Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way; New Medical-Billing System Provides Precision; Nine Codes for Macaw Mishaps
September 13, 2011 Wall Street Journal
Today, hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. Apparently, that doesn't allow for quite enough nuance. A new federally mandated version will expand the number to around 140,000—adding codes that describe precisely what bone was broken, or which artery is receiving a stent. It will also have a code for recording that a patient's injury occurred in a chicken coop. Indeed, health plans may never again wonder where a patient got hurt. There are codes for injuries in opera houses, art galleries, squash courts and nine locations in and around a mobile home, from the bathroom to the bedroom. Some doctors aren't sure they need quite that much detail. "Really? Bathroom versus bedroom?" says Brian Bachelder, a family physician in Akron, Ohio. "What difference does it make?"
The federal agencies that developed the system—generally known as ICD-10, for International Classification of Diseases, 10th Revision—say the codes will provide a more exact and up-to-date accounting of diagnoses and hospital inpatient procedures, which could improve payment strategies and care guidelines. "It's for accuracy of data and quality of care," says Pat Brooks, senior technical adviser at the Centers for Medicare and Medicaid Services.
Billing experts who translate doctors' work into codes are gearing up to start using the new system in two years. They say the new detail is welcome in many cases. But a few aspects are also causing some head scratching.
Some codes could seem downright insulting: R46.1 is "bizarre personal appearance," while R46.0 is "very low level of personal hygiene."
It's not clear how many klutzes want to notify their insurers that a doctor visit was a W22.02XA, "walked into lamppost, initial encounter" (or, for that matter, a W22.02XD, "walked into lamppost, subsequent encounter").
Why are there codes for injuries received while sewing, ironing, playing a brass instrument, crocheting, doing handcrafts, or knitting—but not while shopping, wonders Rhonda Buckholtz, who does ICD-10 training for the American Academy of Professional Coders, a credentialing organization.
Code V91.07XA, which involves a "burn due to water-skis on fire," is another mystery she ponders: "Is it work-related?" she asks. "Is it a trick skier jumping through hoops of fire? How does it happen?"
Much of the new system is based on a World Health Organization code set in use in many countries for more than a decade. Still, the American version, developed by the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, is considerably more fine-grained.
Search for diagnoses codes from the International Classification of Diseases, 10th Revision, by typing in a keyword. We've provided a few to get you started.
And see the full table of codes at the Centers for Medicare and Medicaid Services site. Click 2011 Code Descriptions -- Long Format, Table Format and README files.
The WHO, for instance, didn't see the need for 72 codes about injuries tied to birds. But American doctors whose patients run afoul of a duck, macaw, parrot, goose, turkey or chicken will be able to select from nine codes for each animal, notes George Alex, an official at the Advisory Board Co., a health-care research firm.
There are 312 animal codes in all, he says, compared to nine in the international version. There are separate codes for "bitten by turtle" and "struck by turtle."
U.S. hospitals and insurers are bracing for possible hiccups when the move to ICD-10 happens on Oct. 1, 2013, even though they've known it was coming since early 2009.
"You have millions of transactions flowing in the health-care system and this is an opportunity to mess them all up," says Jeremy Delinsky, chief technology officer for athenahealth Inc., which provides billing services to doctors.
Medicare officials say they believe many big insurers and hospital systems are making preparations, but there may be some issues with smaller ones that won't be ready.
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.
Some companies hope to grab business from the shift. One medical-coding website operator, Find A Code LLC, has created a series of YouTube videos with the tagline, "Yeah, there's a code for that." Snow White biting the poisoned apple, the firm says, may be a case of T78.04, "anaphylactic shock due to fruits and vegetables." On April 1, the company posted a document with the secret "X-codes" to describe medical conditions stemming from encounters with aliens.
Other coding cognoscenti spot possible hidden messages in the real codes. The abbreviation some use for the new system itself, I10, is also a code for high blood pressure. Several codes involving drainage devices end in "00Z." Then there are two of the codes describing sex-change operations that end in N0K1 and M0J0. "You could see it ripple through the room as people said, 'nookie and mojo!'" says Kathryn DeVault, who has been teaching ICD-10 classes for the American Health Information Management Association. "Was it purposeful? We don't know."
No, it wasn't, says the Medicare agency's Ms. Brooks, who says the codes are built according to a consistent pattern in which each digit has a meaning.
"I couldn't if I wanted to insert a cute message," says Ms. Brooks, who admits that she could be described by Z73.1, "Type A behavior pattern."
Medicare and CDC officials say codes were selected based on years of input from medical experts in various fields. Codes describing the circumstances of injuries are important for public-health researchers to track how people get hurt and try to prevent injuries, they say.
Being able to tabulate risks tied to locations such as chicken coops could be "important as far as surveillance activities" for public health research, says Donna Pickett, a medical systems administrator at the CDC. She says the current code for a badly healed fracture is so vague it isn't useful.
Another CMS official, Denise M. Buenning, compares ICD-10 to a phone book. "All the numbers are in there," she says. "Are you going to call all of the numbers? No. But the numbers you need are in there."