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Sep 2015

Here They Come…Hey-Hey It’s the ICD-10 Codes

Starting October 1, all U.S. providers are required to start using a new system known as ICD-10 medical codes to describe illnesses and injuries when they bill a claim. The codes will cover common illnesses as well as rarer medical calamities such as whether the patient was crushed by a horse, injured by a boat propeller, struck by a turtle, hurt knitting and crocheting, spacecraft collision injuring occupant, swimming pool of prison as the place of occurrence of the external cause, pecked by a chicken, burn due to water-skis on fire, art gallery as the place of occurrence of the external cause, and problems in relationship with the in-laws.

According to a New York Times article, the coding change is causing waves of anxiety among health care providers, who fear that claims will be denied and payments delayed if they do not use the new codes, or do not use them properly. Some doctors and hospitals are already obtaining lines of credit because they fear that the transition to the new system will cause cash-flow problems.

Under the new coding regime, government programs and private insurers will require doctors, hospitals, clinics and nursing homes to report vastly more information about the care they provide. Physicians will now have to answer questions like these:

Did a diabetic also have kidney disease, eye problems or nerve damage? Did a patient with high blood pressure also have signs of congestive heart failure? Was that broken finger on the left or right hand? Was the fracture in the top, bottom or middle of the finger?

But the questions from medical providers will need to go even deeper.

Was the patient bitten by a horse, a snake or a shark? Pecked by a turkey? Crushed by a crocodile? Or sucked into a jet engine?

The new catalog of codes includes more than 100 for gout and more than 200 for diabetes. In a sign of the times, the government lists more than 30 codes for injuries caused by acts of terrorism.

The codes, from the 10th revision of the International Classification of Diseases, or ICD-10, have significant implications for patients. Physicians may need to perform additional tests to help determine if a patient with high blood pressure has heart failure.

ICD-10 includes 68,000 diagnostic codes, compared with 14,000 in the current compendium. The number of codes for inpatient hospital procedures will expand to 87,000, from 4,000.

Health Care consumers often need prior approval from insurers for expensive tests and medical procedures. To get approval, they need a valid diagnostic code. Physicians fear there could be initial delays as the initial process gets underway next month.

Professional coders play a valuable role in the health care system. Coders read through mountains of medical records in order to assign codes to describe a patient’s medical condition. Accurate coding helps ensure patients receive the necessary care they require. It is also a way to justify the services provided. The previous 30-year-old codes had failed to keep up with changes in medical technology and treatment.

The coming ICD-9 shift may be the most dramatic change in health care reimbursement in decades. In 1983, Medicare started paying hospitals a DRG rate, which is a fixed amount for each case, based on the diagnosis. However, this shift was only for hospitals and Medicare patients. In 2014, under the Affordable Care Act (aka Obamacare), millions of uninsured people obtained Medicaid or government subsidies for private health insurance, but together those changes affected fewer than one in 10 Americans. However, the ICD-10 codes will be used by doctors and hospitals for virtually all patients..

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