70,000 Reasons to Call In Sick

 

You may have missed the unveiling of the 10th version of the International Classification of Diseases (ICD) on October 10.  Known to its friends as the ICD-10, the list is a compendium of medical codes used to describe patient symptoms and the medical procedures used to address the problem.

Use of a standard code set across the healthcare industry is supposed to streamline billing, insurance reimbursements and even treatments. But ICD-10 now contains about 70,000 codes representing how an American can officially be ill, get hurt, or move on permanently to a better world.

If you have a  “burn due to water skis on fire,” – that’s a code V91.07XA. If you got hurt during your encounter with a UFO, that’s a code V9540XA (“Unspecified spacecraft accident injuring occupant, initial encounter.”) Code V9540XD covers “Unspecified spacecraft accident injuring occupant, subsequent encounter.”

Should you get hurt while you are paddling around in the prison swimming pool, that’s a Y92146. If you intentionally tried to harm yourself with cobra venom, it’s a T63042A. And if you “walked into lamppost,” were “struck by orca,” “bitten by a macaw,” were “wounded when playing a brass instrument,” or were “crushed by a human stampede while resting or sleeping” – fret not- there’s a code for all of those too.

ICD-10 codes are very specific. Take injuries caused by alligators, for example. There’s a code for being bitten by an alligator, another for being struck by an alligator, yet another for being crushed by an alligator, and even one for the somewhat alarming “other contact with alligator.”

The exhaustive nature of ICD-10 is further complicated by the need to mix and match codes to comprehensively describe a condition and its treatment. If you swallow a poison mushroom, for example, your bill might include about 19 codes.

To get reimbursed for providing care, medical professionals need to puzzle together the set of the right codes – diagnosis codes along with separate procedure codes – for each patient that they see.  Then insurers study the codes to determine whether those treatments were medically necessary.

The Centers for Medicare & Medicaid Services pushed for ICD-10, saying that ICD-9 (which has been in use since 1979), did not provide sufficiently detailed information about medical problems and procedures.  ICD-10 also includes a separate set of ICD-10 procedure codes, which has expanded from 4,000 in ICD-9 to 72,000.

Health care analysts are concerned that ICD-10 may lead to confusion, and may require longer patient visits to sort out all the details of a medical issue so that it can be exhaustively reported.

Medicare officials say they won’t deny claims solely for lack of specificity for the first 12 months. Providers just have to get the general category of illness correct until next October. Commercial insurers aren’t offering an extended grace period, and hospitals also have to begin using the correct procedure codes immediately.

Some analysts are predicting problems stemming from ICD-10, ranging from inaccurate medical bills to denied health services. A recent “survey showed 20% or more of physician practices have not received the billing system updates necessary for ICD-10” which could result in delays submitting and processing patient claims. An article in Forbes noted that health plan enrollees could see a delay in authorization for certain tests and procedures if doctors aren’t adequately coding the services. Insurance claims also could be refused.

It’s certain that use of ICD-10 will eventually become easier for healthcare professionals. That said, many people have the sense that the process of getting healthcare is unnecessarily complex.  If the thought of waiting even longer than usual at your doctor’s office while the kinks in  ICD-10 are worked out makes you feel a bit ill, look into a telemedicine plan.

The best telemedicine plans offer free consultations with local doctors 24/7 via phone or video chat,  along with access to a broad range of experts who can provide insight on virtually any health or wellness issue, as well as counselors on call will work with members to help resolve personal issues ranging from addiction to depression, stress, and loss. You can skip the doctor’s office, the emergency room or the urgent care clinic and still get the care you need – including prescriptions – for many common ailments.

Call us at 1-800-238-5163 to find out about how dental savings plans can help make quality dental care affordable.

 

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