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ICD-10: How Insurance Coding Regs Will Affect You, The Patient

ICD-10: How Insurance Coding Regs Will Affect You, The Patient

ICD-10-CM and ICD-10-PCS Takes Effect October 1, 2015 After Many Delays

icd-10 codes frustrate doctors

About ICD Codes

Doctors inform insurers and governmental health agencies what diseases and disorders they are treating with a numerical code system. The codes were developed by the World Health Organization (WHO). The current codes called ICD-9 (9th revision of International Classification of Diseases) date back to 1979. They began as 3 digit codes (000) then morphed to 3 digits with a decimal point (000.0) and eventually 2 digits after the decimal (000.00). Each number gave more specificity to the diagnosis. In all there are approximately 14,000 unique codes in the US ICD-9 set.

In approximately the year 2000, the WHO made sweeping revisions to the ICD system with a 10th revision, hence ICD-10. It began practical use outside of the US in 2004. The new codes may be as short as 3 letters and/or numbers to as long as 7 digits. This is to provide more specificity to each diagnosis. For example the codes now tell left or right for an ankle sprain. It also details which ligament and what caused the injury.

icd-10 codes

The New ICD-10 is Already in Use Around the Globe, So Why the Delay Here and Why the Big Deal?

The US medical system was set to roll out in 2011 and has been pushed back each year since. Barriers to implementation were the massive changes mandated by the Affordable Care Act (ObamaCare) including the mandate for all providers to begin computerized data collection and reporting. Insurer’s computer systems are all based on ICD-9 and have had to be re-worked to recognize and process ICD-10, no small task.

Remember the fear of Y2K? The world held their collective breaths as computers and other electronics around the world that were designed to recognize a two digit year would now have to be changed to acknowledge 4 digits because nobody knew if a computer would think 00 was 1900 or 2000. Luckily, because of computer engineering, Y2K was mostly a non-event. But like Y2K, ICD-10 is a system that uses a totally different format and could cripple health information systems.

The US is a Unique Healthcare Market.

Most of our care is through private insurance companies. That means hundreds of insurance companies must re-work their networks to comply on their time and at their expense. MediCare and MedicAid the nations government run healthcare programs cover approximately 30% of the population, through what is known as CMS. Each of the European countries cover far fewer people than the vast US population. These other countries also use a single payor using a single computer network. Additionally, other countries code sets are smaller than the US version. As of right now for the US, there are 69,000 codes within ICD-10-CM for offices of doctors and another 72,000 in ICD-10-PCS for hospitals. That’s over 155,000 codes!

Will ICD-10 Crash Medical Information Systems?

CMS as a taxpayer funded program, does not use the latest computer technologies. Add to the that, the fact that CMS has yet to do a large sample test. The only tests performed have been small scale tests. ThisĀ  harkens back to the ObamaCare debacle when the HealthCare. gov site was untested and overwhelmed by even a meager amount of traffic.

So How Does ICD-10 Affect You, the Patient?

Doctors must know how to diagnose you properly with the new codes. The computer systems must be able to recognize the new codes and transmit them to insurance companies. The insurance clearinghouse must recognize the codes and compare it to what treatment was provided. If there is a single glitch anywhere in that process, your claim will not be sent to the insurance company and the doctor/staff will need to re-code. Once the information does make it out of the clearinghouse and makes it to the insurance company, the insurance computer system must now recognize the codes, compare them to the treatment and make a decision on whether to pay or not. Again, if there are any glitches there, there will be no payment made.

All of this means time and man hours for the doctor’s office. You may notice more notices from insurance companies saying your claims were rejected. You may notice your doctor’s office being busier than usual administratively as their work loads will increase. And you may notice your doctor takes longer to record your visit because he or she must now consider a huge set of new codes to plug into their computer. We’ve already seen that doctors spend most of their time with a patient looking at a computer screen rather than sitting face to face and just talking thanks to the electronic records mandate. This is another step away from personalized healthcare in the US towards impersonalized “cattle call” medicine as seen in other countries.

So in October we will Learn if the ICD-10 Coding is the New Y2K Non-Event or if it is the Next ObamaCare Failure.





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