Wacky Maladies in Our New Medical Billing Codes

ICD-10 is almost here.

On October 1st, medical billing will become vastly more detailed. While ICD-9 has 14,000 diagnostic codes, ICD-10 includes more than 68,000. Meanwhile up from 4,000, hospital inpatient procedure codes will reach 87,000. To prepare, medical providers have been racing to hire coders, training personnel and creating billing protection systems just in case reimbursement is delayed or denied.

Where are we going? To the cost of bureaucracy.

But first, some history and wacky codes from ICD-10…

Classification History

In 17th century England, a statistical survey of childhood mortality rates was a beginning of using disease classification to grasp healthcare needs. Knowing they were coping with a 36 percent mortality rate of children younger than six years old from maladies that included convulsions, thrush, smallpox and measles, those researchers provided some of the earliest disease prevention data.

For our own ICD system, we can look to the International Statistical Congress which compiled the first version of the International Classification of Diseases in 1853. What we have now is the 10th version with the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services deciding what should be included. What we also have is a history of data collection that has facilitated disease prevention initiatives.

ICD-10 Humor

However, with ICD-10, the code list could be excessive.

The danger of knitting is covered by Code Y93.D1:

Other codes include getting sucked into a jet engine, burns while water skiing, a bizarre personal appearance and in-law relationship problems. The macaw injuries list has a code for getting bitten, one for getting struck and a third for “other contact.” Then, each of those have a separate code for the initial encounter, a subsequent encounter, and “sequelae.” Four of the codes for crocodiles cover bitten, struck, crushed, other contact. Bumping into a lamp post includes similar detail.

This is a hang gliding code list:

From: whyy.org

Our Bottom Line: Transaction Costs

The media has been having fun with odd examples. But the serious side is the transaction costs.

When I call CVS to renew a prescription, my time spent listening to irrelevant information from their recorded message creates a transaction cost. With cost defined as sacrifice, a transaction cost is what I could not do because of standing in line, filling out forms, making lots of phone calls. Under communism the long lines for everyday goods and services were such an expensive transaction cost that they helped to expedite the former Soviet Union’s demise.

Some people say that ICD-10’s 100,000 plus detailed codes create too high a transaction cost for medical billing.