Medical Industry Hit With New Procedures

It’s hurricane season, but a tsunami will hit the medical industry on Oct. 1 this year. By federal mandate, almost all medical billing must use diagnostic and procedural codes from the ICD-10 (International Classification of Diseases), moving from the ICD-9 system that has been used for the last three decades.

The World Health Organization (WHO) adopted the ICD-10 system in 1990, for implementation in 1994. ICD-11 has already been developed, yet we are being pushed into ICD-10, even though it will be superseded in a couple of years.

ICD-10 is a massively more complex system with much greater diagnostic detail, including laterality (left vs. right). The number of diagnostic codes in ICD-9 jumps from about 14,600 to almost 70,000 in ICD-10.

Procedural codes shoot from about 5,700 to 72,600! ICD-9 uses a maximum of 5 digits in a purely numerical code. ICD-10 uses a letter, then a number, then 5 possible alphanumeric figures, greatly increasing the number of possible codes.

For example, there are 9 different codes for pressure ulcers in ICD-9, and 125 possible codes in ICD-10. The 12 codes for fractures of the femoral head and neck in ICD-9 explode to 576 codes in ICD-10.

Implementing ICD-10 will impact every system, process and transaction that contains or uses a diagnostic or procedure code. Insurance contracts with ICD-9 codes must all be reworked, and legal evaluation of these new contracts will be needed.

The transition from ICD 9 to 10 will be more costly and onerous than those required for the Diagnosis Related Groups (DRG), the Health Insurance Portability and Privacy Act (HIPAA), and Y2K combined. It is the biggest change to the medical care system since the creation of Medicare in 1965.

Cost estimates for implementation of ICD-10 nationwide vary from $5.5-13.5 billion. Only $0.7-7.7 billion in “benefits” due to improved “functions” are anticipated over the next decade.

Thus, costs far exceed benefits and are borne almost entirely by providers, that is, hospitals and medical practices that will be forced to submit bills using the new codes.

Is it any wonder doctors are selling their practices and moving into the hospital structure at an increasing rate?

What exactly are the benefits? It is frankly hard to discern any practical benefits for physicians or patients. The masterminds now in control of medical care simply want more granular data to enhance their ability to dictate practice.

Here is a partial list of the rationale for more complex data, from proponents:

• Measuring quality, safety and efficacy of care.
• Designing payment systems and processing claims.
• Research, epidemiology and clinical trials.
• Setting health policy.

Obviously, this is about ratcheting up central control over the practice of medicine. It’s inconceivable this will improve patient care. By diverting attention and resources away from patient care, it will cause a deterioration in quality of care.

Practice will increasingly be transitioned to algorithm, with loss in the ability to individualize care. It’s also inconceivable that meaningful clinical research will be generated from this massively increased amount of (mostly useless) information.

On a practical level, hospitals and medical practices will need to employ full time “coders” who will be tasked with assigning codes in a way to produce maximum reimbursement from the payer.

This is the same game that was perfected after the conversion to the DRG system for hospital payments during the 1980s. Since fee-for-service is to be replaced by “payment for quality (outcomes),” payment will need to be adjusted for severity of illness.

Creative coders, using the infinitely more complex ICD-10 system, will strive to convert a common cold to a double pneumonia to justify a higher “bundled” payment.

The central takeover of medicine is nearly complete. ICD-10 is going to hit, and hit hard. Unless more physicians opt out of this system and return to practicing Hippocratic medicine with strict confidentiality of information, individualized medical care in the U.S. will be swept away.

Since 1990, Dr. Amerling has been on staff at the Beth Israel Medical Center (now Mount Sinai Beth Israel) in New York. He served as director of Outpatient Dialysis from 1995-2012. Amerling is board certified by the American Board of Internal Medicine for Internal Medicine and Nephrology. He also is president of the Association of American Physicians and Surgeons. He has been published in many journals. For more of his reports, Go Here Now.