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Medicine Government IT

Doctors On Edge As Healthcare Gears Up For 70,000 Ways To Classify Ailments 232

HughPickens.com writes: Melinda Beck reports in the WSJ that doctors, hospitals and insurers are bracing for possible disruptions on October 1 when the U.S. health-care system switches to ICD-10, a massive new set of codes for describing illnesses and injuries that expands the way ailments are described from 14,000 to 70,000. Hospitals and physician practices have spent billions of dollars on training programs, boot camps, apps, flashcards and practice drills to prepare for the conversion, which has been postponed three times since the original date in 2011. With the move to ICD-10, the one code for suturing an artery will become 195 codes, designating every single artery, among other variables, according to OptumInsight, a unit of UnitedHealth Group Inc. A single code for a badly healed fracture could now translate to 2,595 different codes, the firm calculates. Each signals information including what bone was broken, as well as which side of the body it was on.

Propoenents says ICD-10 will help researchers better identify public-health problems, manage diseases and evaluate outcomes, and over time, will create a much more detailed body of data about patients' health—conveying a wealth of information in a single seven-digit code—and pave the way for changes in reimbursement as the nation moves toward value-based payment plans. "A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders," says Dr. Rogers. "ICD-10 will give us the precision to do that." As the changeover deadline approaches some fear a replay of the Affordable Care Act rollout debacle in 2013 that choked computer networks, delaying bills and claims for several months. Others recollect the end-of-century anxiety of Y2K, the Year 2000 computer bug that failed to materialize. "We're all hoping for the best and expecting the worst," says Sharon Ahearn. "I have built up what I call my war chest. That's to make sure we have enough working capital to see us through six to eight weeks of slow claims."
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Doctors On Edge As Healthcare Gears Up For 70,000 Ways To Classify Ailments

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  • by art123 ( 309756 ) on Monday September 28, 2015 @07:27PM (#50616595)

    Here is my favorite.

    As if being sucked into a jet engine the first time wasn't bad enough.

    http://www.icd10data.com/ICD10CM/Codes/V00-Y99/V95-V97/V97-/V97.33XD

  • My sister is a nurse (Score:5, Interesting)

    by Snotnose ( 212196 ) on Monday September 28, 2015 @07:37PM (#50616639)
    I used to think she was exaggerating how people specialized in not medical training, but in translating doctor's diagnosis into something the government could grok. One day about 5 years ago she brought over a binder that converted ailments to codes, I couldn't believe it. It was about 300 pages of stuff on something minor, like stitches and shots. She works for Kaiser and said they had as many coders as they had nurses, coders being people who converted diagnostics into codes for the government.

    I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
    • By the time the codes get to your insurance company, denied, sent back, recoded (hopefully), sent back to the insurance company, you be fine! And then the insurance company will sue you for fraudulently submitting a claim... Which will be processed within the week.

      • by BradMajors ( 995624 ) on Tuesday September 29, 2015 @12:19AM (#50617781)

        I have had that problem. My doctor gave me a valid ICD diagnosis. My doctor prescribed me a standard drug for my condition. My insurance company says that my drug is not prescribed for my ICD diagnosis. They are OK with my drug being prescribed for some other ICD diagnosis codes.

        • Ding! You hit the nail on the head.

          The International Classification of Diseases was originally for compiling WHO statistics, but has been embraced by the pen-pushers in health care. You might think the US insurance industry likes it because it affords manifold opportunities to deny someone a claim (code not covered / wrong code assigned, sorry, bad claim), I couldn't possibly comment.

          The UK is ahead of the USA using ICD-10 ; we've used it for years. We also use a somewhat more limited set, of around 14,000

    • I used to think she was exaggerating how people specialized in not medical training, but in translating doctor's diagnosis into something the government could grok. One day about 5 years ago she brought over a binder that converted ailments to codes, I couldn't believe it. It was about 300 pages of stuff on something minor, like stitches and shots. She works for Kaiser and said they had as many coders as they had nurses, coders being people who converted diagnostics into codes for the government.

      I can see h

      • It's a great way to deny claims.

        Wrong code? Sorry, fraudulent claim. You can bet that the insurance industry will have more skilled coders than the hospitals.

        Gerbil up the arse with *fire damage*?? Sorry, we only cover gerbil up the arse, lubed.

    • by Osgeld ( 1900440 ) on Monday September 28, 2015 @07:52PM (#50616737)

      a hillbilly making minimum wage can look up a car part out of tens of millions in about 3 seconds, with 3-4 questions, using a green screen terminal connected via dialup

      your nurse sister has a binder

      I don't think the number of codes is the problem

      • by Mr D from 63 ( 3395377 ) on Monday September 28, 2015 @08:18PM (#50616857)
        There is absolutely no ambiguity in what any particular car part is. Classifying medical conditions is far from being so black and white.
        • Re: (Score:3, Insightful)

          I can't decide which of you guys to give "+1 Insightful." I went to a tech school to study insurance coding, and you're both completely right.
      • I worked on some of the tools for ICD-10.

