Letter to the Editor: Ever Been Bitten by a Killer Whale?

Dear Editor,

Ever been bitten by a killer whale? Have you sustained burns while waterskiing? Been hit by a spaceship? Know someone who was sucked into a jet engine more than once? Though these sound bizarre, if a new and controversial medical coding system goes into place a year from now, those are exactly the kind of questions doctors across Alabama will soon have to ask patients in order to list a patient’s diagnosis and treatment plan.

When a patient is examined by a doctor, the patient’s diagnosis and treatment plan are “coded” by the doctor. Each diagnosis and prescribed treatment, everything from broken bones and sprained ankles to more serious incidents such as cardiac events and strokes, has a code number. These codes are established by the World Health Organization to classify diseases and other health-related problems.

The present list of codes being used, ICD-9 (International Classification of Diseases, 9th Edition), contains roughly 13,000 codes. While updates are periodically required to keep up with changes in medicine, the switch from ICD-9 to ICD-10 is massive, with nearly 70,000 new and oftentimes bizarre codes that will add little or nothing to the care of patients. Indeed, in most cases, it will require considerably more time than the current system to find the right code, taking away from the time a doctor can spend with his or her patient. Everyone involved in the delivery of health care who submits claims to insurance companies – from doctors to hospitals – will be affected.

In theory, these new codes could allow for better tracking of health threats, like infectious diseases. But, there’s no indication that switching coding systems will really improve the care of patients. Health care should be about the patient, not the paperwork.

The Medical Association of the State of Alabama believes there has not been enough testing of this new system, particularly in rural areas, like so much of Alabama. Do Americans really need a code for “hurt at the opera?”

Bizarre codes aside, this issue is quite serious and the stakes are high. Patients trust their physicians to diagnose and treat them to the best of their ability so the patient’s health can improve. But if physicians can’t find a code or put down the wrong code, insurance companies may delay or even deny necessary treatments.

While better testing by the federal government would ease some of the concerns my colleagues and I have regarding ICD-10, there’s little or no indication that this totally new coding system will improve delivery of health care. I can’t help but wonder whether the switch to ICD-10 might mirror the launch of Healthcare.gov, which technicians are still trying to debug. Patients can’t wait that long for their treatments.

While our medical coding system may need updating, now is not the time as the entire American health care system is still reeling from implementation of the Affordable Care Act. With the 2017 due date of ICD-11 right around the corner, we’ll be doing this all over again in less than three years.

“Head banging into wall, multiple encounters…” wonder if there’s a code for that?

Ronald Franks, M.D.
President,
Medical Association of the State of Alabama