70,000 Ways to Code Medical Care and Possibly Delay Claims

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While patients might not be aware there is a system for coding medical diagnoses and procedures, they should be aware that the system was updated effective Oct. 1. Doctors offices and insurance companies now have 70,000 ways to code patient’s care, which will undoubtedly result in some delay in paying claims or possibly in pre-approving procedures because the old code or the wrong code is used. Medical personnel will also be asking a lot more questions about hos and where someone got sick or injured than ever before to try and determine which potential code to use.

The new ICD-10 coding system — officially named the International Classification of Diseases, 10th revision — demands greater precision about the medical condition and often about the circumstances that led to it. That is because the ICD-10 is extremely specific.

The added options detail which bone was broken and where the patient got hurt, from a vast range of possibilities such as the opera house or three different codes related to walking into a lamppost. Going forward, it will not be enough to say a child fell on a playground, the code used will differentiate from a fall that is related to a swing, a slide or a jungle gym. Dermatologists need to indicate which of eight kinds of acne a patient has. Get the very complex picture?

The switchover is the first time the medical-coding system was updated in 36 years and the change is a major one. In the old system, hospitals and doctors use about 18,000 codes to describe medical services in bills they send to insurers. The version expands the number to about 140,000 overall ways to code medical care at physicians’ offices and in hospitals and possibly force insurers to deny or delay claims. (The number of diagnostic codes doctors use jumped from 14,000 to over 70,000. The number hospitals use for procedures exploded form 4,000 to more than 70,000. )

The conversion was reportedly required by the Centers for Medicare & Medicaid Services to provide more specificity than possible under the previous coding system. The outgoing ICD-9 codes were believed to provide inadequate information about medical conditions and hospital procedures. Much of the terminology in the 36-year-old medical-coding system was obsolete and did not account for newer procedures. The government believed that the new system will eventually facilitate better electronic processing of claims and better accommodate future health care needs.

The ICD-10 is actually copyrighted by the World Health Organization (WHO), which publishes the coding system for use worldwide. The WHO authorized the adaptation of ICD-10 for use in the U.S. for the government’s needs.

The actual conversion was a massive undertaking for insurance companies, doctors’ offices and others who use the coding system. They made considerable investments in upgrading computer systems and training personnel.

One profession sure to benefit from the greater specificity in diagnoses and treatment data will be researchers and others trying to improve patient care. Computerized records with more detailed information will eventually add valuable information on trends and treatments in the foreseeable future. But, in the meantime, get ready for the fact that doctors, hospitals and insurance companies are dealing with 70,000 ways to code medical care and possibly delay claims submitted.

Written and edited by Dyanne Weiss

Sources:
U.S. Centers for Disease Control and Prevention: International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
Wall Street Journal: 70,000 Ways to Classify Ailments
Forbes: Patients Brace For Erroneous Bills In Shift To New ICD-10 Medical Codes
Columbus Dispatch: New medical coding system adds a lot more specificity, paperwork

Photo courtesy U.S. Navy

One Response to "70,000 Ways to Code Medical Care and Possibly Delay Claims"

  1. Rick Olson   October 5, 2015 at 12:10 pm

    We’ve had years to prepare for the change and, without additional delays, have finally caught up to the rest of the modern world. Change is always difficult but ICD-10 is a positive step forward for a modern information-driven healthcare system that needs to get a handle on costs.

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