I strongly suggest that a pledge to read a synopsis of the philosophy of the 13th century Franciscan William of Ockham on a weekly basis be inserted in the oath of office taken by every government employee. Clearly highlighted should be his nominalist doctrine, Ockham’s razor, which avows that the best solution to a problem is usually the simplest. Pare to a minimum the number of confounding variables.
Prima facia evidence for this mandate is the revised International Classification of Diseases (ICD-10), which was rolled out this past October and must be used by doctors and hospitals for virtually all patients. Justification for the revision was the old codes were in use for over 30 years and did not reflect changes in medical technology and treatment. Moreover, the ICD-10 had potential benefit as it required doctors to make a deeper assessment of most patients because without proper coding insurance claims would be denied. Simply put: no code, no money.
So how is ICD-10 different from its predecessor? Simple, ICD-10 includes 68,000 diagnostic codes compared to 14,000 in past usage and the number of inpatient hospital procedure codes expanded to 87,000 from 4,000. These are not typos. No wonder medical providers have been ramping up their coding skills and hiring coders at a frantic pace.
You have probably experienced the immediate effect already. To meet coding standards, such as coincidence of heart failure with hypertension, additional testing and cost and patient time is added to an already extended health care budget. Lines of credit had to be secured to compensate for delays in payment by many insurers. Patients can be frustrated because tests, such as MRI, often require pre-approval and coding snafus delay the process. Moreover, doctors and hospitals will step up efforts to collect patients’ share of the bill at the time of service to offset disputed insurance reimbursement.
I appreciate that accurate coding helps ensure that patients get the care they need and provides oversight to justify services provided; however, too much of a good thing is not necessarily better. Code W58.13 is for patients bitten by a horse, snake or a shark, pecked by a turkey or crushed by a crocodile. If you are sucked into a jet engine, posthumous reimbursement is set by code V97.33. A less humorous, but more common example of coding prolix relates to a fractured femur, where right or left, compound vs. closed, routine or delayed healing and deformation resulting from rejoined bone fragments must all be enumerated.
The bottom line? As always, the cost for all this coding is bore by the health-care providers, who will not receive a plug nickel for their services without strict adherence to 155,000 new rules.
By Norman Silverman, MD, with Ryan McKennon, DO and Ren Carlton