There is a reference book used in the medical professions and the insurance industry called the International Classification of Diseases. It gives a code for the various diagnoses. Insurance companies and the government Medicare administrators can set a price for each affliction so as to determine reimbursement rates.
The previous 9th edition had some 14,000 entries. The new 10th edition has 68,000. And they are really specific:
- getting struck or bitten by a turkey (W61.42 or W61.43)
- injuries caused by squirrels (W53.21)
- getting hit by a motor vehicle while riding an animal (V80.919)
- spending too much time in a deep-freeze refrigerator (W93.2)
Americans spend $2.8 trillion each year on medical care. These codes determine how that fortune — nearly one-fifth of the nation’s economy — gets divvied up among thousands of hospitals and the doctors who work there. It is how the federal government, and most private health insurers, assess a value for each patient visit.
The prospect of quadrupling the number of medical codes used in those calculations has touched off a heated debate over whether more specificity is an onerous layer of bureaucratic red tape — or a valuable chance to better understand and treat complex medical conditions.
The codes in ICD-10 can seem absurd in their granularity, replete with designations for seemingly impossible situations.
There are different numbers for getting struck or bitten by a turkey (W61.42 or W61.43). There are codes for injuries caused by squirrels (W53.21) and getting hit by a motor vehicle while riding an animal (V80.919), spending too much time in a deep-freeze refrigerator (W93.2) and a large toe that has gone unexpectedly missing (Z89.419).
At the AAPC conference in San Francisco, the organization sold shot glasses inscribed with “F10.950” — the code for an unspecified alcohol-induced psychotic disorder. “Give ICD-10 a shot!” it says in blue script.
Hospitals and insurers have fought the new codes, calling them a massive regulatory burden that will cost them billions of dollars to implement without improving patient care. For years, their protests succeeded: The federal government has twice delayed implementing the new code set, which was initially set for 2008.
ICD-10 proponents contend that adding specificity to medical diagnoses will provide a huge boon to the country. It will be easier for public health researchers, for example, to see warning signs of a possible flu pandemic — and easier for insurers to root out fraudulent claims.
“How many times are people going to be bitten by an orca? Probably not very many,” said Lynne Thomas Gordon, chief executive of the American Health Information Management Association. “But what if you’re a researcher trying to find that? You can just press a button and find that information.”
Gordon notes that the United States relies on the last edition, written in the 1970s. “We are so far behind we can’t compare data with other countries,” she said.