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Dr. Campbell: Ridiculous codes overwhelm doctors

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Dr. Kevin Campbell shares his medical expertise with WNCN every Wednesday morning and also contributes his blog and health tips to WNCN.com.

When I was in medical school in the mid-1990s at Wake Forest University, the only thing I knew about "codes" was how to use an ATM machine (which was often linked to a very empty bank account).  As my training progressed through internship, residency and fellowship, the idea of coding provider services never even crossed my mind.

No one taught me anything about the "levels of service" or what an ICD-9 (The International Classification of Diseases) code actually was even though the coding system has existed for more than 30 years.  I remember my teachers and mentors scribbling on a card in the front of the chart whenever they interacted with a patient, but I had no idea what the exercise was about.  Years later, I am all too familiar with coding of patient services.

Billing codes serve as a way for the Center for Medicare and Medicaid Services (CMS) to create a payment schedule for services rendered based on diagnoses.  Each diagnosis is given a particular code and then there are "modifiers" that attempt to make the billing code more specific.  Government bureaucrats created a massive list of poorly contrived codes that have been utilized for the last decade known as ICD-9.

Over the years, those responsible for these codes have realized that in order to accurately document medical conditions and improve billing accuracy (and reduce fraud) that these codes are in need of updates.  Thankfully, our government has been working on this new system tirelessly over the last several years.  In fact, the Wall Street Journal reported on the development of this new brilliant system as early as 2008.  

Next year, the new set of billing codes will go into effect–they have been created with the goal of improving the specificity of the diagnosis and improving care (through quality measures).  This brilliant work and expansive list of new codes (approximately 150,000 codes as compared to the current 18,00) includes such ingenious diagnoses as code W5621XA "bitten by an orca, initial encounter."

Another important code that has been created is the commonly used W6112XA-"struck by a macaw".  As a practicing physician, I am relieved that when the next patient who visits my office after suffering "a burn due to water skis on fire"–I can quickly and easily document the encounter using the ICD-10 code V9109XA.

As government seeks to continue to regulate healthcare and contain costs, it seems to me that our efforts in reducing costs and improving quality of care are a bit off track.  Instead of working to improve efficiency and reduce redundancy in healthcare, we are now focusing on creating codes for injuries that may only occur to Wile E. Coyote during an epic battle with the RoadRunner.

As a physician, I have been required to complete nearly 20 hours of online training to help me understand the new ICD-10 coding system.  After an endless marathon of computer modules, I still have no idea how or why the ICD-10 system will improve my ability to care for patients or improve either the efficiency or quality of care in my practice.   In fact, I am certain that the new coding system will actually add more hours of documentation to my already burgeoning pile of electronic paperwork.

Eventually something has to give - there are only so many hours in the day.  Personally, I would rather see patients and care for those that need my help rather than coding for an attack by a talking bird or a personal watercraft injury due to burning water skis.

Our healthcare system has lost its way.  The new coding system is just one example of misplaced priorities within regulatory agencies.  Instead of creating codes for ridiculous scenarios, we should be training docs to provide thoughtful efficient care. We should be teaching doctors to communicate with each other about patient care and to avoid unnecessary testing.

Time, money and energy could be much more effective if spent on engaging patients in preventative care strategies and modification of risk factors.  Until then, I can at least sleep well tonight knowing that there is in fact an ICD-10 code for the next patient who walks in my office after being "hurt at the opera" …I will be able to quickly use code Y92253.

Please note:  All of the codes mentioned in this blog are real. They are all part of the 150,000 codes that doctors and billing specialists are supposed to know and implement in the next year.  You can verify all codes by using this ICD-10 code look-up website

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