Federally-Mandated Medical Coding Gums Up IT Ops

Lucas123 writes "The change over from a medical coding system in use since the 1970s to an updated version that adds more than 50,000 new 7-character codes is being compared to Y2K as an IT project that is nearly impossible to complete on time. ICD-10, which replaces ICD-9, adds far more granularity to medical diagnosis and treatment. For example, ICD-9 has one code for a finger amputation. In contrast, ICD-10 has a code for every finger and every section of every finger. An 'unfunded mandate,' the change over to ICD-10 codes is a multi-year project for hospitals, state Medicaid organizations, and insurance providers. The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records."

meh.

[Ephemeriis]

The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records.

For the most part, this isn't my problem.

ICD-10 has been on the radar for a while now. At least a couple years. And it's Federally mandated. So we didn't have any problem adding the necessary funds to our budget this year.

Each of our HIS vendors has already got ICD-10 stuff ready to go. We'll have to pay them for their time, or a software release, or whatever... But, as far as my own labor is concerned, it'll basically involve giving them remote access or throwing a disc in the drive.

Most of the labor involved is in our coding department. They're going to have to send folks out to get (re)trained in the ICD-10 stuff. They are, understandably, a little stressed. But they've been working on this for a while, too.

Procrastination hurts

[RKThoadan]

While this is definitely a huge pain, I have little sympathy for those complaining about the timing of this when the standard was finalized in 1992.

Re:Good.

[Anonymous Coward]

The misattribution of the reason for rising costs in health care is unfortunate. The fact that government as a payor is in this system is one of the main reasons costs rise as such a rate.

I work on the revenue side at a fairly large health system, and due to our population we have approximately 50% of our patients privately insured, and close to 50% are government insured. (There are very few people coming in the doors who truly have no coverage, despite what the politicians would have you believe). The privately insured generally repay approximately what's billed, but for the government paid accounts, we would do well to recover 50%, 40% is a better guess. This is because the government solves its own budgetary problems by withholding increases to its medical payouts. In this area, we're still being paid at 2002 rates in 2011. We never withhold a needed service, so we just eat the cost.

But we have to make the books balance somehow. We're non-profit, but we still have to keep the lights on. Charge rates have to go up across the board, and the money lost on literally every government paid patient who walks in the door is then made up by the privately insured. You hear about $8 tylenol being billed, well, tylenol has to cost $8 because you're actually buying a whole bottle and sharing it with everyone else.

I think we're going to continue to have a huge gap of misunderstanding while people continue to emote over "big business" and "fat cats" and "obscene profits" without understanding what the real financial issues are on the ground.

Posted as AC due to PHB concerns.

Re:Makes a lot of sense

[Anonymous Coward]

No. Not at all.

Coding, is just a manner of recording in a concise format, what diagnosis was made, and what treatment was given. This way the data can be used for billing and statistics.

I have never, ever seen medical codes (be them ICD9, ICD10, SNOMED) ever used by doctors, medical technologists, or anyone with any direct influence over patient care. They aren't used in X-ray equipment (so there's no risk of incorrect examinations or incorrect interpretation), blood-work analysis machines, etc.

Being an MD, and part-time software developer, I've done a lot of work with medical databases. I looked at coding of educational files, and being able to import selected educational cases directly out of the hospital's electronic record system, in anonymised fasion, into an educational system. The first thing I noticed was that the coding (in this case ICD9) was extremely inaccurate, and often wildly misleading - fewer than half the codes I looked at were correct. The reason was that the coding was done by clerical staff, who read through the charts, and worked out what codes to use. These clerical staff weren't doctors, nurses, or other people trained in medical diagnosis. As a result, they would frequently misinterpret the charts and the wrong codes would be sent to billing and for government health statistics.

Re:And it slows things down

[BlackHawk]

As someone who's working with this stuff right now, I can say if it's slowing you down, you're not taking advantage of the available tools. They're out there. Keep looking. Moreover, "data entry" is one way of looking at it. A different way to call it is "documenting what they're doing with sufficient detail". That was the entire point of these kinds of standardized coding systems: to (as best as we can) remove the fuzzy documentation in the systems before, and to remove the idiosyncrasies from medical records. With the proper coding systems in place, a patient in Allentown who moves to Duluth can have his PHI moved to the new caregiver and be (for the most part) confident that the Iowans will be able to understand what the Pennsylvanians did for him before. Yeah, there's going to be transitional pain. There always is. But as has been pointed out in other posts, it's not like ICD-10 ambushed anybody. Frankly, if you haven't been moving toward ICD-10-capable systems for at least 2 years, you've been slacking. There's a penalty for that at crunch time.