        Aside from the data being rather horrible (it takes quite a chunk of code to parse it correctly - and most users haven't written that code properly), I also worked on tools for defining conversions of SNOMED CT to ICD-10.

        If you think ICD-10 is scary, wait until you see SNOMED CT ; 70,000 codes? Try 400,000, which you can use in combination with each other (codes qualifying codes), with 1.5M descriptions.

        • by sribe ( 304414 )

          ...it takes quite a chunk of code to parse it correctly - and most users haven't written that code properly...

          WTF? The format of the data is dead simple. Parsing it took me almost no time at all.

    • by AK Marc ( 707885 ) on Monday September 28, 2015 @08:14PM (#50616833)
      Mostly the result of insurance companies and doctor's fraud. A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud.

      Yes, the government does it by moving the cost of compliance to the user (the codes are on the doctor's side, the government just verifies), rather than the other way, where the government would be spending much more on fraud investigations and compliance.

      I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?

      It's not going to cost the government much. Just like the IRS. All the complaints about the IRS being inefficient are about the cost to comply, not the cost of the IRS. The IRS is an order of magnitude (or more) cheaper than the same services from a private service. But partly because they push the cost to the person complying.

      What I find funny is all the conservatives who hate ACA want the government to pay more (moving more compliance cost back to the government), rather than the smaller, more efficient government proposed.

      • by jcr ( 53032 ) <jcr@mac.cOPENBSDom minus bsd> on Monday September 28, 2015 @09:18PM (#50617131) Journal

        The codes make it easier to sniff out fraud.

        More like, this Byzantine complexity makes it easier to delay payment and deny coverage.

        The ACA was the insurance industry's wet dream. Obama, the dems in congress, and far too many of the republicans, handed it to them on a sliver platter.

        -jcr

      • by Tablizer ( 95088 )

        A doctor inflating costs to recover more wasn't unusual. The codes make it easier to sniff out fraud.

        I wonder if they did a cost/benefit analysis of the cost of insurance fraud versus the cost of detailed encoding.

        Also, I wonder if there's not a way to phase it in gradually, one limb at a time or something, or only patent's with ID numbers that end in 3 and 7, or the like. One-Big-On-Switch launches are disasters in the waiting.

        • It has been being phased in slowly. Many institutions have been dual-coding for years now. Now is just the mandatory switch. Kind of like how there was HDTV for years before the day everyone officially stopped broadcasting in SD.

      • Yes, the government does it by moving the cost of compliance to the user (the codes are on the doctor's side, the government just verifies), rather than the other way, where the government would be spending much more on fraud investigations and compliance.

        That's what makes it dangerous - you're decoupling the cost of compliance from the benefit of compliance.

        Picking a number out of thin air, lets say 10% of medical transactions are fraudulent. The extra work of learning these codes and looking up ones

        • You have the correct thesis, I think, but some poor examples:

          Pollution - everyone bears the cost but only the polluter benefits.

          Overfishing...

          Not exactly; the people who pay low cost for the goods/services provided by the polluter/overfisher also benefit.

          The examples of credit cards are better. MBSs, I'm not so sure - I don't think there was "tricking" there so much as an artifact of booking rules associated with unrealized gains and losses. Add to that the hot-potato nature of financial instruments, and

    • how in hell do they think people making 20k/year are going to do a good job at entering codes?

      As a first step, they could try using a computer instead of a binder.

      • how in hell do they think people making 20k/year are going to do a good job at entering codes?

        As a first step, they could try using a computer instead of a binder.

        Get the guy who created that 1000 key emoji keyboard [slashdot.org] to help out.

    • a) It is going to cost a shitload of money

      b) They'll do the best they can- most of them do care

      c) You didn't ask for an option "c" but this is the most important: This is just going to make the whole thing worse. By a lot.

    • by NoKaOi ( 1415755 )

      This is only really an issue because all the big EMR products are flaming piles of crap. If the software was decent, there would be no reason to have to memorize so much stuff, the software should guide them through it in a matter of seconds. The folks who deal directly with insurance should be the only ones that have to memorize all that.

      • The doctor's and nurses don't need to know any of the codes. However, they do need to document things much better than they have been doing so far in order for the coders to categorize things correctly.

        As far as the software goes it varies a bit by vendor, but I expect that the real slowdown part is in tracking down the documentation in the record, not assigning the codes. We are slowly moving away from free-form dictation by doctors into more data-oriented documentation which makes this part a bit easier.

        I

        • Not only do doctors and nurses not need to know ICD9/10 codes, the vast majority do not know them. It was not taught to me ever in 4 years of med school and 3 years of residency. If a doctor ever uses a code, it's from the CPT set.

