Thank goodness we made it to October. Now we have a new medical coding system in place. The use of this new coding system — called ICD 10 — is now mandated by the federal government for hospitals and healthcare providers across the United States.
And just by the fact that I have the ability to code for an orca bite or (God forbid) an accident due to water skis on fire, I know that I will be able to provide better care for my patients.
Originally designed by the World Health Organization as a way to track worldwide disease and collect health and wellness statistics, the ICD coding system was intended to be a way to identify and target certain diseases and injuries.
The hope was that by tracking disease, specific interventions could be made in order to improve outcomes in areas where a particular health risk was present.
The U.S. has adopted this coding system as a way to capture billing information for the purposes of reimbursing physicians and hospitals for the work that they perform. In the previous iteration, ICD-9, there were nearly 55,000 diagnosis and procedure codes. Under the new system there are almost 155,000.
Over the last year, doctors and hospital personnel have been required to undertake hours of “ICD-10” training in order to ensure competence with the new coding system by October 1.
The new system expands the types of diagnoses, and is intended to be much more specific — requiring that statements of laterality and the chronicity of a particular ailment or injury be included in the diagnostic code.
For physicians, this means tons of additional electronic paperwork. With electronic medical records (EMR) already in place — and barely functional in some instances — physicians are already overwhelmed with data entry and screen time.
Now, in order to complete an office visit in EMR, physicians must navigate a new, and even more cumbersome, coding system. We have codes for injuries that occur while falling from a spacecraft, injuries sustained in a Macaw attack as well as a thermal injury that occurs while skiing on water skis that are, in fact, on fire.
Do any of these codes help us care for our patients with diabetes, heart disease, or hypertension? Do my patients benefit because I am able to carefully code in the EMR the fact that their chest pain is due to “native coronary artery disease with angina”?
Wouldn’t the result be the same if I simply wrote in my office note that the patient has prior coronary artery disease and is having typical angina and likely needs an evaluation with a particular test?
In many cases, I expect that the codes that are recorded in the middle of a very busy office day will be no more accurate than the previous system. Many providers will simply click a diagnosis that is “related” to the patient’s problem in order to move the electronic paperwork along. (That is, instead of searching an endless list of codes for the exact letter and number combination that is required).
When exactly did anyone demonstrate that more specific coding of diagnoses by physicians improved patient care and impacted outcomes?
I argue that is simply the result of the combination of continued government ignorance (and arrogance) when it comes to dabbling (or meddling) in healthcare.
Bureaucrats love to create paperwork, committees, meetings, and agendas. They often pontificate on the benefits of a particular plan or algorithm even when they have no data to support their position.
Doctors care for patients — and our government should let us all do what we do best, which is spend time with our patients, connect with them, and work to improve their health.
For now, however, we must continue to look for the right code--especially when we encounter a person who has been injured by a jet engine. Here it is — V97.33XD: Sucked into jet engine, subsequent encounter
Posts by Kevin R. Campbell, M.D.
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