health care less expensive and more streamlined, but like most data initiatives, it just adds cost and complexity to the system.
And the people who benefit from that make money by adding complexity, which is the head of a medical coding consulting company (you can see how bad things are when there is a consulting company for the codes) tries to justify the absurdity.
Let’s say you’re in some kind of accident that involves an insurance claim — whether it’s a vehicle or boating accident, or even if you’ve been bitten by an animal. It’s not enough to say, “I was hit by a car” or “an animal bit me.” The insurance company needs to know exactly how that injury occurred so when they go back and look at how to pay out a claim, it helps the patient have their story told properly and allows for potentially better benefits and care.
Does anyone actually benefit from an entire profession that breaks down Injured in Animal Encounter to 600 categories of classification? Besides the people who make money classifying it. The bureaucracy expands and the cost of everything goes up.
NEWSHOUR: Flaming water skis. That’s another colorful one. When would that ever come into play?
HOLLY CASSANO: Well let’s think. Flaming water skis might occur if someone was trying to do some kind of a stunt in Hollywood (the movie “Yogi Bear” comes to mind). maybe they’re putting some kind of ignition fluid onto the water skis for a movie. If I was a coder in an emergency room in Los Angeles, it’s quite possible I’d see something like that.
Yogi Bear was an animated movie. But maybe there should be a code for animators hurting their wrists while moving around 3D sprites of a bear on flaming water skis. I know my wrists are hurting while typing this. Someone get me a code. Pronto!
By utilizing ICD-10 and being more specific about what has gone on with that patient, a doctor in Florida can help someone who was bitten by a rattlesnake out west a few months before. The patient is probably suffering some ongoing issues from the venom, so when another provider goes into their records, they can see: “OK, they were bitten by a rattlesnake, here was the severity of that injury, and let me see what I can do to treat them more specifically,” — which is a lot more helpful than dealing with the unknown.
Or the attending physician could just write into the medical chart. “Patient bitten by a rattlesnake.” But that wouldn’t add six degrees of complexity and ten degrees of expense to the process.
NEWSHOUR: This is a big change for doctors, hospitals and especially professional coders. Just how big is the lift here to implement this new system?
HOLLY CASSANO: It is a very big undertaking but I feel at this point it’s more from an IT (information-technology) standpoint, and it’s more or less of a challenge depending upon what type of office system a provider currently has. There actually are some providers out there who are still on paper, believe it or not. For those individuals, it’s going to be a huge undertaking because they not only have to convert all of that paper into an electronic health record system, they then also have to find one that can handle ICD-10. There are also vendors who you can outsource your coding to, if say, you feel you need assistance during the transition. There are companies that specialize in assisting providers, hospitals and other health care organizations with streamlining their coding operations. For organizations that have an electronic health record system of some sort — which is most — they need to assess and review the vendor’s ICD-10 implementation plan in order to determine if that vendor can handle transitioning ICD-10 into their current system.
If you can make it through that entire paragraph, you have some idea of Reason 41 of why your health care is so much more expensive than it used to be.
It may, prove to some degree, during the initial transition to have some hiccups on the provider side of things. But if they are armed with the proper coding tools out there, it should be somewhat seamless. Coding is not done from memory, so they will utilize the same types of coding tools they do now for ICD-9. If you have a tool like that, which is what I currently use, it’s not going to be that difficult. You just have to plug in “injured in opera house” and the code will pop up.
Here’s a crazy idea, what if we walked this back all the way to “Doctor writes stuff in chart, chart goes into medical record, physicians have access to medical record”?
Tragically the entire profession of coding might go up in a wisp of smoke and a doctor’s visit might end up costing 20 dollars less.
NEWSHOUR: Is there any part of you that thinks this may be going overboard, like distinguishing between an injury in a mobile home’s bathroom vs. the garden or foyer?
HOLLY CASSANO: Well, yeah (laughing). I think that some of these codes really may or may not be necessary. But part of the problem with ICD-9 is annually, due to various strange incidents or new disease processes, the governing bodies and decision-makers in health care — the Centers for Medicare and Medicaid Services, the American Medical Association, the American Hospital Association and others — are tasked with looking to create new codes from providers and others requests in the health care community in order to report these strange and/or new incidents and diseases. Which is one of the areas ICD-10 will assist with and cover more of the bases.
As Ancient China could have told us, bureaucratic complexity is the enemy of getting anything done.
Making health care cheaper requires wiping out 90 percent of the bureaucracy that acts as the middle man between providers and patients.