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New medical codes offer more detail

Marketplace Staff Sep 13, 2011

New medical codes offer more detail

Marketplace Staff Sep 13, 2011

Kai Ryssdal: If you go to the doctor for, say, a sprained ankle — it’s an entirely different thing than going to the doctor for, say, the flu. Not so much different for you and me. We just want to get better.

But it’s very different for your doctor’s bookkeepers, who fill out insurance forms — not with an actual description of your ailment – but with a number, a code, that corresponds to whatever’s wrong with you.

Sounds like a boring thing for us to be talking about? In truth, it’s kind of a funny story. Anna Mathews wrote it up in The Wall Street Journal today. Anna, good to have you with us.

Anna Mathews: Good to be here, thank you.

Ryssdal: I sort of can’t believe I’m asking this question, but what’s going on in the medical coding world? It’s a little crazy.

Mathews: Well, what’s happening is that we are moving to a new coding system. It’s going to start in 2013. It expands the number of codes from around 18,000 to around 140,000 and there’s a whole lot more detail there.

Ryssdal: I imagine so — 18,000 to 140,000. Let’s remind people what these codes are. They’re on the forms that your doctors fill out when they see you.

Mathews: Yes. They are not codes that you would typically see, but it’s in the claim that your doctor of your hospitable would send to your insurer and that’s how medical providers talk to insurers. They send them these forms with lots of numbers that say exactly what they did and exactly what the diagnosis was that the patient had.

Ryssdal: And you can see the need for these, but there’s a level of detail that you write about this morning. And I chuckle because I was actually laughing when I read the piece. I’m just going to read a couple off here. You ready? Favorite one of all time: V91.07XA, which is you say a burn due to water skis on fire. I mean, really?

Mathews: Really. It is in there. You can look it up, as they say.

Ryssdal: But why?

Mathews: I’m not sure I have a good answer for that. The code set was developed by the federal government, so you’d have to ask them. But the suggestion I had from a coding expert was perhaps it was a code for trick skiers who are going through hoops of fire. That’s the best we could come up with.

Ryssdal: All right, so here’s another one: W22.02XA, walked into a lamppost, initial encounter. Or W22.02XD, walked into a lamppost, subsequent encounter.

Mathews: Indeed. And in fact there’s a third code for walked into lamppost, sequela — which means sequels or further follow-up visits.

Ryssdal: You’re making that up!

Mathews: I am not making that up. There are three walked into lamppost codes. It must have been a very severe encounter.

Ryssdal: Must have been, right? And entirely sober, I’m sure. You talk to people who do this for a living and granted there’s a need to track this stuff and make sure that we know what’s happening in a public health sense, but why this level of detail?

Mathews: Well, what the federal agency said when I talked to them was that it would lead to better tracking of what’s actually being done, which is good for research. From a public health perspective, what they said is it’s helpful to be able to know where injuries occur so that public health researchers can work on ways to prevent them.

Ryssdal: Is this going to do anything to make health care cheaper or more efficient?

Mathews: It depends on who you talk to. There is an argument that having more detail in this medical claims could lead to improved payment strategies because insurers and the federal government, which pays for a lot of health care, will have a better sense of what it’s paying for.

Ryssdal: And in all seriousness, data codes are serious stuff when you start getting to electronic medical records and transmission of information and all that stuff.

Mathews: It’s very important and it’s also how your insurer knows, as I said, what they’re paying for and what’s going on with you. So one interesting side effect is insurers will get a lot more information about their members, about patient. You mentioned the water skiing code, but my insurer might never have known in today’s world that I was a water skier. But now they might be able to see in the coding, in the bill that they receive, that I received an injury while water skiing.

Ryssdal: And maybe I’m going to have to pay for more in my insurance, hello?

Mathews: You never know. Starting in 2014, we’re not supposed to pay more based on our health status. But until then…

Ryssdal: Anna Mathews from the Wall Street Journal. Anna, thanks so much.

Mathews: Thank you.

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