On the heels of the Obamacare rollout comes ICD-10

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 health care 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.

Recently, the New York Times described 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 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 advisers.  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 health care 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.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • whoknows

    Can’t agree more. There are 30 admins for every physician and it is only getting worse. Medicine has turned into a big business with huge databases to be filled and lots of money to be made. Meanwhile pts suffer not being able to get to contact in follow up the doc they just saw. obviously they are too busy with not just seeing pts but also more and more regulations. It comes through clearly that pts like myself get lost and can’t get the follow through required.

    I, personally have been unable to get a standard of care for a bread and butter sort of problem. No one at this academic center is responsible and it is a nightmare. I have to fly back to east to physicians i know to get care quickly at this point.
    They certainly have gotten well paid for the consult and imaging done urgently, but no follow up at all. I am literally lost in the system. When I complain, all I get are tons of admins that do not understand the clinical significance. this place is frightening.

  • southerndoc1


    No other country in the world uses ICD-10 for billing: it’s strictly for epidemiology and mortality reporting.

    Many countries have ICD-10 systems that only require 3 digits. Australia has a total of 16,000 ICD-10 codes, Canada and Germany less than 20,000. Compare that to our 155,000.

    Another disgraceful example of the medical societies choosing to bend over and grab their ankles, rather than represent the interests of physicians and patients.

  • Bob

    ICD stands for International Code of Death, which measures a lot of things about quality but has no relationship to costs except in the US of A!
    Using it for pricing was the easy way to “do both” for commercial insurance after WWII, which slid over to commercial insurance and Medicare in 1965 and eventually to Medicaid in the 1980′s.
    So we are told our costs are too high [because we pay twice as much as other countries] and our results are too low, because we use ICD’s for coding prices, which will change to ICD-10 that the rest of the World has been using since 1991, and a couple of year from now we will change to ICD-11 that they are using now that relates to our “Quality of Care” and as long as we are measuring against a different standard the true quality of care will never be well measured.

  • Ava Marie Wensko George

    Dr. Campbell, actually you are incorrect about connecting ICD-10 (or any other ICD version) to billing in France, Germany, Canada, and other countries. All other countries use the ICD system to report morbidity, mortality, and to track epidemics. The United States is the only country that uses the ICD system to bill.

    Another issue I have with your view of ICD-10 and Obamacare is that all parties should have been ready for ICD-10 well ahead of the Obamacare roll out except that the AMA pressed for a delay. The fault is with the AMA, not with the government on this one.

  • jflink

    I fundamentally disagree. This amounts to whining. The classification of diseases that we see is a fundamental responsibility of physicians. It is not intended for billing and may in fact be misused and unsuited for billing. However, for a (nonsense)system that insists on charging for every gauze pad or reflex tested, it should not be surprising that the payer (insurance more than government) might ask why an EKG is done for a hangnail.

    ICD 10 (International Classification of Diseases) is nearly 15 years old. ICD 9 has been patched annually by CMS but is still completely out of date. At least a part of the frustration with trying to use ICD 9 is the illogical codes provided and the absence of meaningful codes -trying to fit a square peg in a round hole. As an electrophysiologist, Dr Cambell should be among the most able at recognizing the anachronism of ICD 9 and be asking for a better system.

    Understanding what we do to and for our patients should be a goal. Understanding cholecystectomy should not be a mater of billing codes for procedures. You owe it to your self as much as to your patients to know what your success and failures are – and not just by remembering the last case which is the only alternative.
    Finally, I suspect that Dr Cambell’s frustrations are more a consequence of a meaningless EMR than the need to list dx.

  • Gregory Phillips

    ICD-10 is a coding system designed by professionals at the WHO with the patient in mind.

    ICD-10-CM is a coding system designed by government bureaucrats with the help of the Medical-Industrial complex to sell software, create a burden on the treating physicians by increased documentation and to provide metrics so the value based purchasing initiative can be implemented (read pay cut for physicians). There are actually less codes in ICD-10 than ICD-9-CM.

    ICD-10 does not equal ICD-10-CM. Those that equate the two as equal are either terribly uninformed and naive or standard-bearer’s for the bureaucrats that are doing their best to obfuscate the truth.