Come October, slip on a banana peel and hope Doc codes it right

CMS website snip

Snip from website, Centers for Medicare and Medicaid Services/US Government

October 1 is the deadline for changes to medical coding, the transition from ICD-9 to ICD-10.

Your physician will have no choice in adapting, whether he’s a small business or part of a large conglomerate. The codes will multiply, from approximately 17,000 to more than 150,000.

How will this affect you, the patient?

If, like me, you see potential for serious errors if one digit in a long alpha-numeric string is wrong, consider yourself a visionary. One physician asked in a column about the change, “Is there a code for ‘Driven insane by ICD-10 codes?’”

After Republican senators expressed concern that the government wasn’t planning on doing testing on their end, the Centers for Medicare and Medicaid Services said in March, 2014, “it will offer limited end-to-end testing to ‘a small group of providers’ at some point in ‘summer 2014’ and promised that ‘details about the end-to-end testing process will be disseminated at a later date.’”

The Weekly Standard reported that testing snippet, after being turned down more than 2 dozen times by government officials who apparently aren’t eager to expound on the benefits of ICD-10.

Although the government isn’t testing extensively, bureaucrats are insisting physicians test carefully in order to be ready for the classifications spawned by the World Health Organization funded in part by U.S. tax dollars.

The coding system did need to be updated, by the way. As is the norm with anything related to government, however, the overhaul ended up being overkill.

It must be pointed out these changes are not a result of diktats in the PPACA/Obamacare.

The government bureaucracy rarely envisions consequences, but based on my experience covering healthcare matters over the years, I’d wager the switch will transfer resources from patient to bureaucracy—the complexities will have to be paid for.

The worst potential consequence may be coding errors that could theoretically cost someone his or her life, or, in a more positive scenario, great discomfort. There is also potential for expanding the fraud that currently bilks healthcare dollars, transferring them into the hands of criminals at an alarming rate.

The Weekly Standard column on ICD-10—it’s a must read—cites some of the silly codes contained in the massive index:

“So these exotic injuries, codeless for so many years, will henceforth be known, respectively, as T63622A (Toxic effect of contact with other jellyfish, intentional self-harm, initial encounter), V9542XA (Forced landing of spacecraft injuring occupant, initial encounter), V9733XA (Sucked into jet engine, initial encounter), and V80731A (Occupant of animal-drawn vehicle injured in collision with streetcar, initial encounter).”

Forbes pointed out the expansion of Medicare and Medicaid fraud:

“[S]camming Medicare and Medicaid is so lucrative that the Russian and Nigerian mobs have gotten involved.  And one of the New York crime families has moved to Florida because defrauding Medicare is both more lucrative and less dangerous than some of the traditional organized crime activities.”

The Weekly Standard article cited costs of the switch to ICD-10 projected by one study:

“The study projected that the total cost of the ICD-10 implementation would be $83,290 for a small practice (3 physicians and 2 administrative staffers), $285,195 for a medium practice (10 providers, 1 professional coder, and 6 administrative staffers), and $2.7 million for a large practice (100 providers, 10 full-time coding staffers, and 54 medical records staffers).”

Another negative for patients will likely be additional reductions in the time the physician or, as is increasingly common, the physician’s assistant will spend listening to you. So if you have an encounter with a banana, be sure to explain whether the banana just exploded or you slipped on the peel. There may be a code for both in ICD-10.

(Commentary by Kay B. Day/March 5, 2014)

About Kay Day

Kay B. Day is a freelance writer who has published in national and international magazines and websites. The author of 3 books, her work is anthologized in textbooks and collections. She has won awards for poetry, nonfiction and fiction. Day is a member of the American Society of Journalists and Authors and the Authors Guild.
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