Germany uses them. France uses them. Canada uses them. But America? We may not be ready for them.
A new set of medical diagnosis codes — those series of numbers and letters that appear on insurance forms and doctor’s-office paperwork to signify everything from heart disease to athlete’s foot — are being used by many other countries.
But the U.S. is still stuck in the ’70s, with American healthcare workers relying on codes developed in 1979.
On Oct. 1, the federal Centers for Medicare and Medicaid Services is expected to implement the latest version, the 10th version, of the International Classification of Diseases. The American healthcare community is expected to follow whatever CMS does, as doctors will need the new codes for reimbursement for medical services for Medicare and Medicaid patients.
But Several Republican House lawmakers have pointedly questioned whether the federal government would be ready by this fall to implement the new codes. On their minds is the botched rollout of healthcare.gov.
“When CMS flips a switch, something breaks,” Rep. Michael Burgess, R-Texas, told a House subcommittee Wednesday.
Burgess called for CMS to share a contingency plan in case its systems have trouble implementing the new codes this fall.
CMS, which did not have a representative at the House hearing, did not return a request for comment from the Washington Examiner. A Government Accountability Office report released earlier this week said the agency was on the right track about implementing the new codes.
The federal government could allow doctors to use both sets of codes for a small period of time until industry and CMS are fully ready, said Rep. Joe Barton, R-Texas.
But that won’t be easy.
The old version has roughly 13,000 diagnosis codes, and the new one has about 68,000. In some cases, diseases or conditions will get completely new codes. Chronic meningitis, which is 322.2 under the old code, becomes G03.1 in the new version.
That’s partly because the new code set reflects changes in terminology over the past 30 years — and it also allows doctors to specify greater detail about what they’re treating.
For example, under the old code, there was a single code to reflect tobacco use or dependence. Under the newer version, there is an entire category on nicotine dependence, with several subcategories to identify the tobacco product used by the patient, according to the GAO.
In the old code set, which featured combinations of up to five letters and numbers, there were codes for, for instance, dog bites. In the new set, which includes combinations of up to seven letters and numbers, there’s a code exclusively for being bitten by a pig. (It’s W55.41, in case you’re curious.) The new set also has separate codes not only for being bitten by a duck but by being struck by a duck.
Rep. Renee Elmers, R-N.C., questioned whether doctors could implement the new codes with so many other government requirements on their plate. “Many of our physicians are trying to meet” the requirements for the federal push for electronic health records, she said.
However, subcommittee chairman Rep. Joe Pitts noted that the implementation has already been delayed by several years. Any further delay would “entail additional cost to keep [the old code] systems current,” the Pennsylvania Republican said.
Democrats on the panel argued against pushing back the date when the new codes take effect. “Since 1979, new medical devices and treatments been developed, and our coding system has to reflect modern medicine,” said Rep. Kathy Castor, D-Fla.
Doctors invited to address the hearing clashed over the projected cost of implementation. A rural doctor said he has already moved to the new codes and it didn’t cost him anything, while a urologist countered the new codes will cost small practices $250,000 and larger practices of 100 physicians or more up to $8 million.
While CMS may have set its deadline as Oct. 1, Congress can overrule that date. CMS originally planned to implement the new codes in October 2013, but that date was pushed back to 2014 to give industry more time to prepare. Congress then pushed the 2014 deadline back to this year.
