ICD-10: An Acronym Everyone Will Know Soon
Stephen Hayes has a must read article about the coming implementation of new medical coding standards known as ICD-10. I have personally met doctors who promised to retire before these standards go live in October due to their complexity. Perhaps more will quit once they learn about ICD-10’s Kafka-esque logic. For example, code T63813A is “toxic effect of contact with venomous frog, assault, initial encounter.” There is not a single venomous species of frog on the planet at this time. Oh and you can see a doctor several times for the same malady and each can be considered an “initial encounter.” Last I checked a dictionary I’m pretty sure initial had a very strong connotation of “beginning,” because the adjective “subsequent” would be used to describe encounters coming after the initial one. Not according to the geniuses behind ICD-10.
The expectation is that insurers will reject all claims due to “incorrect coding” soon after implementation, forcing the smallest providers out of business. Larger providers are expected to survive. Thinking about this though, I’m not so negative. There are already hospital administration coding specialists. While healthcare providers enter the initial codes, these specialists are used to figure out better ways to code patient treatments and educate the providers on using better codes next time. ICD-10 implementation is guaranteed to thicken this relatively new layer of bureaucracy in the health care system, perhaps by having the health care providers document the patient encounter in a traditional way, leaving the coders to determine the proper ICD-10 code later. Eventually you will have a war between the ICD-10 specialists working for providers and those working for the insurers, including the federal government. As I’ve learned with the business of Medicine or any other extremely complex system, unintended consequences are the norm. It’s way too early to predict complete disaster.
That’s the optimistic view at least, and it’s only optimistic insofar as it decreases the burden on physicians and other providers. It will not save money; that layer of bureaucracy is going to become critical and expensive, meaning that health care costs will rise. Add in the disappearance of small practices who can’t afford to implement ICD-10, and you will have fewer providers competing with each other.
The pessimistic side of course is that providers like my wife will spend even more time on on unpaid documentation than she does now, and I remind her that whatever is free is abused. For example, today she spent an hour looking up formularies and speaking to an insurance company trying to find a patient a drug her patient’s insurance company would pay for. All that time was gratis. She is therefore considering her career options, as I’m sure many providers are. Medicine is a vast field with many different ways to earn a living, and the skills she has developed will serve her well. She loves treating the sick and she still shows the passion that I saw nearly 20 years ago in the African bush when she helped African villagers. But she didn’t go through medical training to spar with desk-jockies and the coding schemes they pulled out of their asses. Everyone’s favorite example? Code V9027XA: “Drowning and submersion due to falling or jumping from burning water-skis, initial encounter.”
Who will not be served well will be the patients of the providers who leave primary care because of ICD-10, on top of the already burdensome documentation requirements, buggy and poorly written EHR software (no fax capability within the system – so the providers have to print out the prescription and carry it over to the fax machine), declining reimbursement rates, and patients who are overmedicated, overweight and over-indulged.
Here’s a tip: Make sure you get sick before the end of the year, and hope you stay healthy afterward.
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