To improve medical care, we need more beans to count

The Pediatric Insider

© 2011 Roy Benaroch, MD

At a time when our country is nearly bankrupt and medical costs are eating up a huge part of our taxes (and our children’s taxes, and our grandchildren’s taxes), government and insurance-industry officials have come up with a scheme that’s sure to help: more diagnosis codes!

When you visit a doctor, we come up with a bill that includes a “procedure” or “evaluation and management” code, plus a “diagnosis” code. The diagnosis code is picked from a list of about 18,000 numerical codes from a real page-turner of a book called the “ICD-9”. Those 18,000 diagnosis codes include just about anything you could think of.

But not, apparently, anything anyone could think of. Starting soon, your doctor will have to use the new, expanded ICD-10, including 140,000 codes. Included are many new codes that are sure to be useful:

W5631XD  Bitten by other marine mammals, subsequent encounter (This covers manatee attacks, but not sea lion bites. Sea lions have their own code, W5611XD)

Y92253 Injured in an opera house (note that if one were bitten by a sea lion in an opera house, the doc would be required to submit both the Y92253 and W5611XD codes.)

V9027XA Drowning and submersion due to falling or jumping from burning water-skis, initial encounter (The water skis were presumably lit on fire to scare off marauding sea lions. In the opera house.)

(Thanks to the Wall Street Journal for this clever tool to help find ICD-10 codes.)

This is not a joke. Your doctors will be required to use these new codes, which will mean getting our billing systems up-to-date to accept them. For my practice, that requires upgrading our practice management software (to do that, we must also upgrade our server, database, and OS software.) Total cost: $42,000. That could have paid for some well-deserved raises or bonuses for my staff, or even for me to hire an extra nurse. Instead, I will gain the ability to bill for “V9135XA Hit or struck by falling object due to accident to canoe or kayak, initial encounter”.

So: I’ll spend practice money in a way that doesn’t benefit my patients one bit, but rather gives the administrative pygmies more beans to count. This will (predictably) lead to a need for more support staff, more consultants, and even more administrative pygmies to implement this huge new complication. I wonder if there’s an ICD-10 code for “Health care system, destroyed by its own administrative weight and senseless overhead”?