    • by sribe ( 304414 ) on Tuesday September 29, 2015 @09:49AM (#50619421)

      I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?

      It's pretty ridiculous to have the 20K/year person translating to codes. The doctor should choose the ICD code. Before anybody argues with that, I write EMR software, and work directly with doctors, nurses, techs, clerks, and billing people. I've seen what a mess happens when the 20K/year person chooses codes, and I've seen how little up-front time it takes for doctors to figure out what codes they should be using, and also that over the long-term it's *0* extra time for them to do it right to start with, rather than trying to have someone else do it and clean up the mistakes.

      Of course, some places still insist on doing it wrong ;-)

  • by mhkohne ( 3854 ) on Monday September 28, 2015 @07:44PM (#50616677) Homepage

    I have the sneaking suspicion that this is going to backfire massively. They'll have bad data hither and yon as overworked medicos end up entering the wrong codes (hey, it's a broken femur, who cares which side?) as often as the right ones. They won't get the supposed benefits of more granular data because the data will be so screwed up that they won't be able to draw any conclusions at all.

    Nothing like an industry standard to screw things up on a grand scale.

    • The problem with granularity is the same one as the problem with trying to describe each grain of sand.

    • I have the sneaking suspicion that this is going to backfire massively. They'll have bad data hither and yon as overworked medicos end up entering the wrong codes (hey, it's a broken femur, who cares which side?) as often as the right ones. They won't get the supposed benefits of more granular data because the data will be so screwed up that they won't be able to draw any conclusions at all.

      Nothing like an industry standard to screw things up on a grand scale.

      I suspect you'll be right for the first five years and there will be a lot of ugly news stories. Then people will figure out how to work with the system, fix the bugs, and then things will get better.

    • by AK Marc ( 707885 )
      How will it backfire? There'll be bad data? It'll be found, and the doctor charged with the cost of finding and correcting it. It's a self-correcting problem, and not one that will cause medical care problems.
    • by Okian Warrior ( 537106 ) on Monday September 28, 2015 @09:20PM (#50617141) Homepage Journal

      I have the sneaking suspicion that this is going to backfire massively. They'll have bad data hither and yon as overworked medicos end up entering the wrong codes (hey, it's a broken femur, who cares which side?) as often as the right ones. They won't get the supposed benefits of more granular data because the data will be so screwed up that they won't be able to draw any conclusions at all.

      Nothing like an industry standard to screw things up on a grand scale.

      It won't backfire, it'll work perfectly.

      The insurance companies sit between the doctor and the patient, view medical care as an expense, and seek to avoid paying by any means.

      Having an enormously complicated system of classification gives them many more ways to deny claims, leaving the patient on the hook for the bill.

      I've had personal experience with this: for a procedure which was 100% covered, the anesthesiologist put the wrong diagnosis code in his notes and the insurance company wouldn't reimburse him for that reason (but everyone else - doctors, nurses, hospital - was OK).

      It took 2 1/2 years and about half a vertical inch of paperwork to straighten it out, and was a nightmare. Some tidbits:

      1) The insurance company could tell the doctor that he used the wrong code, but wouldn't say what the right code was.
      2) The med techs swore up and down that it was the right code (in fact, the *only* code), the insurance company stated with equal strength that it was not.
      3) Since it is a mistake with either the doctor or insurance company, nothing the patient can do will help - they are completely helpless.
      4) A doctor can't "just change" their notes, even when they've made a clear and unarguable mistake.
      5) If you resubmit a claim, the company will deny it based on the previous denial, even if the mistake has been corrected.

      #3 above is the most frustrating. The patient has to convince someone else to spend time and effort to fix something which is not their problem.

      This new system is just a bureaucratic boondoggle that lets insurance companies avoid payments.

      It's saying, in effect, that they care more for paperwork than they do about providing health care.

      • Re: (Score:3, Informative)

        by Anonymous Coward

        Posting as AC so as to not lose moderation above. I had this happen one time when my child went in for an annual checkup that is definitely covered. They denied the claim and said the wrong code was used.

        I asked the doctor's office and they said "we think we used the correct code".

        So I called the insurance company back and said "they think they used the correct code, you said they didn't, so you tell me what the correct code is." Front-liner said "we can't do that". I said "fine, you probably want me to

    • by Jeremi ( 14640 )

      In a sane world, Google or IBM or someone clever will come up with a program where you type in a rough English description of the injury and it returns the set of codes that are likely to match that description, and then guides you interactively towards choosing the correct code from that set.

      I'm going to be naively optimistic and assume that this has already been done, at least to some extent. :)

      • try Intelligent Medical Objects, IMO
        i don't work for them, just know about them.
        they do exactly this.

