Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

I’m not worried about ICD-10. Here’s why.

P. J. Parmar, MD
Physician
August 1, 2014
110 Shares
Share
Tweet
Share

It is possible to categorize every human ailment, and assign every disease a code. This is called the International Classification of Diseases (ICD), which was first formalized as a short list of malaises at a meeting in Paris in 1900. Since then, this list has been revised ten times, getting longer each time, in an effort to aid epidemiological and policy matters around the world. The ninth edition (ICD-9) has been around since 1975 as a bible-thick book with about 13,000 codes. For example, 786.5 means chest pain. On the other end, some codes are as specific as E845.0: “accident involving spacecraft; occupant of spacecraft injured.”

The tenth edition, ICD-10, was supposed to be implemented throughout U.S. health care this year, but was recently postponed by an act of Congress until at least 2015. This 10th edition has 68,000 codes, with increased specificity over the ninth edition. For example: w5609XA: “other contact with dolphin, initial encounter,” or V95.45XD: “spacecraft explosion injuring occupant, subsequent encounter.”

Every doctor uses these codes every day. We have to write a code that corresponds to the problem, in order to get paid. (Doctors that don’t bill insurance companies, only take cash or work for free, don’t have to worry about all this.)

In training, I used to look up the most specific ICD-9 after every visit. It took me a couple minutes of flipping through a book or going to Codapedia. Now I have to pick a code up to 50 times a day, for every patient visit, lab order, home nurse authorization, request for incontinence diapers, x-ray order, and everything else imaginable.

Looking them up would waste an hour each day, and I’m not going to memorize 13,000 codes. So instead I have 20 memorized, and I pick from the same 20 for every patient. That’s right, most of family medicine, which includes many varied ailments, reduced to 20 codes. Does your wrist hurt? Forget 726.4 “enthesopathy of wrist,” I use 729.5 “pain in limb.” Do you have knee pain from arthritis? 729.5. Your big toe hurt because of gout? 729.5. Elbow pain because you were bit by a dolphin? 729.5.

Of course there are different codes for every type of big toe ailment, and insurance companies tell doctors to be specific with our coding. For example, 250.00 is “type 2 diabetes without mention of complication,” while 250.63 is “type 2 diabetes with neurological manifestations, uncontrolled,” and there are codes for every permutation in between. Although the suggestion is to be specific, I have absolutely no incentive to do so. So I use 250.00 every time I have a diabetic.

By no incentive, I mean: No insurance company argues with my 20 codes. They don’t allow 401 “hypertension” because it does not have enough significant digits, but I don’t waste time deciding between 401.0 “malignant hypertension” and 401.1 “benign hypertension,” I just use 401.9 “hypertension unspecified” every time. And my claims don’t get rejected from Medicare, Medicaid, Blue Cross, or ten other insurance companies I routinely bill.

In fact, I have a huge incentive to not use other codes. My 20 codes are tried and tested, I know they will get paid. But if I try a code that I usually don’t use, I sometimes do get rejected. As mentioned, if I use 401 instead of 401.9, I get rejected. Then I have to submit a new code in a time wasting, trial and error game of getting paid. That is to say, there is a big incentive for me to not be specific with my coding.

I have never had someone call me up and say “we notice your patients have a lot of pain in their limbs, could you please be more specific next time.”

This might make me sound like I am not playing by the rules. Like some epidemiologist somewhere will not be able to make a pie chart of big toe ailments, and advances in big toe medicine will suffer because of me. But guess what: Every other doctor does this also! Well many of them anyway.

Almost every outpatient family doctor has a “superbill,” a paper that, among other things, has a short list of 50 codes. Here is an example from a family medicine organization. Scroll down to page 2, and notice the phrase NOS, which stands for “forget your 13,000, I’m picking from my fave five.”

Of course when I really don’t know an appropriate code, I look one up. This happens a couple times a week for me, and probably the same for other doctors.

Paper superbills have been replaced by electronic systems that make it easier to pick more complex ICD-9 codes, but really, most family docs still default to a few memorized codes.

There is a lot of talk about the transition to ICD-10: A Y2k style fear of retooling electronic systems and workflows for the major change in coding methodology. Doctors are putting a lot of effort into opposing it; you can’t read about medical policy these days without seeing worries about ICD-10.

I am not worrying. I suspect I will have to memorize a different set of 20 codes. When I see a patient who got injured in a spacecraft explosion, you better believe I am going to use M79.609, “pain in unspecified limb”, unless my bills stop getting paid. And if they do, I will learn incrementally more codes to barely get by, but you will never find me looking up one of 68,000 codes, 50 times a day.

I’m pretty sure that most providers out there are going to do the same. Doctors who specialize in rotator cuff surgery will have their most common 20 rotator cuff codes memorized, and will look up other codes occasionally as needed. And the epidemiologists and policymakers who count these things will be left with similar quality data to what they have now: nonspecific in and nonspecific out.

Categorizing diseases to advance medicine is an important endeavor, but I am not going to add an hour to my already packed day of seeing patients. This is why I don’t care about ICD-10.

P.J. Parmar is a family doctor at Ardas Family Medicine and blogs at P.J.! Parmar.

Prev

Measuring the value of emergency department care

August 1, 2014 Kevin 1
…
Next

Law and medicine are more intertwined than they should be

August 1, 2014 Kevin 4
…

Tagged as: Primary Care

Post navigation

< Previous Post
Measuring the value of emergency department care
Next Post >
Law and medicine are more intertwined than they should be

More by P. J. Parmar, MD

  • This doctor doesn’t mind if your cell phone rings

    P. J. Parmar, MD
  • I started a family medicine practice for $11,000. You can, too.

    P. J. Parmar, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Stop the arranged marriages between patient and provider

    P. J. Parmar, MD

More in Physician

  • Challenging the diagnosis: dehydration or bias?

    Sydney Lou Bonnick, MD
  • Practicing medicine with conviction

    Arthur Lazarus, MD, MBA
  • The power of memory in shaping human identity

    Emily F. Peters and Sandeep Jauhar, MD, PhD
  • Physicians have no autonomy. Here’s how to change that.

    Diane W. Shannon, MD, MPH
  • The erosion of patient care

    Laura de la Torre, MD
  • Navigating adulthood in the digital age

    Eleanor Menzin, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Lab Tests That Escape FDA Oversight May Come Under Agency Review
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Low Tidal Volume Compliance Still Lacking in Mechanical Ventilation
  • IV Immunoglobulin May Cut Infection Risk of Anti-BCMA Agents for Myeloma
  • When's the Best Time to Get the Updated COVID Shot?

Meeting Coverage

  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Plant-Based Estrogen Improves Lipids in Postmenopausal Women
  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

I’m not worried about ICD-10. Here’s why.
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...