Code Chaos

March 10, 2014

The new health care coding system could prove disastrous, says Stephen Hayes, senior writer at the Weekly Standard.

On October 1, 2014, the United States will begin implementing ICD-10, the system for classifying injuries as promulgated by the World Health Organization. Some of the more ridiculous codes from the new ICD-10 include:

  • Suicide by jellyfish (T63622A -- Toxic effect of contact with other jellyfish, intentional self-harm, initial encounter).
  • Injured during the forced landing of a spacecraft (V9542XA -- Forced landing of spacecraft injuring occupant, initial encounter).
  • Sucked into the engine of an airplane (V9733XA -- Sucked into jet engine, initial encounter).
  • Death from jumping from burning water-skis (V9027XA -- Drowning and submersion due to falling or jumping from burning water-skis, initial encounter).
  • Attack from another human with frog venom (T63813A -- Toxic effect of contact with venomous frog, assault, initial encounter).

The codes are also broken down into "initial encounter," "subsequent encounter" and "sequela." But it's not as simple as it seems. There can be several "initial encounters." As one student asked during a training session on ICD-10, "So a subsequent visit would still be an initial encounter?" The student continued, "Wait, there could be five initial encounters with the same physician?"

With the changes, the number of codes in the system will skyrocket from 17,000 to 155,000. Jeff Hinson, a regional administrator for the Centers for Medicare and Medicaid Services, called ICD-10 "the foundation for health care reform."

The codes are hardly an insignificant part of health care. Health care professionals "use ICD codes to talk to one another," says Hayes. The codes are used to record diagnoses and services provided, and insurance companies use them for reimbursement. Errors in coding can mean that claims go unpaid or audits are conducted.

Doctors and hospitals are expecting a drop in productivity and revenue due to the changes. Even a health care consultant who is a proponent of ICD-10 said of the changes, "This is probably going to be the most painful year we've seen in the history of U.S. health care."

Source: Stephen F. Hayes, "Code Chaos," Weekly Standard, March 10, 2014.

 

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