Blog | Monday, November 2, 2015

The folly of ICD-10


On Oct. 1, every single physician across the country who bills insurance companies, every hospital, every diagnostic laboratory, every medical facility of any sort that bills Medicare or private insurers switched the set of codes they use to submit diagnosis information to insurance companies from the ninth International Classification of Diseases (ICD-9) to ICD-10. Why? Because the change was mandated by the federal government. So you might think that ICD-10 has clear advantages over ICD-9 that will streamline bill submission and make it easier for healthcare providers to do what they do. You'd be wrong.

ICD-10 adds tens of thousands of diagnosis codes to the previous database to allow (actually, to demand) that diagnoses and procedures are documented in minute levels of specificity. There are 845 codes for angioplasty. Perhaps you broke your leg. You would expect different codes for different fractures of different bones, but searching for “tibia fracture” yields more results than my electronic medical record system can display. Make it a closed fracture of the left tibia and there are still more codes that it can show. There are ten codes for a closed fracture of the left tibial plateau. Here's one just for fun: S82.132K closed fracture of medial plateau of left tibia with nonunion.

The ICD-10 codes make it possible for the first time for your physician to inform your insurance if you've been struck by parrot [W614.02XA], bitten by orca [W56.21XA], or were in a hot air balloon when it caught fire [V96.04XA]. If those codes sound like reasonable degrees of specificity that doctors should have to document before getting paid, please consider ‘train accident involving fire injuring pedal cyclist’ [V81.81XA] and ‘toxic effect of contact with sea anemone, assault’ [T63.632A]. It's not that there are a few preposterous codes in the new list. It's that there are more preposterous codes in the new list than I could possibly fit in this blog post, even long after I succumb to writers' cramp [F48.8].

The anticipation of the transition has been a major tension headache [644.209] for medical groups, billing companies, and electronic medical records companies. The estimated nationwide costs of the transition gave many physicians and hospital administrators an acute stress reaction [F43.0]. And, though nothing catastrophic has happened in the first week, doctors won't know for months whether bills submitted with the new codes have been approved, leading many to worry about extreme poverty [Z59.5].

Is this going to yield better health outcomes? No. Certainly not anytime soon. This won't improve communication between doctors. This will only change communication from doctors to insurance companies. The hope is that by extracting all this data, national groups will have a much better idea of what is ailing us. How accurate this data will be, and how it might lead to improved patient care, is beyond my ability to speculate. I'm very curious how the tally of ice yacht accidents [V98.2XXA] will help us make yachting safer. Also, what is an ice yacht?

The important message is that this won't get better. The ICD mavens who foisted this on us have no incentives to make insurance billing simpler or easier, primarily because they have no fear of job loss [Z56.2]. There's no conceivable scenario in which ICD-11 emerges in a few years as a much easier and saner version of ICD-10. The only way to avoid this bureaucracy is for more doctors to realize that they can't do better than working directly for patients, and for patients to realize that their insurance company doesn't have their best interests at heart. It's only when we escape the insurance system that we can tell those who will be drafting ICD-11 to go engage in procreative management [Z31.9].

Learn more:

70,000 Ways to Classify Ailments (Wall Street Journal)

Patients Brace For Erroneous Bills In Shift To New ICD-10 Medical Codes (Forbes)

ICD-10 Debuts Today, Whether Physicians Are Ready or Not (Medscape)

Another Path to Reform (my previous post about ICD-10)

Follow me on Twitter, where I will try to tweet a ridiculous ICD-10 code every day until I get very very bored of it

Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000. Holding privileges at Cedars-Sinai Medical Center, he is also an assistant clinical professor at UCLA's Department of Medicine. This post originally appeared at his blog.