ICD-10: The Code Overkill Has Gone Live

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Published: Sunday, October 18th, 2015 @ 11:51 am
By: John Locke Foundation ( More Entries )

Publisher's note: The author of this post is Katherine Restrepo, who is the Health and Human Services Policy Analyst for the John Locke Foundation.

The medical code overkill is now here. After a four-year delay, the US health care system has crossed over to an updated medical diagnosis coding system endorsed by the World Health Organization (WHO), formally known as the tenth edition of the International Classification of Diseases, or ICD-10.

The ICD is the most widely used index of medical diseases and injuries, dating back to the late 1890's. For over 30 years, public and private third-party payers in the US have used the ICD-9 — the 9th edition — to calculate reimbursements to medical providers.

Under the new version, doctors can now classify ailments using an extensive list of more than 70,000 codes — up from 14,000 under ICD-9. Seems a bit excessive.

The rationale behind the exponential increase is that more codes are intended to help clinical researchers better track disease patterns and health outcomes. Moreover, providers can now submit more accurate claims based on more specific diagnoses and be paid accordingly. For example, instead of a provider adding a modifier as to which patient's digit or appendage has suffered an injury, there are now specific codes that include laterality.

And now that a physician can get very specific, coding can get weird. Real weird. For anyone who happens to have the latest ICD book lying around, check out chapter 20. In those 70 pages, you'll come across a plethora of trauma codes that make one wonder how often some of these accidents occur. Stephen Hayes of the Weekly Standard decided to investigate:

Some codes appear to be anticipatory rather than descriptive. Has anyone in the history of mankind ever attacked another human with frog venom? Or sought contact with the same for the purposes of intentional self-harm? Probably not — and not just because frogs don't produce venom.

But code T63813A is "toxic effect of contact with venomous frog, assault, initial encounter." I asked Dr. Kyle Summers, one of the world's leading experts on poisonous frogs, about this. He told me that frogs do not produce "venom," and therefore, while some are poisonous, none are "venomous." Summers further explained that while members of the Embera tribe of western Colombia have used batrachotoxin from the skin of frogs in the genus Phyllobates on the tips of blow-darts to kill monkeys, he did not know of any incidents in which the darts have been used on human enemies and had "not heard of anyone intentionally hurting themselves by contact with a poison frog. But," he added, "I have not researched the issue." Other codes describe occurrences that would seem unlikely to result in any kind of injury at all, such as code W20XXA, "contact with non-venomous frogs."

Pushing aside this hilarity, the monumental switch has cost a lot of time and money for health care providers. According to CMS and other medical IT sources, providers were warned to set aside 6-12 months of reserves in the event of a catastrophic rollout resulting in lengthy payment delays. The Weekly Standard further explains:

A 2008 study on the costs of implementing ICD-10 from the health care IT firm Nachimson Advisors warned that "significant changes in reimbursement patterns will disrupt provider cash flow for a considerable period of time." The study projected that the total cost of the ICD-10 implementation would be $83,290 for a small practice (3 physicians and 2 administrative staffers), $285,195 for a medium practice (10 providers, 1 professional coder, and 6 administrative staffers), and $2.7 million for a large practice (100 providers, 10 full-time coding staffers, and 54 medical records staffers).

While ICD-10 pushes for more accurate medical documentation, research, and billing, an exorbitant number of codes also means more room for error. And more errors means more delayed reimbursement for providers, as claims may not be initially processed as "clean." There seems to have been a smoother transition than expected since ICD-10 went live on October 1, but don't be surprised by news in the next week or so about providers and health systems hurting due to reimbursement denials, coding mishaps, and government overreach.

But don't worry. There's probably a code for that, too.

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