The Next Government-Based Healthcare Debacle: Coding for Orca Bites?

Due to the ineptness of the Obamacare team and the debacle that has ensued, the botched rollout of the Affordable Care Act has dominated the political and medical headlines since October.  However, other healthcare changes are on the horizon (and have gone virtually unnoticed by the public) that have the potential to further disrupt our ability to treat patients.  In fact, the technical and time consuming aspects of these new government mandated changes for 2014 may result in even larger scale computer glitches than those seen with the infamous Obamacare website.  (if you can believe that).  This week in the New York Times, author Andrew Pollack describes a new government medical coding system that must be implemented in 2014.

For decades the Center for Medicare and Medicaid Services (CMS) has established billing codes for documentation and reimbursement purposes.  These codes are created by the World Health Organization (WHO) for the purposes of standardizing diagnoses in order to track diseases throughout the world–it allows for comparative study.  However, several governments (such as the US, France, Germany, Canada, and others) have long adopted these codes as a way to standardize billing for medical procedures.  These codes have long fallen short of specifically describing what is actually going on with the patient and have led to difficulties in accurately charging for medical services and procedures.  In brilliant fashion, there is now a new iteration of the coding system known as ICD-10 that will be mandated by the US government effective this fall.   Luckily, there are now codes for injuries that occur while skiing on waterskis that are on fire as well as codes for orca bites.  As you may imagine, these codes will certainly streamline my ability to treat my patients with these very very common ailments.

So why is it that our government and its agencies think that there administrators are well qualified to develop codes for medical diagnoses?  How is it that bizarre codes for humorous and extremely unlikely scenarios are being included and programmed into the system?  

If you ask CMS administrators, they will tell you that these new codes were adopted by the US government after careful consultation with coding experts, CMS administrators and physician advisors.  However, I am not exactly sure which physicians were involved in signing off on codes for “balloon accidents”, “spacecraft crash injuries” and “injuries associated with a prolonged stay in a weightless environment”.  The issue at hand is the fact that government is once again working to regulate situations and concepts that they do not understand.  Moreover, they mandate changes without adequate input from experts in the field in which they plan to regulate (such as physicians…)

What are the ramifications of ICD-10 and how might it affect healthcare delivery?

Certainly, if the healthcare.gov website is any indication, I would expect that the technology side of implementation of the new coding system is likely to be plagued with errors and inefficiencies.  Imagine developing software that will assist in billing and coding of numerous diagnoses for each patient–including “struck by a macaw” and “bitten by a sea lion” (yes, these actually exist).  ICD-10 will increase the number of available codes from 17K to more than 155K.  From a physician/provider standpoint, the coding process will likely bring efficiency and productivity to a slow crawl as the new codes are phased in.  In a survey conducted earlier last year, 90% of physicians expressed significant concern over the transition and nearly 75% anticipate a negative impact on their practice (both operationally and financially).  Practices and hospital systems will now require new employees (at a cost that ultimately will be passed on to the consumer) that are trained and expert in applying the new codes in order to keep up with government mandates.  Over the last year, physicians have been subjected to online courses and training in the new ICD-10 coding system–many leaving the classes more confused than when they began.

Ultimately, physicians will have to change the way in which they document office visits and procedures in order to ensure reimbursement.  Altogether, these changes are likely to make an overloaded system even more cumbersome.  As we have seen with Obamacare and other government related policy changes, more work is created, more inefficiencies are exposed—in the end, the patient will suffer.  Providers will become overwhelmed by even more government related paperwork and documentation requirements.  More time spent on coding Orca bites means less time in the exam room chatting with a patient.  My how medicine has changed….

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6 responses to “The Next Government-Based Healthcare Debacle: Coding for Orca Bites?

  1. I have a so called rare dx….Trust me its a nightmare finally requiring a trip to Mayo that was ignored…GRRRRRRR…..Thank god for my Primary doc who stays on the specialist butts or I would get flush out with the trash. I pray he still has time to keep up to see that I get the care medicare pays for and I deserve.

  2. Thank you. An excellent explanation of why we should move from our current system to a single payor system that moves away from fee for service. Clearly the problem is not how to match codes with reimbursement, no matter how howmany (or how few) codes we use. What is embarrassing is that establishment medicine had not been able to come up with a reasonable alternative to the current dysfunctional system or to “Obamacare.” Deal with it. As a retired physician, I just do not understand why “no” is an answer. Get real.

    • Dear Sir,
      Thanks so much for reading and responding to my blog post. However, with all due respect, I completely disagree with everything that you have written. Nothing about my post argues for a single payor–in fact, the information I provide demonstrates the complete ineptness of government to control and regulate healthcare. I refuse to simply “deal with it” because my patients deserve better from their government and their healthcare. Obamacare is more about one President’s planned legacy that the people he claims to want to help. As physicians we must first do no harm–allowing the government take over of healthcare will absolutely harm our patients and hamper our ability to provide the high quality competent care they all deserve.
      Best
      Kevin

  3. Kevin: I think the consultants were Bert and Ernie. Nothing about ICD-10 instills confidence that our patients will benefit from this move. All ICD-10 proves is that bureaucrats are lousy at anything that requires special knowledge or training.

  4. These new codes are absolute BS. No one, especially physicians, can be expected to waste time on them (Orca bites!!!). This is what is driving physicians to retire or go to concierge practices. Can we get real around here? No medical admin (shorthand for pink collar workers) would ever be able to work with these, and physicians don’t have the time. Having working in the heathcare standards community, I can tell you that this is a waste of time and money. Do they really go through the entire animal kingdom for bite types? What’s next? “Hit head on a) igneous rock, b) metamorphic rock, or c) sedimentary rock”?

    Dear God.

  5. Kristin Tremmel RN CNOR

    I have to agree that this coding is BS. As an OR nurse I have seen surgeons having to flip through the code book that we kept in every room (this was a few years ago prior to EMR) to determine the code for whatever procedure they had done, when they could be on to the next patient already. When my cat bites me, I don’t wonder if the cat was long haired or short-haired. It is still a cat bite, right? I’m still going to go wash it, put some antibiotic ointment on it and a Band-Aid.

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