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I recently wrote about some of the impacts that government regulations around the Affordable Care Act are having on small medical practices. One of those differences has to do with coding. These codes are established by the World Health Organization, part of the United Nations, in a medical classification list called the International Statistical Classification of Diseases and Related Health Problems, usually just called “ICD.” This is really two lists: a list of diagnosis codes and a separate list of procedure codes.

The current set, ICD-9, has about 13,000 diagnosis codes and 3,000 procedure codes. The 30-year old ICD-9 suffers from several problems: it lacks detail, uses generic terms, is based on outdated technology,and has limited capability to add new codes.

The new set, ICD-10, addresses those problems. It provides for up to 68,000 diagnosis codes and 87,000 procedure codes.

In a recent one-week nation-wide test involving over 127,000 claims from 2,600 health care providers, suppliers, billing companies and clearinghouses, only 89% of the claims were accepted without issues. This test involved claims from only about 5% of potential claim submitters, and only included those who agreed to be part of the test and had been working on this conversion for years. After October 1, 2015, claims that do not use ICD-10 or have issues with the ICD-10 codes will not be processed, and claims not processed will not be paid. The official position: physicians are urged to set up a line of credit to mitigate any cash flow interruptions that may occur.

As you can imagine, there are some fairly unusual codes. One that has made the NPR circuit is V91.07: burn due to water-skis on fire. But NPR did not get the story correct. V91.07 is an invalid code; you must use one of the three subservient codes to describe the diagnosis in greater detail:

  • V91.07XA – initial encounter
  • V91.07XD – subsequent encounter
  • V91.07XS — sequela

A “sequela” is a chronic condition that is a complication of an initial event.

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For some reason, there are different sets of ICD-10 for different countries, so for those of us who travel to foreign countries, there is likely to be some confusion with your insurance provider and local healthcare facility if you are injured or sick outside your home country.

Many organizations have already been working on this conversion for a few years. There are also lots of companies out there to help medical staffs make the transition. For example, Find-A-Code has search solutions for small practices ($300/year) and larger facilities ($950/year).

Like a lot of things in the Affordable Care Act, the end result of the convesion will be beneficial to patients. Getting there will be a really interesting ride, and will contibute to the loss of small medical practices with potentially a significant negative impact in rural areas.

The real concern will be the significant number of coding errors during the transition. Each diagnosis coding error can lead to health workers adminstering the wrong procedures, especially as patients are shifted between doctors and other care providers in larger medical organizations.

The last word:

Considering the large number of people who have access to your health care information, and the number of breaches in personal health care data, you should be concerned over misuse of your data. Certainly the government will have access. Expect companies, perhaps legally, to offer your health care information to your current or potential employer, and certainly to your insurance providers.

Read carefully the fine print around any job or insurance application you submit. You may be granting them access to all of your medical data as well as your financial data as part of a “background check.” HIPAA actually treats much of your medical information as a valid part of your employment record. This includes anything related to drug testing, Family and Medical Leave Act, Americans with Disabilities Act, Occupational Safety and Health Administration, workers’ compensation records, sick leave or return to work documents, and anything related to a drug or alcohol free workplace.

There are legal restrictions on what a company can access or ask for, but if you say “yes” in a job application all bets are off.

Comments solicited.

Keep your sense of humor.

Walt.

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