'Avalanche Of Time-Wasting Paperwork For Doctors' in Government's ICD-10 Coding Scheme

ICD-10CMSReady for another bureaucratic headache? On October 1 of this year, under federal government rules, most medical providers and insurers will have to switch over to ICD-10, a new coding system for patient diagnoses and inpatient procedures. The new standard has almost ten times as many codes as ICD-9, which it supersedes. That's supposed to allow for greater precision. It also increases complexity, however, as I've reported, and has the health industry concerned over confusion and costs in the course of the massive transition.

The ICD-10 changeover would be daunting no matter what, but the hard deadline plays a big role in fears. Last week, Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, insisted that the deadline is firm and fast (it was already delayed once), though CMS may allow for some hardship exceptions. That's not really calming anybody, as Grace-Marie Turner and Tyler Hartsfield of the free-market Galen Institute note in an op-ed for Investors Business Daily which refers to ICD-10 as an "avalanche of time-wasting paperwork for doctors."

Dr. Susan Turner, president and CEO of Medical Group Management Association (MGMA), says the transition will be "one of the most complex and expensive changes our health care system has faced in decades."

The ICD-9 has about 17,000 codes, while the new ICD-10 will have more than 140,000. These cumbersome new administrative responsibilities will take away from the time doctors can spend with their patients. ...

In a recent letter to HHS Secretary Kathleen Sebelius, Dr. James Madara, CEO of the American Medical Association, said it will cost a small practice up to $226,000 to comply. And there is no opportunity to phase in the new system and iron out glitches. (We saw how this worked out with the ObamaCare website ... )

Because this coding system directly facilitates payments, physicians who do not transition on time will experience a delay or cessation of payments. To weather this transition, CMS suggests that small and medium-size practices should have access to "reserve funds or lines of credit to offset cash flow challenges."

Turner and Hartsfield refer to Canada's somewhat speed-bumpy transition to ICD-10 a decade ago. That changeover, according to Carl Natale of HealthCareITNews, was staggered over the period from 2001 to 2005. Natale cites Gillian Price, who was a consultant for Canadian healthcare organizations during the transition.

Speaking of productivity, it tanked. The reduction ranged from 23 percent to 50 percent. And Price said productivity never fully recovered. There was no way it could given the complexity of the new codes and the changes needed in the healthcare organizations.

Natale's 2011 article doesn't bash the new coding system, but it does provide some hard lessons acquired over a phased-in adoption of the system. It's hard to see how the American experience, planned for one day while the system is already reeling from Obamacare, will be easier.

As it turns out, my wife and her fellow pediatric providers are spending their lunch today going over ICD-10 changes at the local hospital. They're not even affiliated with the hospital—my wife's practice is independent—but they round on newborns whose parents pick them as their pediatricians. In the course of rounding, they need to know a couple of codes that will update with the new system. That apparently requires an hour-long meeting.

The rest of ICD-10 my wife is handling in-house, including training, updating her electronic health records system, and socking away cash reserves. So far, she's pretty confident in her preparations. She's leaning on payers on whom she relies (**cough** Medicaid **cough**) to test their systems.

October 1 is also supposed to be the next deadline after which health plans must be Obamacare compliant to be renewed, if that isn't delayed.

For people who like watching bureaucratic trainwrecks, this promises to be an interesting year.

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  • Pro Libertate||

    Let me guess. This system will allow insurers to deny even more claims than they are now. Thanks, government!

  • Brett L||

    I was going to go with "even more opportunities to fraudulently bilk CMS", but I like the cut of your jib.

  • Rasilio||

    Both are actually true

  • ||

    Well, that is the point, dude. How else are they going to "cut costs"?

  • Pro Libertate||

    It's so weird that I can sit here and see it happen to my family, yet the media somehow cannot detect any problems caused by Obamacare at all, except for some stupid website not working.

  • ||

    Disgusting partisan scum hacks don't give a fuck about you or your family, ProL. They'd happily gas you and bury you if it got rid of a drag on the narrative.

