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Doctors prepare for new codes to catalog illnesses

Nova Safo Sep 28, 2015
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The nation’s healthcare system is preparing for a big transition on October 1, when all healthcare providers and insurers will switch to a new coding system for cataloging various diagnoses.

The change is mandated by the Medicare system, and Sean Cavanaugh, the director of the Center for Medicare, said it’s overdue.

“The medical codes we use for diagnosis and billing haven’t been updated for over 35 years,” Cavanaugh said.

The result is that a lot of detail is currently missing, both for public health experts who may want to track illnesses and patterns, and for healthcare policy experts who may want to look at what’s working and what isn’t in the nation’s healthcare system.

“For instance, we recently had a … threat of a problem with Ebola. And the current set [of codes] does not have a code that’s specific to Ebola,” Cavanaugh said.

The new, more detailed codes will be important for the transition to a new way of paying doctors and hospitals — for results, rather than procedures.

In order to make that transition, the industry has to answer this question for each medical practitioner: “How sick is your population,” said Farzad Mostashari, founder and CEO of Aledade, a healthcare consultancy, and the former national coordinator for health information technology at the Department of Health and Human Services.

Mostashari said once we answer that question, we’ll know how good a job a doctor is doing in getting patients healthy. And that’ll help with the ultimate goal “to have [medical practitioners] share in the savings if you take better care of the patient and if they end up costing the system less.”

In the short term, the codes might also help hospitals and others bill certain insurers for additional ailments, bringing in more money. But that doesn’t mean all doctors are happy about the change. There are lots of complaints that there will be additional digital paperwork that doctors won’t be reimbursed for.

The American Medical Association expressed concern that while Medicare is offering a one-year grace period to doctors to ensure they get paid if they make honest mistakes in coding, all private health insurers and Medicaid have not expressly offered the same grace period.

“Questions remain if physicians will be forced to follow patchwork of disparate coding standards for each payer. The resulting confusion and inconsistency in claims processing would create unnecessary administrative costs and take resources away from patient care,” said AMA President Steven J. Stack, in a written statement.

Also, there are lots of snickers about the new codes getting too specific, such as ones that differentiate between an alligator bite versus a crocodile bite.

Medicare’s Cavanaugh said most doctors will only need to learn some of the new codes, not all 70,000. “If they don’t have crocodiles or alligators in their community, they don’t need to worry about those codes.”

There are also codes differentiating between an injury incurred at the opera house versus one at the library. Presumably, more doctors will have to concern themselves with those codes.

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