The language of medical billing hopes to cover any possible malady, no matter how obscure.
Updated Sept. 10
Behind every sore throat and suture, every embarrassing rash and broken toe, there’s a billing code that allows doctors and hospitals to turn your pain into payment.
Today’s code set, called ICD-9, lists approximately 14,000 different ways Americans get sick or hurt themselves. There’s another 4,000 or so procedure codes, which represent the treatment provided.
This information is the lifeblood of the U.S. health care system, and in October, it’s scheduled for a reboot. ICD-10 is coming, and bringing with it more than 140,000 new codes.
“In this case, bigger is better,” says Dr. Evan Gwilliam, founder of the website FindACode.com, which lets coding professionals search for the right entry based on keywords.
“Much like if you remember phone books–which we don’t use much any more–a bigger phone book contains more phone numbers and therefore it is more likely to contain the phone number that you need.”
A modern system
Medicine has changed dramatically since 1979, when ICD-9 was implemented. The new codes attempt to capture those advancements, as well as give public health researchers better data on how and where people get hurt.
And that’s led to some very weird new codes in ICD-10.
“One of the most famous ones is ‘burn due to water skis on fire,'” says Gwilliam. “The creators of the code set wanted there to be codes to describe any possible circumstance where someone could be injured. And I think they’ve done it, because water ski fires don’t occur that often, but theoretically it could, therefore there’s a code to cover that scenario.”
There’s a code for being bit by a turtle, another for being struck by one. Did your hang glider explode? That’s V96.15XA. If it only caught on fire, but didn’t explode, use V96.14XA. You get the picture.
Ready, set, code!
Turtles and hang gliders make good icebreakers during day-long ICD-10 training seminars, of which Shiny George has sat through her fair share. She’s Senior Director of Health Information Management at Thomas Jefferson University Hospital, and is an unabashed cheerleader for coding professionals, who do the heavy lifting of translating doctors’ notes into numbers.
“This is the closest you can come to medicine without being a doctor,” says George. “You read medical records, you translate those diagnoses and procedures and do codes, and you get it. You can talk to a physician in the medical language.”
George and her team were speaking ICD-10 fluently three years ago, before the federal government delayed an earlier planned transition. To stay fresh, Jefferson’s coders have been recording both the new and old versions.
“We have invested a significant amount of time, resources, money, sweat and tears, but we are ready for October 1, 2015,” she says.
Not everyone shares that enthusiasm. Many doctors’ groups, including the American Medical Association, worry about the costs of switching to ICD-10.
An industry-funded study put the price tag for a large practice at up to $8 million, though coding groups say that’s way, way overblown.
Along with software and training, another possible expense is delayed reimbursement from insurers, Medicare and Medicaid caused by glitches when the system switches over.
Dr. William Harvey, a rheumatologist at Tufts Medical Center in Boston, says that will hurt small medical providers.
“For better or worse, health care is a business just like any other,” he says. “There are not many businesses who could withstand three month interruptions in their cash flow and still operate.”
On top of that, doctors are being asked to absorb a huge amount of other changes in how they work, from electronic health records to accountable care organizations and payment reforms.
For its part, the federal government says it understands the concerns of smaller practices.
“There’s no excess staff in the office, nobody is sitting around twiddling their thumbs,” says Dr. William Rogers, who is serving as the Centers for Medicare and Medicaid Services ICD-10 ombudsman.
“So we understand that October 1st is going to be a scary time and we are going to make sure as best we can that people get paid if they deliver a service.”
Rogers says while some ‘growing pains’ are inevitable, everyone will get the hang of ICD-10 sooner, rather than later.
“You know, in 6 months, 99% of the problems will be gone.”
Independence Blue Cross says it’s expecting a smooth transition come October 1, and that there won’t be anything close to a three-month delay in reimbursing doctors.
“I think it is fear of the unknown,” says Joan Jennerjahn, who is managing the ICD-10 transition for Independence. “I think there is a fear of going from something that’s been very familiar and in place for what, over 30 years, to something that’s new.”
Jennerjahn says all those new codes will help the health system do a better job measuring quality of care, not just the quantity.
Evan Gwilliam, from FindACode.com, agrees with that take.
“It will do a better job of tracking information,” he says. “It will provide data that we can use to improve our health care system, and in the long term, it may even save money as we become more efficient, even though the short term is going to be a little difficult.”
And just in case a doctor does, say, type in the wrong code for hang glider explosion, the feds are offering a one-year grace period for minor mistakes.
ICD-10-CM Tabular List of Diseases and Injuries