Vast New Government Coding System: Did That Turtle Hit You or Bite You?
If President Obama's administration has its way, health care providers will soon be forced into a massive new government coding scheme where they will have to distinguish for filing purposes between whether your injury was caused by walking into a lamppost, having your water skis light on fire, and whether you were struck or bitten by a turtle.
Critics like Oklahoma Republican Senator Tom Coburn say the U.S. Department of Health and Human Services is requiring providers to adopt a new international diagnosis coding system next year that will increase health system costs, burden providers, and is unlikely to improve care.
The primary difference between the current codes, called ICD-9, and the new ICD-10 system is the sheer volume of codes providers will be required to check when entering patient information. ICD-9 currently has approximately 18,000 codes while ICD-10 uses approximately 140,000 codes. But most of the increased number of codes is due not to new diseases or clinically necessary information, but to requiring excessive and often ridiculous detail.
As an example of how outlandish and clinically irrelevant many of the codes are, consider some of the new requirements concerning the location of injury sites and the nature of injuries within the new coding system:
- The new codes account for injury sites, ranging from opera houses to chicken coops to squash courts.
- One code is for “burn due to water-skis on fire” and another for “walked into lamppost.”
- The codes are so nuanced that “bitten by turtle” and “struck by turtle” are separate codes.
- There are a total of nine codes strictly pertaining to injuries that occur in and around a mobile home.
- There are 72 codes pertaining to birds and 312 codes related to animals.
- There's even a code for civilian drone strikes.
The new codes may not help improve health care, but they will certainly increase the cost of compliance for many providers. One study from the American Medical Association, the Medical Group Management Association, and others has estimated the adoption costs for a small practice at $83,000, ranging up to $2.7 million for a typical large practice. And an Ernst & Young report notes that HHS estimates the cost of the coding conversion at $1.6 billion, but “costs won’t even break even until 2018.”
Senator Coburn, who has long been a critic of the new coding system, has introduced an amendment to the Farm Bill, currently under debate in the Senate, which would prohibit the move to ICD-10.