  • Pro Libertate||

    Well, I guess I should be happy that I suffer anonymously. They're satisfied now socking it to the upper middle class, anyway, so no camps. Yet.

  • WTF||

    It's so weird that I can sit here and see it happen to my family, yet the media somehow cannot detect any problems caused by Obamacare at all

    Harry Reid knows you are just lying about that. Because racist.

  • Rasilio||

    Technically this has nothing to do with Obamacare

  • Pro Libertate||

    That's crap. Market distortion distorts.

  • Rasilio||

    No, I mean ICD10 is completely independent of Obamacare.

    I think Obamacare might have fixed the conversion date but the ICD10 conversion process had already begun before Obama was even elected with the original planned go live date of 10/1/2011. In January 2009 more than a year before Obamacare was passed and signed into law that deadline was pushed out to 10/1/2013.

    I am not saying anything in favor of Obamacare of the ICD10 standard, I am just pointing out that the 2 things are not related. They are 2 completely separate government cluster fucks that just happen to deal with health care and be taking place at roughly the same time.

  • Pro Libertate||

    Oh, I see. I meant that the insurers going on their Denialarama is connected to Obamacare.

  • lsg621||

    I'm a nurse who has had to fight with insurance companies to cover medical procedures for patients because of denial due to lacking a matching ICD 9. I'm hoping the ICD 9 system will eliminate this problem. It will also keep physicians from overcharging for certain procedures. Maybe that's why the author of this article is so invested in trashing ICD 10: he knows his pediatrician wife may not be bringing home as much money because the coding will more accurately reflect what was ACTUALLY done for her patients. Lastly, coding doesn't "take away" from patient time as the article would have us believe. It takes, literally, less than one second to type the diagnosis into a database to obtain a matching ICD 9 or ICD 10.

  • robc||

    1 second is 1 second.

    Add that up over every code and it adds up.

  • Adam330||

    But someone has to know them, which means they have to study them and/or look them up. Which takes time.

  • Scarecrow Repair||

    If there are more fine-grained definitions, then typing in a description is likely to find 8 times as many matches with subtle distinctions, requiring either more careful thought to get the right one, or more hurried "pick a card, any card" practice. Guess which one likely after the first few dozen time wasters.

  • wwhorton||

    Legit question, not snarking: How will ICD-10 prevent overcharging?

  • Lord Humungus||

    and what will happen is that certain codes that are "close enough" will be used over and over...

    My first job out of college was doing customer support. Each solution had to be assigned a code. It was helluva lot easier to just pick a generic one than get into the specifics.

  • UnCivilServant||

    Odds are even better that "Close enough" pays a higher reimbursment rate than the hard to find specific codes.

  • Rasilio||

    Whichever one pays more it is a safe bet that every dr's office in the country will learn to use that code very quickly

  • Brett L||

    It is far, far worse. I spent 5 years on an epidemiological solution that used ICD-9 reporting, and even then they were doing all sorts of surveys and reviews on the data because even with 17000 codes, there was a ton of overlap. Now imagine 10x the number of codes. But Pro L is right. IIRC, there were about 5 different ways to input flu or pneumonia that were essentially the same, but based on the diagnosis checklist you used (or your own experience) you as an experienced clinician could be "wrong" in a way that in no way affected successful treatment.

  • ||

    Our EMR provider has done some training webinars on it and they're going to roll out the whole ICD-10 database in the near future. Our billing department has been exceptionally cranky, particularly those who trained as coders under ICD-9.

    Extra fun: claims opened the day before ICD-10 rolls out will be ICD-9, but if we request an upgrade of diagnosis or add a body part the new diagnoses will be in 10.

  • Brett L||

    Contra to the sockpuppet, this is overkill. What happens if we don't know it was an accident at the time of coding? What if they can't determine if the crash or the extraction caused the injury?

  • ||

    The kind of overkill I want on my tombstone. Unless it's like how the main character in Dead Like Me died (space-station toilet seat striking her down on reentry).

  • Pro Libertate||

    SETTING A BROKEN LEG IS AN EXPERIMENTAL PROCEDURE: DENIED

  • DaveSs||

    Someone told me that one of the 'benefits' of ICD-10 was that it would allow for more accurate statistical analysis.

