ICD-10 is not a character in an upcoming fall TV show, but instead something far less glamorous. ICD stands for International Classification of Diseases and is a list of codes used by doctors and hospitals when billing insurance companies.
It’s been around since 1946, with the 10th iteration going into effect on October 1st. And it may be an unpleasant October surprise for doctors and hospitals. Don’t blame Obamacare. Don’t blame Bush. Instead blame an overreaching government bureaucracy.
The current version, ICD-9 uses a 4- or 5-digit code for particular diseases or injuries — for example, 540.9 for appendicitis. ICD-10 ups the ante with a 7-digit code, and a total of 68,000 codes to choose from, compared to only 13,000 codes in ICD-9.
In the era of big data, more specificity is good, right? Sure. But at some point it becomes counter productive. Imagine having a 20-digit social security number, indicating not only who you are, but also your height, weight, hair and eye color, smartphone preference, and favorite TV show?
This is what ICD-10 provides within its 68,000 codes. Codes exist for being hurt at the opera (Y92253), walking into a lamppost (Y92253), walking into a second lamppost (W2202XD), getting sucked into a jet engine (V97.33XD), being burned due to water skis on fire (V91.07XD), and being bitten by a pig (W55.41XA).
What could go wrong here? Plenty.
Will all 68,000 codes be available in the electronic medical record system of every physician and hospital? Or in the billing systems of every insurance company? This all requires upgrades to complex computer databases. Remember all the problems with the official Obamacare website, Healthcare.gov? Will this transition be any better?
How much mental effort will physicians devote to picking the correct code for each patient? Pick the wrong code and don’t get paid. Will your doctor be thinking about how to repair your pig bite or your broken nose from walking into a lamp post? Or will your busy doc, already an hour behind in the office, spend their extra few minutes in the exam room trying to figure out which ICD-10 code to use?
A recent survey of medical practices revealed a shaky optimism toward the ICD-10 transition. Only 43 percent feel they are currently on track with their preparation. Don’t forget the cost of this transition. The American Medical Association reports, “The mandated implementation of the ICD-10 code set will be dramatically more expensive for most physician practices than previously estimated.” What a surprise, a government program costing more than anticipated.
For individual practices, the costs range from $83,000 to $285,000 for practices of 3 to 10 physicians. Yet physician pay will only rise 0.5 percent per year, far less than the rate of inflation. The numbers don’t add up.
Physicians can respond by selling their practices to hospitals, opting out of insurance altogether, making patients wait longer for appointments, having nurses or physician assistants replacing physicians, or retirement. Obamacare is already pressuring physicians to close their practices. This latest ICD-10 mandate may accelerate the process.
Government regulations and mandates have a cost: $1.88 trillion in 2014. We all pay these costs, either directly through higher prices for goods and services or indirectly through longer waits and reduced access to high-quality medical care. The ICD-10 transition is another push in this direction.
Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor. This article originally appeared in Independent Journal.
