New codes to transform medical billing by Oct. 1

Some fear glitches in major overhaul

1/12/2014

The new codes cover drowning after jumping off fiery water skis, or getting injured while at an opera house or in the act of knitting.

NEW YORK TIMES

Know someone who drowned from jumping off burning water skis? Well, there’s a new medical billing code for that.

Been injured in a spacecraft? There’s a new code for that too.

Roughed up by an Orca whale? It’s on the list.

Starting later this year, a transformation is coming to the arcane world of medical billing. Overnight, virtually the entire health-care system — Medicare, Medicaid, private insurers, hospitals, doctors, and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment.

The changes are unrelated to the Obama Administration’s new health-care overhaul. But given the lurching start of the federal health insurance Web site, HealthCare.gov, some doctors and health-care information technology specialists fear major disruptions to health-care delivery if the new coding system — also heavily computer-reliant — is not put in place properly. They are pushing for a delay of the scheduled start date of Oct. 1 — or at least more testing beforehand.

“If you don’t code properly, you don’t get paid,” said Dr. W. Jeff Terry, a urologist in Mobile, Ala., who is one of those who thinks staffs and computer systems, particularly in small medical practices, will not be ready in time. “It’s going to put a lot of doctors out of business.”

The new set of codes, known as ICD-10, allows for much greater detail than the existing set, ICD-9, in describing illnesses, injuries, and treatment procedures. That could allow for improved tracking of public health threats and trends and better analysis of the effectiveness of various treatments.

Officials at the Centers for Medicare and Medicaid Services declined to be interviewed about the new codes. But a spokesman said the agency was “committed to implementing ICD-10 on Oct. 1, 2014, and that will not change.”

Still, the troubles with HealthCare.gov have given new ammunition to those urging a go-slow approach on ICD-10 and have made it harder for the government to stand behind assurances that the transition will go smoothly.

The Medicare and Medicaid office now appears to be open to greater testing of the system. Also, the Obama Administration relaxed some deadlines for enacting electronic medical records.

Dr. John Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston, said the need to prepare for ICD-10 and the Affordable Care Act and to achieve so-called “meaningful use” of electronic health records all at once could overwhelm computer staffs throughout the health-care industry.

“It’s just this collective sum of activities that exceeds the capacity of the system to absorb it simultaneously,” he said.

Dr. Halamka said his hospital was spending $5 million this year on ICD-10, $7 million for the Affordable Care Act, $2 million on meaningful use, plus $3 million to comply with a federal health-care privacy law.

“Basically, I’m not doing anything but federal regulatory mandates,” he said.

ICD-10 is the 10th revision of the International Classification of Diseases, which is issued by the World Health Organization.

Having a common global code allows for easier collection, comparison, and analysis of the causes of death and illness. Most other countries already have adopted ICD-10, at least for record keeping and in some cases for reimbursement.

The classification was first issued in the 1800s. An early one listed “visitation of God” as one cause of death.

But as medical knowledge and technology have improved, more codes are needed. ICD-9, which allows codes of up to five characters, has about 14,000 codes to specify diagnoses and 3,000 to specify inpatient procedures. The code, which has been used in the United States for medical statistics since 1979, has run out of room to incorporate new knowledge and technology.

ICD-10, with codes containing up to seven digits or letters, will have about 68,000 for diagnoses and 87,000 for procedures.

While ICD-9 had a single code for certain repairs to blood vessels in the head and neck, ICD-10 allows specification of the particular vein or artery and the particular procedure used. Extra codes allow recording of whether a patient was visiting the doctor for the first time or a subsequent time for a particular problem, and whether broken arms and some other injuries occur on the left or right side of the body.

There are dozens of codes dealing just with the big toe — contusion of the right great toe, contusion of the left great toe, with damage to the nail or without, initial encounter or subsequent encounter, blisters, abrasions, venomous insect bites, nonvenomous insect bites, lacerations, fractures, dislocations, sprains, and amputation, not to mention the vague “acquired absence of unspecified great toe.”

ICD-10 has been the subject of jokes, however, for its catalog of possible injury causes, like those burning water skis. There are codes for injuries incurred in opera houses and while knitting, and one for sibling rivalry.

ICD-10 already has been postponed by a year. It was originally scheduled to go into effect this past Oct. 1, which would have coincided with the rollout of the insurance Web site.

Some health-care executives say predictions of a fiasco next Oct. 1 will prove as erroneous as those that said civilization would collapse on Jan. 1, 2000, because computers could not handle years beginning with a 2 instead of a 1 — the so-called Y2K issue.

“It’s not going to be a shock to the industry to confront this,” said Christopher G. Chute, professor of biomedical informatics at the Mayo Clinic. “We’ve literally had seven or eight years to anticipate it.”

A survey by the American Hospital Association in May found that about 94 percent of hospitals were moderately to very confident about being ready on time. Both the hospital association and America’s Health Insurance Plans, which represents insurers, said that their members had spent a lot of time and money getting ready for ICD-10 and that the changeover should not be postponed again.