  • Now instead of using big data to identify trends and pattern, doctors will need big data to figure out which code to use when they fill the forms. Good news is, with the right instance type on AWS and a latest build of mahout, locating the right code for any disease should take less than an hour.

  • From the website:

    Suggest a feature or send your comments to feedback@icd10data.com.

    Here's the feature I suggest: stop putting LSD in the water cooler at your office.

  • and in 2016 when the gop system kicks in and now you have 70K new ways to get black listed.

  • A complete medical report including dictated audio, and imagery, is maybe 50 MB, or 400 megabits, in size.

    Let's just cut the crap, and use 2^(400 million) medical codes, each of which maps to one such report. Then the insurance companies may review than as they like.

  • I used to work on a project like that, where the bean counters ran amok and tried to create accounting codes for the minutest detail of the job. I pissed them off by entering all my time under "Development" or "Debugging."

  • Panic! Panic! (Score:5, Informative)

    by bperkins ( 12056 ) on Monday September 28, 2015 @08:56PM (#50617041) Homepage Journal

    How could we be forced into using this untested system so quickly! We should start using it only after it's been used in other countries for 20 years!
    Oh wait. [wikipedia.org]

  • by sandbagger ( 654585 ) on Monday September 28, 2015 @09:09PM (#50617093)

    No sympathy.

    This was a well publicized deadline with plenty of infrastructure money provided up front. Oh -- your HMO or physician practice spent all that money on something else. I guess that must be the evil federal government's fault.

  • I think that capturing the data is a good thing but how they are doing is going to have a lot of errors entered. One big list of every possibility is terrible for usability. Instead of a long list I would have created a hierarchy. The major problems would be up top such as fractures, poisoning, surgical and then the valid options would be given to the user as they drill down. For example fracture -> {bone name} -> {side of body} or surgical -> suturing -> {artery name}.

  • by fahrbot-bot ( 874524 ) on Monday September 28, 2015 @09:41PM (#50617241)

    70,001 - Stress induced from working with 70,000 medical codes.

  • ... tearing the arm off the politicial that thought of this mess and beating him/her over the head with it? Do we search under brachium or cranium?

  • You should. If there is anything you can count on, it is that this will lead to more revenue and profit for them. Just as the Health Insurance Industry Bailout Act of 2010 (more commonly called "The Affordable Care Act" or "Obamacare") was the greatest corporate handout in the history of government, you can count on the insurance industry making plenty of money off of this as well. The longer an insurance company can deny payment for services, the greater the chances are that they won't have to pay it at all.
  • by KermodeBear ( 738243 ) on Monday September 28, 2015 @11:00PM (#50617531) Homepage

    I am offended! Look! JUST LOOK AT THIS! [icd10data.com]

    Oh sure, there's code for being struck by a raccoon, or bitten by a pig, or "other contact" with a horse (I won't judge), but what about bears?

    Yeah, that's right. We bears are shoved into the "other" category. I am so sick of the micro aggressions of the medical patriarchy that is trying to marginalize the needs of the ursine community.

    Well I'm not going to take it anymore!

    No garbage can will be safe, nor all the salmon in any river. We will break into your homes and eat your pies, and we will smash down your fences to eat your bird seed, we will wage a war on your apiaries and your cries of anguish from a lack of honey will only drive us deeper into rage.

    You've been warned!

  • the only reason for that is to leak personal, medical history to all the layers of the system. from your health provider, employer and credit card company.

    there's no reason any of this would help a physician.

    in America, with or without this, you will still be at the only "first world" country were a visit to the ER will only warrant any procedure of your bowels are exposed. for more than 3 inches.

  • Quite exaggerated (Score:4, Interesting)

    by Kjella ( 173770 ) on Tuesday September 29, 2015 @04:02AM (#50618275) Homepage

    I just checked our use here in Norway and the total number of valid codes here is less than 20.000. However, there are a couple orthogonal codes bring the number of combinations way up, like in accident codes there's a code for the cause of injury (16 codes) * location (11 codes) * industry/activity (16 codes) that together is 1000+ combinations but many are non-sensical. And they are orthogonal to the medical codes describing the actual medical injury.

    So multiple leg fractures would be S827, a not transported related fall injury W0n, construction area goes under "9 Other" as location as work injuries are typically classified by industry and construction industry is b, so in total "S827 W0n9b". If you sustain the same injury as a pedestrian in a road traffic accident it'd be V0n, location 1, activity usually r Other (everything but work, education, sports and exercise) so "S827 V0n1r". They usually wrap the accident codes up on a single A4 page to choose from, I've actually seen that in the ER room. And of course "Unknown" are options on both. Same thing with the medical codes, instead of multiple fractures you can code each fracture in detail using supplemental codes. It's as complicated as you want it to be.

Karl's version of Parkinson's Law: Work expands to exceed the time alloted it.

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