Are You Kidding Me?

By Dr. Gary Prant DPM, Arbor Foot Health Center

Perhaps you have read articles about the new ICD-10 diagnosis code system which is going to be implemented in the United States by October 1, 2014. Every condition a doctor sees is coded numerically. The current system, ICD-9 has been in use since the 1970s. It provides about 17,000 numerical codes to describe various medical conditions. These codes are used for accounting purposes by physicians’ offices, hospitals, and insurance companies. On October 1 the number of diagnosis codes will increase from about 17,000 to 155,000.Medical Files

 Some people actually think that increasing the number of diagnosis codes from 17,000 to 155,000 is going to increase diagnostic accuracy or have tremendous value for research.

According to experts, the level of detail required by the new diagnosis code differentiates between injury by a brass instrument or a string instrument and has different codes for being bitten by a squirrel the first time and being bitten by squirrel again another time. There are six separate squirrel related codes, 11 different codes for dog related injuries and 23 different codes for lizard injuries.

According to a spokesman for CIGNA insurance company, “whether you get hurt in a restaurant or a movie theater might not mean much to a doctor or patient but it could come in handy for certain types of research and insurance matters.”

According to Matt Katz president of the Connecticut State Medical Society, “some of it does help with reporting and tracking infections and even pandemics. So there is benefit, but the costs outweigh those benefits right now.” He continued, “It is fearful for many physicians because it could be financially catastrophic for many practices, it’s thousands and tens of thousands of dollars per practice, and in some cases per doctor. It’s cost prohibitive for many physicians.”

Let’s be realistic. It is extremely likely that a busy physician is not going to pick the exact correct code in a system as complex as this new diagnostic classification system. For a busy practicing physician the first priority is to carefully listen to patients, thoughtfully evaluate their problems, formulate and then implement a treatment plan. Taking the exactly correct diagnosis code in a diagnostic classification system which has 21 different codes for lizard injuries is a lower priority for most busy physicians.

Of course all patient encounters will have to be encoded with the new coding system but here’s the reality of it: doctors will most likely use a few codes over and over. The medical data collected will be skewed because of the overly complex diagnostic classification system. Is a busy doctor is going to bother to classify 21 different lizard injuries or six separate squirrel classifications? (As an aside isn’t it amazing that there are so many different kinds of lizard injuries!)

Whenever you make a data collection system too complicated the data becomes suspect. Come on; does anybody think the data collection from this mess is going to yield honest and valuable conclusions?bigstock-Baby-Iguana-38438962

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