If you ever get access to the inner sanctum of a doctor’s office, besides the dirty scrubs on the floor, the shaving kit on the windowsill, and the remains of Chinese take-out from last week perched on top of the printer, you might notice a rank of post-it’s on a wall somewhere with a bewildering array of numbers and dots. It’s always post-its or some other disposable but never-disposed-of scrap paper tacked to the walls. Those numbers are the diseases your doctors most commonly sees. In numeric form. These are called ICD-9 codes. They allow all billing, essentially. If what you have doesn’t have an ICD-9 code, you aren’t sick, you’re imagining it, go away, no one is going to get paid to see you.
Here’s something I came across while poking around at Health Wonk Review, which will be hosted, by the way, by our own Brad Wright on March 13th. Did you know that this October we’ll be getting a new ICD? No, not an implantable cardiac defibrillator, though some of us may need one of those after we see the size of the Tenth Edition of the International Classification of Diseases. Sarah Kliff, a blogger for the Washington Post, tells us that while ICD-9 had 14,000 codes, ICD-10 has 68,000. So, that’s better. It’s more, you know, numbers.
One of the reasons for the new edition, and the one proponents will tout, is actually a good one. The ICD-9 can’t expand anymore. There are no more qualifiers you can add to, say, Pneumonia NOS (not otherwise specified). The basic diseases have generally been divided by research and innovation into sub-categories based on new microscopic findings, genetic testing, etc. So it’s more specific. It’s also going to be great for moldy researchers and poverty-stricken grad students. Data-mining will be much more fun and informative. You can look up, for instance, how many doctors billed for the ICD-10 code “bitten by large turkey” presumably with a modifier if it was a wild turkey.
We doctors are understandably wary of this new edition, and not just because we’ll have to get bigger offices to accommodate all the post-its we’ll have to add to the walls. You see, it’s generally the doctor who generates the code, at least initially. So it’s more work for us. Nothing new there. Most new policies and procedures produce more work for doctors and, even more often, for nurses. But the work increase is greatest for the medical coders. The US has over 186,000 medical coders. That’s 186,000 people who work in the medical field doing absolutely nothing that has anything to do with the actual care of people. Looks like there will be more soon. Wonderful job opportunities out there college graduates!
The AMA, which is of course against implementation of ICD-10, estimates it could cost $50,000 to $8 million dollars for doctors offices to transition, and it would cost a lot of time as the billers would have to slow down until they learned the new codes. Plus there will be more coders. So, not cheap. Now, a major RAND Corporation study in 2004 estimated the potential benefits of switching to ICD-10 outweighed the costs by as much as $4.5 billion. But isn’t it the RAND corp people who said EMR was going to save the health care industry so much money?
So the new ICD codes are not money-saving. They’re not time-saving. They make zero impact on patient care, either in quality or in quantity. They do have the advantage of being more specific and generating better tracking and research data. But what is the mantra for healthcare reform? “Lower Cost, Higher Quality”?