Possible Symptoms of New Medical Codes: Cash Flow Problems for Doctors, Denial of Services for Patients

Source: New York Times

The nation’s health care providers are under orders to start using a new system of medical codes to describe illnesses and injuries in more detail than ever before. The codes will cover common ailments. But also included are some that are far less common: whether the patient was crushed by a crocodile or sucked into a jet engine.

The more than 100,000 new codes, which will take effect on Oct. 1, have potential benefits: they will require doctors to make a deeper assessment of many patients. But the change is causing waves of anxiety among health care providers — some doctors and hospitals are already obtaining lines of credit because they fear that the transition to the new system will cause cash-flow problems.

Under the new coding regime, government programs and private insurers will require doctors, hospitals, clinics and nursing homes to report vastly more information about the care they provide. Did a diabetic also have kidney disease, eye problems or nerve damage? Did a patient with high blood pressure also have signs of congestive heart failure?

The codes, from the tenth revision of the International Classification of Diseases, or ICD-10, includes 68,000 diagnostic codes, compared with 14,000 in the current compendium. The number of codes for inpatient hospital procedures will expand to 87,000, from 4,000.

Professional coders play an invisible but indispensable role in the health care system, reading through medical records and assigning codes to describe patients’ conditions.
Accurate coding helps ensure patients get the care they require. It is also a way to justify the services provided. The old codes, in use for more than 30 years, have not kept up with changes in medical technology and treatment.

As people make the change, doctors and hospital executives say, it is inevitable that some claims will be denied for services that were provided but not properly coded. Many doctors and hospitals say they will step up efforts to collect the patient’s share of the bill, including deductibles and co-payments, at the time of service.

On its website, Aetna says, “Medical claims will be denied if they don’t use the new ICD-10 codes” for services provided on or after Oct. 1. Stacie Watson, an Aetna executive, said: “We are ready. Test results are encouraging. There should be very little disruption if providers and everyone else is ready.”

Insurers, researchers and some doctors see many potential benefits in use of the new codes. Doctors will have to provide more information about the cause, severity and complications of an illness or injury.

Public health officials say the new codes will help them identify outbreaks of disease, causes of death and community health needs. Researchers say the data will help them evaluate new treatments and procedures.
Says Dr. Michael R. Marks, an orthopedic surgeon and coding expert, “We will be speaking a new language. It’s like switching to German after speaking English for 30 years.”

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