    My response to him was that people are going to find those close enough codes making any meaningful analysis impossible.

  • lsg621||

    That's a people problem. Not a problem caused by ICD 10. If people are doing their jobs correctly, ICD 10 will allow for greater specificity. FYI ICD 9 relies on people to input the codes as well so the problem of inept or corrupt doctors and medical coders still exists.

  • Brett L||

    Hi Tulpy-poo!

  • robc||

    The system is designed to work with people.

    Or, should have been.

  • Adam330||

    But people are people, and people will be the ones using the system. Designing a system for angels is a clear way to failure and unintended consequences.

  • db||

    People are people
    So why should.it.be
    Government should complicate the ICD?

  • Policywonk||

    Do we really need to know, from a public health standpoint, whether someone was injured by being bitten by a parrot or pecked by a turkey?

    Or, in the sporting category, that burns were caused by your water skis being on fire? Or that you were stabbed by crocheting?

    These are all real ICD-10 codes.

  • ||

    As soon as I heard they weren't letting anyone see or practice with the new stuff before it was rolled out, my clusterfuck alarms started screaming.

  • db||

    It's a jobs program. Now single moms will be able to out-earn doctors by making $38992 per month from home doing.medical.coding.

    Seriously, I talked to.a woman a couple of.weeks.ago.who.is going to school for "medical coding." She, no shit, told.me that she needs to know as.much about anatomy and medical procedures as a doctor so she.can app4opriately code them.

  • UnCivilServant||

    Just the names, not how to perform said procedures, or identify which organ is protruding from that nasty sword wound.

  • db||

    "Your arm's off!"

  • Swiss Servator, alles klar?||

    'tis but a scratch!

  • db||

    I'd love to.see a medical coding transcription of that scene.

  • Rasilio||

    So you have the text? I could generate it for you

  • Brett L||

    This should obviously be one of your test scripts. This and the script to Airplane

  • robc||

    Its too long for reason. Sigh.

  • Invisible Finger||

    Is this a new, more sophisticated spambot? The lack of a link made me wonder...

  • Cdr Lytton||

    It's just db. he has a combined space/period key on his smartphone.

  • db||

    I thought I had it fixed when I found and disabled the option to convert a double space to a period (I thought maybe the keyboard was.too.sensitive), but it doesnct seemed to.have fixed it.

    As to the.other.typos, for.some reason on this phone, the autosuggest/autocorrect doesn't workwhen typing in the HyR comment entry field. Also, it has a really annoying tendency to, when a space is the last charqcter on a line in the.box, remove.the.space.

  • Cdr Lytton||

    I'm afraid you're going to have to live with being the John of punctuation.

  • Rasilio||

    The John of punctuation? Does that mean he pays women for periods and exclamation marks?

  • Loki||

    Does that mean he pays women for periods

    Who the fuck would want to pay for that? Ewww!

  • Rasilio||

    Who the fuck would want to pay for that?

    Warty? Epi? Sugarfree?

  • ||

    At least you can comment with your phone. Mine just jumps me to the top of the page when I click (touch, whatever) the comment box.

  • db||

    Mine (old phone) used to do that. There were.times.I.nearly shattered the 5hing.

  • ||

    Mine too. I thought it was just the keyboard at first, or the browser, but I've tried multiple keyboards and multiple browser and haven't had any improvement.

    I'm on a Galaxy S3 with Chrome browser and SwiftKey as my default.

  • db||

    Try making.sure you are looking at the desktop version. As I recall, the mobile site.is.shite.for this.

  • ||

    Interesting, I'll toy around with it when I get home. The site takes forever to load on my phone, even over wifi, so I tend to just avoid commenting when I'm mobile, but it would be nice to be able to jump in occasionally.

  • Lord Humungus||

    it's like talking to the borg.

  • db||

    I've always thought of.myself.as.more of a.Vogon poet.

  • robc||

    Mine does the same.

