There is a change coming to medical coding, and like it or not, it is going to have a major impact on the workers’ compensation industry. In 1979 the United States adopted the International Classification of Diseases version 9, commonly referred to today as ICD-9. It is a listing of 14,000 medical codes that are today the backbone of the medical billing industry in the nation.

It almost seems quaint in comparison to what is coming.

On October 1, 2014 the country will embrace an entirely new coding system, the ICD-10, which hosts an impressive 68,000 medical codes. The index alone of the phone book sized manual is 421 pages.

And you thought your hospital bill was impossible to understand now.

It seems that in the last 30 years or so we have developed a plethora of new ways to get sick and die. Technology has certainly aided in this effort, and the paltry ICD-9’s just no longer can bear the weight of it all. For the last 10 or 15 years, experts have been cramming new procedure codes into the cracks and crevasses of the ICD-9 in order to insure they could take our money as needed – all while properly categorizing why that money transfer occurred. Now, with the ICD-10, the almost 200,000 medical coders that toil in medical facilities across the country will be able code to their hearts content – once they actually learn all the nuances and changes involved, that is.

And for those of us slogging through the complex world of workers’ comp, the fun will just be beginning. Someone will have to pay those bills, and make sure that everything is copacetic. Sounds like a pending boost for the bill review industry, just as soon as they are finished pulling their hair out and are taken off suicide watch.

And all of those injured workers self-managing their own MSA’s should have a whale of a time making sure their medical bills do not run them afoul of Medicare later in life.

How specific are the ICD-10 codes? Very, it would seem.

Have you been struck by a turkey? There is a code for that. Bitten by a squirrel? We’ve got you covered. Getting hit by a car while riding an animal, or spending too much time in your walk in freezer? Those are listed too. Of course, there is also code Z56.6. It's for “other physical and mental strain related to work.”

That one will be used a lot in the treatment of medical coders, I presume.

Some other very specific conditions are listed that have not yet been discovered by the media at large. Only my extreme diligence and research have brought the following to light:

  • Orthoacademitis – This code is for when back surgery is necessary because your orthopedic surgeon has two kids in college
  • CA Orthocausewewanna – Similar to above, only the surgery is deemed necessary because someone has to fund the bribes. Commonly used in California, but not exclusive to the state
  • CranialRectal Inversion – A common code to be used when treating someone who has their head up their ass
  • Oral Poditis – A condition often associated with CranialRectal Inversion, demonstrated by a patient who continually puts their foot in their mouth
  • Mani-mani-pedi-petty-itis – The condition causing an impeccably groomed man to act like a child
  • Blogophelia – Used when treating a blogger with Oral Poditis and/or CranialRectal Inversion
  • Blogofeelya – Used when treating a blogger who is a pervert
  • Padudamentia – Used when treating a patient who is irrationally exuberant about healthcare

Proponents of the new codes say that they will make it much easier for researchers and public health officials to track trends and epidemics, as well as help insurers root out fraud. Lynne Thomas Gordon, chief executive of the American Health Information Management Association says “How many times are people going to be bitten by an orca? Probably not very many. But what if you're a researcher trying to find that? You can just press a button and find that information.”

Help support children with hearing impairmentsI bet the carriers who have been routinely paying for fraudulent Orca bites now just feel silly. And while that is probably not a huge issue in Utah, residents there attacked by Wildebeests can probably rest a bit easier.

Other advantages cited are the ICD-10's provisions for recognition of left and right side of the body. While admittedly some surgeons cannot make that determination competently, it is comforting to know the billing will be more accurate. I am not sure there is a code for “Accidently amputated the left leg when we meant to do the right”. It is also unclear if there is a code for “Lefty loosey, righty tighty”, but if any standard can incorporate it, the 10's are the ones to do it.

It turns out the US is a laggard in adopting these standards. The ICD-10 was first published in 1992, and most developed nations have adopted them. Like that makes a difference. Next thing you know they'll be waving that new fangled metric system around like it's the greatest thing since, well, the new fangled metric system.

Medical providers are bracing for the cost of this change. The American Medical Association performed one study that estimated doctors' offices could incur between $56,000 and $8 million to transition to ICD-10. That is a pretty big spread. I don't know about you, but I want the name of the guy who will pay $8 million. I'd be happy to take care of this for them.

The AMA opposes the implementation, and is still trying to get the government to change its mind. They believe the new standards will unnecessarily burden medical providers and hurt care overall, saying in a letter to Health and Human Services Secretary Kathleen Sebelius, “Adopting ICD-10, while it may provide benefits to others in the health-care system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implementing delivery reforms and health information technology”.

There is no word whether Sebelius responded, or even saw the letter, as it has since been discovered that her desktop computer was being used to host, and it has been routinely crashing since October 1st of last year.

One thing is certain. Change is on the horizon, and we should pay attention lest we be caught flat footed. On the bright side, if we are, there is a code for that. Two codes, actually. A flat left foot is M21.42, while a flat right foot is M21.41.

I C D future, and these guys thought of everything.


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