Chances are, unless you’ve been forced to pay attention by an insurance snafu or malpractice claim, you probably have not studied the five to seven digit numbers that permeate each and every record of a medical encounter.
But by this time next year, the United States health-care industry will be hustling to complete a US$1.6 billion upgrade of diagnostic codes known as ICD-10, which will bump the number of codes used to classify illness and injury from 18,000 to more than 141,000.
Such a boost to the hypochondriacal bucket list is likely to prove somewhat disruptive to medical care, although a large cadre of consultants, trainers and code-talkers has cropped up to ease the transition.
Diagnostic and billing codes drive the operations of every hospital and medical practice, from the reception desk through clinics and labs and into the back offices.
Virtually every form, software package and administrative procedure inside doctors’ offices and hospitals in the U.S. will have to be revised, a task some call the medical equivalent of another Y2K.
Much of the expansion is aimed at greater specificity.
For instance, the current system, ICD-9, has just one code for a broken arm.
The new setup spells out whether it’s the right or left arm, what part of the arm broke, whether it was an open or closed fracture — all intended to reduce confusion and make care safer, plus expedite billing and insurance claims.
The codes, based on an international system developed through the World Health Organization, are also used by public health agencies including the Centers for Disease Control and Prevention to track incidence of diseases and conditions and causes of injury or death.
However, some details in the coding have drawn doctors’ scorn.
The American Medical Association’s House of Delegates went on record against implementing the changes last November, with members citing the costs and loss of efficiency to their practices, and casting doubt on the value of much of the information being collected.
Among the “too much information” examples cited by critics:
l W22.02XA “walked into lamppost, initial encounter” and W22.02XD for a follow-up visit from the same injury;
l More than 300 codes for injuries related to animals, including 14 for horses and 13 codes each for wounds resulting from a duck, a macaw, a parrot, a turkey, goose or chicken;
l Nine codes to describe infant injuries occurring in baby strollers, such as a fall or collision;
l A futuristic seven primary codes to track initial injuries sustained by occupants of spacecraft; plus a few more for medical problems resulting from “prolonged stay in a weightless environment”;
It’s easy to imagine consumer watchdogs waiting anxiously for a V91.07XA — a “burn due to jet ski on fire.”
Despite such exotic classifications, the reality is that better information is meant to produce more accountability (right now there’s just one code for a failed implanted medical device), less opportunity for health providers to game the system using vague codes and greater understanding of what works and doesn’t work in patient care.
And if things don’t work out quite right, there’s ample opportunity for a do-over.
WHO officials say ICD-11 will roll out soon, with the first nations adopting that upgrade starting in 2015.
Lee Bowman is a health and science wroter for Scripps Howard News Service. Contact Bowman at Bowmanl@shns.com