  • Rasilio||

    Not necessarily, the job is already being automated. I work on a system that among other things will allow you to feed in a medical record, it will parse the text and return a list of applicable billing codes, either ICD9, ICD10, or both

  • The Other Kevin||

    I'm sure implementation of this will go just as smoothly as the web site, individual and employer mandates, and minimum policy requirements.

  • R C Dean||

    To weather this transition, CMS suggests that small and medium-size practices should have access to "reserve funds or lines of credit to offset cash flow challenges."

    Word around the industry is that if you don't have 4 - 6 months operating capital in the bank, you may not survive the transition.

    If this doesn't go really, really well, I think you'll see a fair number of hospitals chew up their cash reserves to a point that forces them to default on their bond covenants or causes their debt rating to downgrade. Either is Very Bad News for a hospital.

    And for what? This certainly won't improve patient care in the slightest. It won't even lead to a better billing and payment system.

    The entire reason for this change is to produce more granular databases for researchers and public health types to massage and crunch. Thats it.

  • Brett L||

    The entire reason for this change is to produce more granular databases for researchers and public health types to massage and crunch. Thats it.

    And our experience is that even ICD-9 didn't work to improve that. Machine sorting by code is as useless now as it was 30 years ago. Making MORE CODES doesn't fix the problem.

  • db||

    I have an idea. There are, what, 150,000 codes? Well, if 150,000 is better than 70,000, why isn't 300,000 better than 150,000?

    Now.stay with me.here, because we have a thing called English, with at least 171,476 codes (Oxford English Dictionary). Better yet, these codes can be strung together into.sentences of arbitrary length, allowing any particular condition.or.proccedure to be uniquely described.

    Now, all we need to do is to create a program that can parse these sentences, and voila! Problem solved. ICD11 to the rescue!

  • Cloudbuster||

    What a nightmare. Here's a random sample:

    2014 ICD-10-CM Code S31.805
    Open bite of unspecified buttock
    Bite of buttock NOS · superficial bite of buttock (S30.870) · Bite (s) (animal) (human) buttock S31.805...

    2014 ICD-10-CM Code S31.815
    Open bite of right buttock
    Bite of right buttock NOS · superficial bite of buttock (S30.870) · Bite (s) (animal) (human) buttock S31.805 right S31.815...

    2014 ICD-10-CM Code S31.825
    Open bite of left buttock
    Bite of left buttock NOS · superficial bite of buttock (S30.870) · Bite (s) (animal) (human) buttock S31.805 left S31.825...

    S31.825 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below S31.825 that describe this diagnosis in greater detail.

    ICD-10 will bite you in the *ss. But you'll have to tell the unsurance company which side of the *ss you got bit on, and whether this is the first time it bit you in the *ss, a followup treatment for getting bit in the *ss or a "sequela" visit (because this pain in the *ss just won't go away).

  • db||

    This reminds me of entering maintenance notifications.into SAP at the.plantbwhere I.used.to work. The functional location structure was.so finely divided, maintenance could reject a.notification if you didn't practically sp3cify thr bolt you.wanted.them to.undo. in.practice, they did the.work, but.often it.made.it.impossible to trqck.reliability problems to tye equipment level because notifications.were.entered.at a much.higher.level.

    For instance, a functional location for a scrubber pump motor bearing thermocouple could look.like this:

    PLANT-UNIT-FGD-SCB-PMP-MOT-BRG-TE01

    but often people would write everything up to
    PLANT-UNIT-FGD-SCB-PMP
    And so it would look like the pump was a real problem when in.actuality you had a chronic problem with motor.bearing.failures due to poor lubrication.

  • NeoToren||

    If you want to check ICD-10 out for real or just for fun, you can do that at

    http://icd10doc.com

    My favorite code is the common "V97.01 Burn due to water ski on fire"
    I couldn't find one for "Major depression due to ICD-10 implementation" though

  • NeoToren||

    Interesting article on the ICD-10 coming this fall.
    Anticipating the angst, we've recently released an app that may help alleviate the pains.
    You can try it at http://icd10doc.com

    Let us know your feedback

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