Don’t panic

Do you remember the Y2K scare? When the calendar year turned over from 1999 to 2000 there was widespread fear that our computer-driven society would suffer some sort of mass meltdown and that apocalyptic-style crisis would ensue. It didn’t. 1/1/2000 was a day much like every other. All those stocks of canned goods and bottled water went unused, nothing exploded, no missiles launched – and we all breathed a sigh of relief.

Well, tomorrow (10/1/15) marks the first day of a new era in the medical world. The beginning of the ICD-10 diagnosis code system. It is a big, scary change; everybody hopes it goes smoothly, but if it doesn’t – it could be Y2K 2.0. The change-over has been put off for the last several years because of the huge amount of preparation it takes to ready the medical software and billing systems for the transition.

Keep calm and …

For those of you unfamiliar with diagnosis codes, here is a little look behind the curtain. When you go to your doctor for an appointment, you describe your symptoms, the doctor examines you and eventually comes up with a diagnosis. The doctor then writes an office note about your visit, recording any significant findings and maybe a line or two about the symptoms you described. The note is as short as possible since the doctor has to move on quickly to the next patient. This note is then made a part of your medical record and can be accessed in the future to verify what happened at that day’s appointment. One important component of your office note is the diagnosis code. This is a short sequence of numbers that describes what injury or illness you have.

This diagnosis code is included on a prescription that is then sent on to your pharmacy, any therapist who will be giving you treatment or anyone who might be fitting you for a brace or medical appliance. The diagnosis code is the only information that we (your Pharmacist, Therapist… in my case, Pedorthist) have about your condition unless we request a copy of the chart notes from the doctor. The diagnosis code is also the only information your insurance company has about your doctor’s appointment.

Follow the money

In an effort to be as profitable as possible, insurance companies do their best to avoid payment for what they deem to be unnecessary treatment. As a result, insurance companies check to make sure the diagnosis code matches a list of approved codes before agreeing to pay for any treatment. For example, if your doctor has prescribed that you wear a knee brace, your diagnosis code must be for a knee injury. The brace might be denied as “not medically necessary” if you just have a diagnosis for a knee bruise, since a bruise is not considered a serious enough injury to require a brace.

Usually this system works pretty well, the insurance companies save money by not paying for unnecessary things. The patients feel vaguely that their insurance coverage is not what it was cracked up to be, but they can’t do anything about it so they pay their bills and move on. Everybody (by which I mean the insurance company and the doctor) is happy. However, this already somewhat dysfunctional system is about to turned on its head.

Old vs. New

The old diagnosis code system was called ICD-9. It contained about 17,000 codes for your doctor to select. Most of the time, it was pretty easy to find a code that somewhat described your problem. If you only had 1 thing wrong with you, you might only have 1 diagnosis code, if you had multiple issues the doctor might use a combination of codes to describe your condition. ICD-9 codes also contained handy “catch-all” codes like this one (my personal favorite) 729.5 which means “pain in unspecified limb”. Ha ha. That’s like saying “Doctor, my leg hurts” and having him say “yes, that’s because your leg hurts…that’ll be $75 please”. But, I digress…

The new ICD-10 system contains 69,000 codes. This means that the physician must be much more specific about what exactly is wrong with his patient. Which is a good thing, it means that each patient’s medical record will now be more complete and contain a lot more information. No more lazy diagnoses, the codes now indicate if this is a new or old condition, how it occurred, and a lot more details about what exactly is wrong. There is a code for everything, this is an actual, real code:  W59.22XA = Struck by a turtle, initial examination. How does that even happen?

What does this mean for you?

Unless you are in the healthcare industry, you don’t have to change much about your daily routine after tomorrow. You may not even notice the transition from ICD-9 to ICD-10. But if (as I suspect) the change-over is a little bumpy, you may notice a snafu or two. For one thing, it will now be easier for an incorrect diagnosis code to be applied to your chart. The physician choosing the code is most likely working with software that helps him choose from a list of possible diagnoses, these lists are long and confusing. It is very easy to click the wrong code and next thing you know you have been diagnosed with an injury from a turtle strike.

You, as the patient, should always know what your medical record says. You can help ensure continuity of care by being well-informed. Remember, you are one of many patients being seen in a busy office and it is very easy for mistakes to be made. You are in charge of yourself. Be your own advocate and make sure a simple data entry error isn’t getting in the way of your treatment. You can google your ICD-10 codes to make sure that they make sense. If you have a question, don’t be afraid to ask. (But as a tip, be cognizant of the fact that your doctor is probably in a hurry – be brief, be courteous).

The other thing you need to know is that insurance approvals might take a little bit more time than usual in the next few weeks. This is because they are busy checking everybody’s new codes to make sure that the treatment is still “medically necessary”. With these new, more complicated codes there is much more information to sift through.

If you have any kind of doctor’s appointment tomorrow, bring a treat for your physician and especially for the office staff. It is going to be a long and hectic Thursday. Expect delays. Hopefully this new system will lead to better quality care in the long run. Only time will tell.

Walk well!