What’s In A Code?
Monday, November 17th, 2008Shakespeare’s Romeo once stated “What’s in a name?” Well, doctors, hospitals and insurers are asking the same question in their line of work…“What’s in a Code?”
A whole lot, according to the Wall Street Journal. Currently, doctors and hospitals use the ICD-9CM billing codes, however, the new ICD-10 billing codes which are coming in October 2011 call for more details about the patients, their conditions and their treatments. (See “Look Out, Docs: Here Comes ICD-10)
For example currently, there are 5 codes for a sprained ankle; with the ICD-10 codes there will be 45 different codes, with very specific details attached to each one. The new system will have 155,000 codes including 68,000 codes describing diagnoses, up from 13,000 currently, and 87,000 codes for different medical procedures, compared with 3,000 today. Hospitals use both types of codes, but physicians use only the diagnostic codes.
“That’s very complicated to a provider,” an official at the Medical Group Management Association tells the WSJ. A rushed doc might just check “unspecified” to describe the injury.”
Apparently, the providers of our healthcare system could be in for a shock.
For doctors and insurers the battle lines are drawn. The Centers for Medicare and Medicaid Services are pushing for this new system, because they claim it can boost claims insurers return to doctors for coding errors by 10%. However, it could become a costly headache for patients and doctors − to the tune of $1.64 billion over the course of fifteen years.
So what is better, having more specific information on each patient or having a frustrated doctor, who just puts in an unspecified code so he can get paid? So I start where I began, “What’s in a Code?” A lot of money and a lot of reasons for doctors and insurers to keep on fighting.