Blog | Monday, November 2, 2015

Why many docs are griping of late


Oct. 1st marked a national transition to a new classification scheme for diagnostic codes in medical care and treatment. These codes are used to translate a diagnosis like strep throat into an alphanumeric code that can be used for research purposes, and of course, billing (the most important aspect!).

When you visit a health care professional, the diagnosis is translated by a biller (now most often done by computer software) into one of these specific codes, which is then submitted to the insurance company for payment. You receive an explanation of benefits (“EOB”) with this information on it (which the insurance company is sure to remind you is “not a bill”), which is usually indecipherable.

The new scheme (ICD-10) has almost 70,000 diagnostic codes, many of which are of a level of specificity that seems absurd. The old scheme, ICD-9, had only about 13,000 codes.

Not only are there more codes, but they come with a wholly different alphanumeric system attached to them. Luckily, the software lets us “translate” the old codes into the new ones, but often, there isn't adequate specificity in the old codes to be valid with the new ones. This is where the headaches result.

If you follow health media, you'll see some funny articles about the transition. NPR ran a cute story headlined “Struck by a Macaw? Now There's a Code for That.” The Wall St. Journal's explainer was headlined, “70,000 ways to Classify Ailments.” Among my favorites: V91.07 — Burn due to water skis on fire. Or W56.11 — Bitten by a sea lion.

It gets weirder than that. There are codes for “injuries from falling space debris.” Doesn't seem all that likely, but you never know.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.