New Coding System to Add Costs, Burdens to Healthcare

Monday, 07 Apr 2014 03:42 PM

By Andrea Billups

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Has your doctor asked you about orca bites? Or burns you suffered while water skiing? What about an attack by an angry macaw?

Those are just a sampling of the 185,000 injury and condition entries listed on a new government coding system set to be enforced in 2015 — another layer of bureaucracy heaped on physicians and providers, many already straining to navigate new regulations under Obamacare.

Called the ICD-10 — short for the 10th revision of the International Classification of Diseases — the coding system was first created for use by the World Health Organization to help doctors standardize procedures and to track disease outbreaks.

Now, under rules from the Center for Medicare & Medicaid Services that are unrelated to the Affordable Care Act, the extensive system must be used in medical practices around the country starting next year, despite physicians saying it will limit patient care and healthcare systems having cost concerns.

"The ICD-10 coding is going to be incredibly burdensome," North Carolina cardiologist Dr. Kevin Campbell told Newsmax.

While Campbell says he used to spend about 25 percent of his time on paperwork, that figure has increased to half.

"It's going to slow productivity," said Campbell, who calls the system well-meaning but a federal overreach.

"The people who came up with it were well-intended, but I am not certain any of them had ever been in a clinical setting. The time and effort to learn and understand these codes and documents in the charts . . . it's just completely overwhelming," Campbell said.

"We already have an EMR [electronic medical records], and now we have to move to a different EMR, and then on top of that, we have this coding stuff. It's just getting ridiculous."

The implementation of the coding system has pretty much flown under the radar, said Robert Moffit, director of the Center for Health Policy Studies at the Heritage Foundation.

"Nobody knows anything about this except for the health-policy community and the healthcare industry," Moffit told Newsmax.

The healthcare industry is already budgeting for its cost, with Blue Cross Blue Shield of Massachusetts setting aside $45 million and the Virginia-based Inova Healthcare spending $25 million to comply, Moffit said.

"That's just two states, and the transactional costs of this regulation appear to be enormous," Moffit said. "The scope of this regulation is huge, and it's going to cause hundreds of millions of dollars of impact to the healthcare economy and to the physicians, and nobody understands it."

Moffit lauded Republicans Rep. Ted Poe of Texas and Sen. Tom Coburn of Oklahoma for managing to delay the reform by a year, moving compliance well into 2015.

Moffit said the program has not been subject to congressional hearings.

"This is a classic example of the bureaucracy making enormously powerful rules that have enormous scope and that are costing millions of dollars and Congress is not taking a hand in guiding this," Moffit said. "Congress has not addressed this issue in any detail."

Moffit urged members of Congress to hold hearings and for the General Accounting Office to conduct a review of the system's cost and viability.

"We have already made a mistake with HealthCare.gov, and now we're talking about imposing on the medical profession a massive transition that they are not ready for at the same time they have to comply with all of the ACA requirements," Moffit said. "I think this is kind of the straw that is breaking the camel's back."

Doctors decry the specificity of the coding plan. Not only are the diagnosis categories more complicated, but it seeks information on where exactly an injury occurred — with coding for venues such as an opera house, a museum, or a music hall.

"Under ICD-9, an angioplasty was represented by one code; under ICD-10, an angioplasty could be represented with one of 854 codes," according to United Healthcare.

While previous billing codes set up about 7,600 classifications for medical procedures and diagnoses, the new system will include about 69,000.

That, says Campbell, is a layer that will keep doctors and their staffs from focusing on patient care — the very reason many became doctors in the first place.

"It is very difficult to maintain the level of doctor-patient relations that we all crave," he said.

Campbell said it is difficult to respect the value of information sought from the new system when one of the categories is "falling out of a spacecraft."

"This is a style of coding designed to track prevalence of disease. We adopted and modified it for billing. The problem is: why do we need these ridiculous codes in the system? There's got to be a better way than to have codes for macaw bites. It's absurd," Campbell said.

Stephen F. Hayes, writing in the Weekly Standard, described some of the odd categorization of injuries that doctors will have to track.

"So these exotic injuries, codeless for so many years, will henceforth be known, respectively, as T63622A (toxic effect of contact with other jellyfish, intentional self-harm, initial encounter), V9542XA (forced landing of spacecraft injuring occupant, initial encounter), V9733XA (sucked into jet engine, initial encounter), and V80731A (occupant of animal-drawn vehicle injured in collision with streetcar, initial encounter)," Hayes said.

Moffit said some industry groups, such as the American Health Information Management Association, support the move from ICD-9 to ICD-10 because of its depth, which will help establish research databases and improve clinical analysis. Those supporters say the current system is "too basic" and the new system aids in reforms, including policy.

But Campbell said the coding system serves to demoralize a profession that is already strained and discourage future doctors from taking up the career, as many cannot afford setting up their medical practices on top of their education bills, Campbell said.

"The best and brightest will be pushed away and will go on to study law and business," Campbell fears. "There will be very little incentive to take on $250,000 in debt when you can't repay it and dig out of the hole."

"Now we are being pushed to do more with less — to see more patients for smaller reimbursement numbers, and yet the cost of supplying our office and taking care of staff and all those things we like to provide for them is very difficult," Campbell said.

"We have less time for individual patients than we used to. It makes me sad."

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