Medical Diagnosis Code Changes

[MBSC]

If an insurance company denies a covered medical procedure performed on or after 10/1/15, it may be because a new ICD-10 diagnosis code was either submitted incorrectly by the provider or processed incorrectly by the insurer. Bring any unexpected denials to the attention of the provider and insurer.

Providers must code all claims with an October 1, 2015 date of service in ICD-10. Most providers won’t start to see any ICD-10 claims returned – paid or denied – for at least a few weeks.

“ICD-10 levels the playing field,” said Thea Campbell, MBA, RHIA, Director of Health Information at Cedars-Sinai Medical Center. “Gone are the days of being able to say, ‘I have 30 years of coding experience.’ Starting on October 1, we all have one day of coding experience.”“Don’t wait until you start to get coding denials before you audit your coders,” Campbell warned. “It’s important to proactively identify errors and take steps to correct them as they occur.”

Technical problems may also rear their ugly heads as payers attempt to process ICD-10 documents. While CMS has assured providers that its systems are up to the task, private payers have been less vocal about their readiness. It may take several weeks to identify any processing issues, and even longer than that to ameliorate them.

Source: ICD-10 is Here, but October 1 Isn’t the Date to Worry About - HealthITAnalytics
History of ICD-10: https://www.webpt.com/blog/post/history-icd-10

 

[gauss]

If an insurance company denies a covered medical procedure performed on or after 10/1/15, it may be because a new ICD-10 diagnosis code was either submitted incorrectly by the provider or processed incorrectly by the insurer. Bring any unexpected denials to the attention of the provider and insurer.

Source: ICD-10 is Here, but October 1 Isn’t the Date to Worry About - HealthITAnalytics
History of ICD-10: https://www.webpt.com/blog/post/history-icd-10

I had a significant issue with this sort of thing last year. DW's pap smear codes had changed and insurance company was saying "not a covered benefit". I knew that this was a required benefit and kept digging.

As it turns out DW's employer maintains the list of covered procedure codes that they send to the insurance company (employer is actually self-insuring).

The employer did not update the list to reflect the new codes in use for pap smears. The provider used the new/proper codes. The insurance company apparently did not vet the list provided by the employer and just rejected claims.

I wonder if all the other employees whose claims were rejected were made whole or not after they corrected our claim.

-gauss

 

[braumeister]

I had a doctor visit yesterday, the first day of this.
After discussing my problem, the doc proceeded to navigate screen after screen of complicated stuff in order to code the visit and also schedule me for an MRI.

While struggling with it, he said "We didn't have this system the last time you were in here, and I'm still getting used to it."

I replied "Is it progress, or just change for the sake of change?"

His response was "It's change for the sake of Obamacare."
Then we had an interesting discussion that would be inappropriate here.

I don't want to get into that, but I honestly feel sorry for professionals who have to bear the brunt of changes wrought by bureaucrats.

To the OP: I'll report on how my visit is handled in the system, since I'm apparently one of the first to experience it.

FWIW, I'm on traditional Medicare with TFL as supplemental. So far, I've had zero problems with this coverage.

 

[EastWest Gal]

I had a doctor visit yesterday, the first day of this.

After discussing my problem, the doc proceeded to navigate screen after screen of complicated stuff in order to code the visit and also schedule me for an MRI.



While struggling with it, he said "We didn't have this system the last time you were in here, and I'm still getting used to it."



I replied "Is it progress, or just change for the sake of change?"



His response was "It's change for the sake of Obamacare."

Then we had an interesting discussion that would be inappropriate here.



I don't want to get into that, but I honestly feel sorry for professionals who have to bear the brunt of changes wrought by bureaucrats.

Your discussion of this with your doctor was probably full of negative opinions and blame of someone else for his frustration. It seems that we humans are very good at never letting the facts get in the way of our opinions.

ICD is an abbreviation of International Classification of Diseases. The U.S. is one of the slowest adopters of the ICD-10 system. Classification of diseases dates back to the 1890s. Work on ICD-10 began in the 1980s, just after ICD-9 was launched in 1979. The system was completed in 1992, and countries started adopting it soon after. The Czech Republic adopted it in 1994. Canada adopted it in the early 2000s, China in 2002, France in 2005. Most countries have already implemented ICD-10. We docs have known about this for s very long time.

Our own National Center for Healthcare Statistics started working on a U.S. version in 1992 and released it for public comment in 1998. They recommended to the Department of Health and Human Services that ICD-10 be adopted in 2003. I've been hearing about this for over a decade. The deadline for implementation has been pushed back several times, for several years, before the launch occurred yesterday.

This paper explains the history of this rather well:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692324/

This classification system has nothing at all to do with the ACA, and predates the passage of the ACA by about 20 years. Obama was a high school student when ICD-9 was adopted, and was a few years out of law school when the first countries started implementing ICD-10.

I have filled in a few days with my old group due to one of them being injured in an auto accident. I worked today and found the coding much more precise, something a geek like me actually likes. It's a learning curve to be sure, but I could see better patterns in the new codes, making them eventually easier to find. It would be almost impossible without computerized coding systems in place, though.

In my career I have had to look at medical records in other languages, and that has been a real challenge. Today I had patients from Niger, Nepal, Pakistan and Peru. Imagine just using the letters and numbers of an international coding system, I would be able to hone in on the part of those medical records that was most important to get translated.

