Archive for the Coding Category

ICD: Episode 10: Revenge of the Codes

Posted in Coding with tags on January 16, 2009 by drbobbs

Last October, I predicted that there was no way the health care industry would be ready for the ICD-10 code set implementation by 2011.  I wagered that it would be pushed back to 2012.  It looks like my prognostication was actually too conservative:

After receiving more than 3,000 comments on its earlier ICD-10 proposal, the feds now say medical providers will have until Oct. 1, 2013, before they have to use ICD-10, rather than a prior proposal of Oct. 1, 2011.

That’s nice, but it would be nicer if the plan was to eventually streamline and simplify the coding process.


Bounty hunters. We don’t need their scum.

Posted in Coding, Economics of Health Care, Health Care Policy, Practice Management with tags , , , on November 21, 2008 by drbobbs

Bounty HuntersDavid Bennett at Medical Economics reports on the Medicare Recovery Audit Contractor (RAC) program:

[P]rivate firms hired by CMS are charged with identifying overpayments and underpayments of the more than 1.2 billion Medicare claims submitted by U.S. health-care providers each year, including hospitals, physicians, skilled nursing centers, labs, and ambulance companies.

Since its 2005 inception, the program is reported to have collected nearly $1 billion dollars.  The program has nevertheless come under fire:

“It’s a bounty-hunter program,” says Elizabeth McNeil, vice president of federal government relations for the California Medical Association. “[RACs] have cost California physicians resources, time, and hassles for the modest amount of money they have collected.”

What’s going to happen when the RAC expands to cover all 50 states shortly before the ICD-10 code set is implemented which coincides with the planned 21% Medicare pay cut for physicians?  And, of course, we already have the never events nonsense.  One can almost convince one’s self that the government, realizing that Medicare is financially doomed, is trying to get all physicians to opt out of it so Medicare patients will have to pay their own medical bills.

The next few years are going to be interesting.

ICD: Episode 10: Attack of the Codes

Posted in Coding with tags on November 11, 2008 by drbobbs

From Jane Zhang at the Wall Street Journal:

[M]any doctors in private practice are expected to have to scramble to adapt to the new system’s greater complexity — especially because regulators are aiming for the new system to be fully in place within three years. Many doctors and insurers are lobbying to extend that deadline to about five years or more, and some say the new codes are unnecessary.

“They are not simple changes. All of that is going to cost money” to buy and install new software and train physicians, coders and nurses, says Tom Felger, a family physician in South Bend, Ind. He worries that in the short run, the five doctors in his practice will end up spending more time on paperwork and less time with patients.

CMS estimates additional costs to the medical industry of adopting the new coding system of $1.64 billion over 15 years.

Some medical-industry officials also are concerned that consumers could see, at least initially, an increase in billing errors. That can lead, for example, to overcharging of patients, or an insurer denying payment for a claim because it was submitted with an incorrect code. Some officials also expect an increase in billing fraud and more delays in payments to doctors and consumers.

One partial solution would be to eliminate ridiculous codes from the set:

I can be quite direct with my coding for any hapless soul who gets run over by a spaceship: “accident involving spacecraft injuring other person” (E845.9). Of equally dubious value is code E996, “injury due to war operations by nuclear weapons.”

ICD: Episode 10: The Coding Menace

Posted in Coding with tags on October 31, 2008 by drbobbs

Brandon Glenn at Medical Economics reports on the imminent arrival of ICD-10:

The U.S. Department of Health and Human Services’ planned transition to a new set of health-care diagnosis and procedure codes could lead to big cost increases to physician practices of all sizes, according to a recently released report from Nachimson Advisors, a Maryland-based health-care information technology consulting group.

The cost to a typical small practice of switching to the International Classification of Diseases, Tenth Revision (ICD-10) code sets within the HHS’ time frame will be more than $83,000.  Nachimson says a typical small practice is one that consists of three physicians and two staff members.

In August, the HHS announced that it would update universal health-care diagnosis and procedure codes with the expanded ICD-10 set and will require providers to fully implement them by October 11, 2011. Providers currently use the ICD-9 set, which was developed 30 years ago. HHS has called ICD-9 “outdated,” due to what it calls the codes’ “limited ability” to accommodate new procedures and diagnoses. 

For a medium-sized practice, the cost increase of the transition to ICD-10 will be in excess of $285,000, according to the report.

Dr. Wes can hardly wait:

Imagine, 290 codes just for diabetes! Yeeeee haaaaa! Diabetes with foot ulcers on the right foot gets one code, diabetes with foot ulcers on the left foot gets another code, diabetes with foot ulcers on both feet, but not involving the shins gets another code… I mean, a new code for every nuance of disease! You get the drift! Isn’t this SPECIAL? Just think of the COST SAVINGS those clever bureaucrats have found!

Given the costs and potential problems with this, I wouldn’t be surprised if ICD-10 implementation got pushed back to sometime in 2012.  Of course, that would constitute more of a reprieve than a solution.