Doctors now can indicate which side of a patient’s body needs surgery or whether he got a concussion in a baseball game or a soccer game, under long-anticipated healthcare billing codes that went into effect Thursday.
Healthcare providers around the country have spent years preparing for the new coding system, after the Obama administration twice delayed its implementation. Known as ICD-10, it expands the number of diagnostic codes from 14,000 to about 68,000, dramatically increasing the specificity of information doctors can transmit to insurers to get paid.
There could be some glitches as providers adjust to the new system, although those won’t be known for a few more days since doctors won’t immediately bill for healthcare services performed starting Oct. 1. And some experts fear that insurers could reject more claims, as they scrutinize more specific codes to see whether certain services were medically necessary.
But overall, providers and insurers say they’re prepared for the transition. They say an update to the billing codes was long overdue, since the current ICD-9 system has been in place since 1979. Under the old system, doctors couldn’t make basic differentiations such as specifying whether a patient had Type 1 or Type 2 diabetes.
“What we’re hearing from our members is they’re ready,” said Lynne Thomas Gordon, chief executive of the American Health Information Management Association. “They see the need for ICD-10 because it’s difficult for people to code with such an outdated system. They’re almost like, ‘Let’s get it over with, let’s go for it.'”
The change isn’t likely to have a huge effect on patients, who typically don’t have to deal with medical billing codes. But it is a big transition for doctors, hospitals, nursing homes, private insurance companies and the government health insurance programs of Medicare and Medicaid, which are constantly transmitting codes back and forth.
Most doctors will use only a subset of codes, depending on their specialty. Hospitals have the most to learn, and they’ve spent millions of dollars on training their billing departments and hiring coding experts whose job it is to know ICD-10 backward and forward.
“Hospitals have been working really hard to get ready,” said Chantal Worzala, policy director for the American Hospital Association. “They’ve been training their staff, they’ve upgraded their IT systems. So the vast majority of our members feel confident they’ll be able to make the transition.”
At the same time, independent doctors and smaller hospitals could struggle more with the transition, since preparing for it cost money and staff hours.
“I think it’s fair to say that smaller hospitals have fewer resources to make this transition,” Worzala said. “That’s not to say they’re not ready.”
The American Medical Association, which represents doctors, pushed back against the new codes until July, when the Centers for Medicare and Medicaid Services eased up on the rules during the transition period. The guidance says claims won’t be denied if doctors list the wrong codes as long as they’re in the right family of codes, along with easing other potential pitfalls for doctors.
The codes are virtually the only way for insurers to decide whether to reimburse for a particular health service, and if so, how much. They’re also used among doctors to transmit a patient’s medical information and communicate what kind of a procedure or treatment the person might need.
The codes also have an impact on scientists and medical researchers who rely on them to study how patients react to certain treatments, Gordon noted. “If you’re a researcher, you have better information to pull upon,” she said.
The codes are so specific that lots of fun has been poked at them. There are codes for being bitten by a macaw, being injured in a prison swimming pool and for being hurt by a “prolonged stay in [a] weightless environment.” At least one Twitter handle, @EveryICD10, is tweeting out every one of the individual codes.
Doctors are especially glad that for the first time, a code for Ebola has been added, a previous oversight they found embarrassing during the Ebola crisis last year, which illustrated how far the U.S. coding system was behind those of other developed countries.
“It was a system that had really run out of room,” Worzala said. “It’s like going to the library to look for a book on psychology, but they ran out of room so they stuck it over in history.”
The new system also could cut down on fraud, said Therese Jorwic, an ICD-10 trainer and a professor at the University of Illinois in Chicago. The specificity forces doctors to be more careful in recording a patient’s ailment. And many new conditions have been discovered since the old codes were implemented more than 30 years ago.
“There have been a lot of things that have changed in the last 39 years,” Jorwic said. “The new system is going to bring the coding system up to date. It will allow for more specificity and data and [will help] combating fraud and abuse.”