This system that your doctor blamed on Obamacare has nothing to do with politics or bureaucrats. It is from the World Health Organization, and has been tweaked and worked over for decades. It is meant to be a communication tool and helps insure accurate and honest billing practices. I'm sorry your doctor was so frustrated. However, don't you think it a bit disingenuous that he blamed the the ACA for his own ill-preparedness? The two are not linked at all, except in the minds of the opinionated and the ill-informed.


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[EastWest Gal]

For fun, here are some of the wackier codes docs need to wade through:

http://exclusive.multibriefs.com/content/17-specific-bizarre-icd-10-codes/healthcare-administration




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[iac1003]

+1 to EW Gal's explanation.


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[samclem]

This system that your doctor blamed on Obamacare has nothing to do with politics or bureaucrats.

Can the doc get paid if he doesn't play this little coding game? It definitely has everything to do with bureaucracy (the doc does not need to know the codes in order to make patients better--and that's the reason we go to doctors, and probably why he went to med school). I fully understand and appreciate the frustration of a medical professional who sees this as an ancillary duty, and who resents any complexity that takes him away from providing care. Last month he knew the codes, now they've been modified and he has to do things differently and that leads to more steps and more time spent feeding the "machine"--and it does not help the patients he sees one bit. And I fully understand and appreciate that bureaucrats and administrative personnel (crucial to making everything work) love these coding systems and want doctors, nurses, and other direct care providers to behave like compliant parts of the bigger machine. And to please not complain to the patients about the machine.

 

[gauss]

I wish that in my engineering career, that I only had to satisfy a change in corporate requirements once every 30 years or so.

I am sure that most cash paying customers would not require ICD-10 coding.

Perhaps the physician could look into setting up a Direct Primary Care practice. I suspect that this will be a growth area for the foreseeable future.

-gauss

 

[razztazz]

I always hated change. Always seemed like some Big Prick in the Sky just getting his jollies. But let's not lie to ourselves. Sometimes things change and sometimes things need to change. Get with the g/d program and put that violin away.

 

[MichaelB]

First cold morning in the midwest this season brings out the curmudgeon in lot of us, eh?

 

[samclem]

I always hated change. Always seemed like some Big Prick in the Sky just getting his jollies. But let's not lie to ourselves. Sometimes things change and sometimes things need to change. Get with the g/d program and put that violin away.

Agree with all. And, that sometimes "the system" doesn't change for the best, or is changed so that "dumb" things are optimized (e.g. lowest immediate cost, least trouble for administrators) at the expense of "smart" things (e.g. lowest long-term costs, best value, allowing doctors to have enough productive time with patients).
Anyway, being a health care provider is a job as well as a calling, they should know that there will be unpleasant parts of the job as well as rewarding parts of the job (just as all of us have experienced). But I don't expect people to whistle a happy tune as the admin pile gets higher and higher. And, as we said in the military--"a bitching soldier is a happy soldier." It's when they stop complaining that a mutiny is afoot.

First cold morning in the midwest this season brings out the curmudgeon in lot of us, eh?

Well, there may be some of that.

 

[rodi]

Interesting that the doctors on the board are defending it, in an informed way.
Thanks EastWestGal.

While I understand razztazz's "change is bad" attitude... It sounds like, in this case, there are legitimate medical reasons to adopt the not-so-new code and finally get into the late 20th century - if only for continuity of record keeping across national borders.

 

[MichaelB]

Interesting that the doctors on the board are defending it, in an informed way.
Thanks EastWestGal.

+1

The second link is priceless. The first condition on the list has affected me many times

Problems with the in-laws

and suspect DW, with the grandkids, is a carrier of another

Parental overprotection

Thankfully, no doctor visits for either, so far.

 

[razztazz]

Interesting that the doctors on the board are defending it, in an informed way.
Thanks EastWestGal.

While I understand razztazz's "change is bad" attitude... It sounds like, in this case, there are legitimate medical reasons to adopt the not-so-new code and finally get into the late 20th century - if only for continuity of record keeping across national borders.

Mmm...? I didn't mean it to sound that way. It was meant to be the opposite. Bad change is bad. Good change is good. When I was young it all seemed bad, and made up just to make me work harder.

But a la samclem, OK yes, sometimes it is bad but we are under no obligation or expectation to be perfect. If change is needed, or at east perceived to be needed, do the thing. If it amounts to a f-up or makes things worse.... try it another way.

The other type of change "Big Prick in the Sky Gettin' off on it", now that's just bad and is to be avoided and we have every right to complain about crappy needless changes. But now we're getting into the realm of a philosophy class.

 

[longranger]

EastWestGal,

The new system is an improvement and yes the US is a late adopter, however to label physicians that have high volume practices and resent the change is unfair. As you are doubtless very well aware, the growing morass of beaurocratic paperwork physicians are now required to complete greatly impedes their efficiency. They are forced to actually spend less time with patients and more time at a computer monitor filling out complex usually boring redundant paperwork.

More importantly the combination of keeping up with ever changing IT systems and the beaurocratic responsibilities cut sharply into time that would normally be utilized to improve ones skills, and keep up with the latest advances in the areas they specialize. This is a documented major contributor to physician burnout in the US.

So I agree that ICD-10 has nothing to do with Obamacare but it just is one more thing to learn that takes time and energy from what a doctor should really be doing, QUALITY PATIENT CARE!! I am practicing full time and in a similar stage of my career as you. "For us"
more senior physicians who are no longer trying to build our practices and grow our nesteggs, paperwork that aids quality assurance and research databasing can be somewhat gratifying to fill our. I cannot imagine starting practice now.

Oh one last thing since I am clearly ranting, LOL, the general public needs to know that there is no reimbursement for the growing data input/clerical functions that have been placed on physicians shoulders.