By: Tamzin A. Rosenwasser, M.D.
On September 13, 2011, the Wall Street Journal noticed the Code Blue in the medical field. They have brought the coding disaster out into the open. Physicians have been dealing with the 18,000 codes of International Classification of Disease (ICD 9), coding their patients’ diagnoses, and the tests and procedures done, all for the convenience of the government and third parties. Now there will be ICD-10, with 140,000 codes, 70,000 for diagnoses, and the rest for procedures. It’s laughably absurd. Is there a code for “Driven insane by ICD-10 codes?”
ICD-10 code books will be larger, no doubt more expensive, and ridiculous. There is no way to come up with a code for the nuances of everything that happens in life, and it is sheer lunacy to try. But someone is trying to shoehorn medical events into 140,000 codes. Who cares whether it was a macaw or a parrot that bit someone? There are nine codes for each of the birds. You can be bitten, struck, or have “other contact with” a macaw, an initial encounter, a subsequent encounter, or sequela. Could petting a macaw be construed as a medical problem if someone got a rash from it? Would you code it “other contact with macaw” or “eczema”?
Pat Brooks, of the Medicare/Medicaid program, is quoted as saying it is for “accuracy of data and quality of care.” What will really happen is that physicians and “billing experts” will be overwhelmed by this flood of trivia. Instead of one code for a poorly healed fracture, someone will be expected to sift through 2,595 codes for the specific type of poorly healed fracture. But they won’t do it. The code for refusing to do something like that is XOX.01.AE.3, which is “perverse human nature pathologically gumming up government work.” Having more than 2,000 codes will not help reduce poorly healed fractures. The data will get less accurate, I predict, because even trained coders will default to some wastebasket code when faced with the bewildering array in ICD-10.
This is an example of our national obsessive-compulsive neurosis. Code E993.8 is “unintentional explosion of own autocannons.” There’s a code for “nostalgia,” and one for “execution, legal.” Regrettably, there is no code for “bad karma.” The codes change all the time, so maybe that will be remedied in an upcoming version.
Donna Pickett, medical systems administrator at the Centers for Disease Control and Prevention (CDC), says codes detailing sites of injury, such as in a chicken coop, “could be important as for surveillance activities.” Does she envision outlawing chicken coops if a certain number of people are injured in them? How about code V91.07XA, “burn due to water-skis on fire, initial encounter?” There’s a code for drowning while jumping from burning water skis. How many times are water skis ever going to catch on fire? What difference does it make? Will we have a mandate that water skis must be fireproof? How about a warning: “Caution, serious burn or drowning may result if water-skis catch on fire?”
Another bureaucrat says it’s like a phone book: “All the numbers are in there. Are you going to call all the numbers? No. But the numbers you need are in there.” However, it is more like having 2,000 numbers that all ring the same telephone. What’s the point? It will slow doctors down. There is no good excuse for such exhaustive record-keeping.
If the Wall Street Journal thinks Sarbanes-Oxley and Dodd -Frank are a drag on business, they should visit a medical practice and see the chaos caused by all this.
If we really wanted to survey what’s going on, how about some codes for what the Congress, Courts, and President do? Code XF0.013.0.BLI; “voted on bill without reading it.” Code TREaa.1984 could be “went along with what Felix Frankfurter told William O. Douglas, viz. “If we can keep (Charles Evans Hughes) on our side, there is no amount of rewriting of the Constitution we cannot do.” Code XK.208.CCL could be “played golf, 3 over par, during financial crisis.” Oh, wait, mistakes are criminal fraud. The code should be XKa.208.CCL, “played golf, 3 over par, during financial meltdown.
Dr. Tamzin Rosenwasser earned her MD from Washington University in St Louis. She is board-certified in Internal Medicine and Dermatology and has practiced Emergency Medicine and Dermatology. Dr. Rosenwasser served as President of the Association of American Physicians and Surgeons (AAPS) in 2007-2008 and is currently on the Board of Directors. She also serves as the chair of the Research Advisory Committee of the Newfoundland Club of America. As a life-long dog lover and trainer, she realizes that her dogs have better access to medical care and more medical privacy than she has, and her veterinarians are paid more than physicians in the United States for exactly the same types of surgery.