Hurt at opera? Struck by orca? There’s a medical code

Karen Bouffard
The Detroit News
  • An expanded system has up to 100,000 codes that describe patients’ diseases, conditions and injuries
  • Experts expect delayed payments to patients and hospitals because of the sixfold increase in codes
  • ICD-10 inspired the creation of a book that has sold more than 10,000 copies
  • Michigan doctors, hospitals have spent tens of millions of dollars to prepare for the code changes

For those pecked by a chicken, hurt at the opera or struck by a flying orca, there’s a code for that.

After years of delay, an updated and expanded medical coding system goes into effect this month. The revision, an expanded version of a system developed by the World Health Organization, has up to 100,000 codes describing diseases, conditions and injuries, along with symptoms, abnormalities, circumstances and causes. The prior edition had 14,000 codes.

Experts expect problems and delayed payments to patients and health providers as the nation adjusts to a sixfold to sevenfold increase in codes that have more detailed information for insurance companies, federal reporting and data collection. Others see humor in the exacting attention to detail.

Michigan doctors and hospitals have spent tens of millions of dollars to prepare and brace for the changes in the ICD — short for the International Statistical Classification of Diseases and Related Health Problems.

“They’re nervous,” said Andrew Boyd, assistant professor of biomedical and health information sciences at the University of Illinois at Chicago who has studied the impacts of the coding system. “We’re talking about 80,000 to 100,000 diagnosis codes — we’re beyond the point of human memory.

“If there is a mistake at any one point, you get a delay in payment. (Some) doctors and physicians groups are actually taking out cash loans for October. Everyone’s learning a new system, so people are anticipating delays in payment that could impact cash flow.”

Converting to an expanded medical code system is a massive undertaking as the health care industry continues to adapt to the federal Affordable Care Act.

The federal Centers for Medicare and Medicaid Services, which developed the codes, expects the changes to “enable significant improvements in care management, public health reporting, research, and quality measurement,” according to the agency website.

Boyd says the U.S. lags most other countries, which already have updated codes to reflect advancements in medicine and technology. In America, the launch of the revised system was delayed several times and was last set to begin Oct. 1, 2014.

“As the rest of the world has transitioned to different country versions, the U.S. is the last,” Boyd said. “There have been delays and delays, and many organization began preparing in 2012.”

Coding practices may vary

The increasing detail of the codes will consume more time to enter, impose more cost and may have declining value depending on how doctors and hospitals use them, Boyd said. He compared the code designers and physicians to “artists” whose “style issues” may lead to uneven practices across health care facilities.

“While we will have the ability to distinguish between being struck by a goose versus a duck, unless the physicians and professional coders see value in the information, the quality of the information stored within the diagnosis codes could decrease,” Boyd said.

Niko Skievaski, a health care information technology professional, also sees the style and humor in the coding endeavor. So he created a start-up and worked with other industry pros as well as artists in the Madison, Wisconsin area to produce a 72-page book called “Struck by Orca: ICD Illustrated.”

The $20 book devotes its 72 pages to scores of codes such as “Forced landing of spacecraft injuring occupant, initial encounter” and an accompanying hand-drawn or photographic illustration. More than 10,000 copies have been sold since December, Skievaski said, and has inspired $15 ICD-10 playing cards.

“We put the book together because we thought it’d be funny, said Skievaski, the book’s editor at ICD-10 Illustrated LLC. “And luckily, others did, too.”

Transition costs add up

The Rand Corp. in 2004 estimated transitioning to the new system would cost hospitals $475 million to $1 billion, but many experts place the cost much higher.

The American Medical Association projects the transition costs for a small physician practice could run anywhere from $56,000 to more than $226,000. Costs to medium-size practices could range from $213,300 to $824,700. And a large practice could spend $2 million to $8 million to implement ICD-10.

Michigan hospitals have been preparing for the switch for several years, said Jim Lee, vice president for data policy and development at the Michigan Health and Hospital Association. They upgraded computer systems, developed new processes for documentation and provided extensive training for coding staff and physicians.

“These activities have entailed significant effort and cost, with many health systems spending millions of dollars,” Lee said. “The hope is that ICD-10’s expanded granularity will provide better data for health care providers, payers and researchers to use in distinguishing newer technologies and resource differences; monitoring resource utilization; improving clinical, financial and administrative performance; and better tracking of public health risks.

“However, given that this is a new program and a massive change for the health care community, the actual outcomes remain to be seen.”

Dr. Malcolm Henoch, associate chief medical officer for Beaumont Health System in Royal Oak, said the Detroit-area health system has paid “certainly in the millions of dollars, and probably in the tens of millions” to prepare for the switch. Part of the expense has been to educate staff and physicians on what he called a new language of medicine.

“ICD-10 is a language that we use not just for insurance reimbursement but for all the reporting we do on our quality and performance,” Henoch said.

“What it will certainly do is provide for a more accurate means to record what we do, the care we provide,” Henoch added. “To the extent it’s a better reflection of the care we provide, it will probably benefit everyone, but to what extent is a question best asked in two or three years.”

So the next time someone gets bitten by a cow, burned on water skis or sucked into a jet engine, rest assured. Doctors will have the proper diagnosis code at their disposal.

Offbeat medical codes

The update and expansion of the International Statistical Classification of Diseases and Related Health Problems in the United States has resulted in some surprising codes.

■W55.21 Bitten by a cow

■W61.33 Pecked by a chicken

■V00.01 Pedestrian on foot injured in collision with roller-skater

■ZB3.1 Problems in relationship with in-laws

■Y92.241 Hurt at library

■Y92.253 Hurt at the opera

■Y93.D1 Accident while knitting or crocheting

■W56.22 Struck by orca, initial encounter

■W56.32 Struck by marine mammals

■V91.07 Burn due to water skis on fire

■W61.12 Struck by Macaw

■V97.33 Sucked into jet engine

■V96.00 Unspecified balloon accident injuring occupant

■V95.40 Unspecified spacecraft accident injuring occupant

Source: Medical Economics