Tuesday, May 28, 2013

ICD-10 codes and politics

Senator Rand Paul has been getting some ink about a recent speech during which he mocked the Affordable Care Act for mandating the use of ICD-10 codes, some of which are pretty silly.

Theses codes are what hospitals and doctors must use when submitting bills to third-party payers.

Please understand that no one has gotten more mileage from making fun of the new ICD-10 codes than I have.

You may recall my posts on the codes for drowning due to falling from burning water skis, contact with (amorous) dolphins and getting sucked into a jet engine.

And I have to agree that the expansion in the number of codes from 18,000 in ICD-9 to over 150,000 in ICD-10 may be burdensome to most doctors.

Senator Paul is a physician, and he should know better. He is either clueless or disingenuous for blaming the ICD-10 code muddle on Obama.

As reported way back in January of 2009 by the Wall Street Journal no less, the ICD-10 codes were to be implemented by the Centers for Medicare and Medicaid Services, but CMS decided to delay doing so after protests by all sorts of medical people and organizations who said that they did not have enough time to comply.

In addition, these codes were not even developed by CMS. ICD stands for the International Statistical Classification of Diseases and Related Health Problems and the revised codes were formulated after many years of discussion by the World Health Organization (WHO).

So whether you love the new codes or hate them, they were going to be put into place regardless of the status of the ACA.

And regarding making fun of them, Mr. Paul is late to the party. My posts about the absurdity of some of the codes were on line in the fall of 2011.


Dave said...

Sorry, Rand is right. PPACA gave ICD-10 a big push, according to ICD-10 proponents. And yes, Obama could have blocked ICD-10, so blaming him makes perfect sense, unless you're one of those "nothing that the Obama admin does is Obama's fault" people that seem to be cropping up all over since they transitioned from killing Bin Laden to harassing Tea Party groups and journalists.


Skeptical Scalpel said...

Dave, thanks for commenting and the link. I do not see anything in the link that contradicts what I have written. Some quotes:

"CD-10 has also been in the works for many years and has encountered its own obstacles along the way."

"Initial work on ICD-10 began in the early 1980s with a final completion date of 1992. In May 1990 ICD-10 was approved and sanctioned by the 43rd World Health Assembly. Other countries around the globe have been using ICD-10 since the mid-1990s, but the United States has been one of the last of the industrialized countries to begin implementation the updated coding system. Some countries that have started using ICD-10 include Germany, France, Sweden and Canada as well as many others."

I am not in favor of these new codes, nor am I an Obama fan. But Rand Paul is misleading you and the American people.

Anonymous said...

Could Have Blocked The New Codes? Hey, Obama Isn't Rick Perry - He ActualLy UnderstandS Why ICD-10 Is Needed.Wonder What Paul Thinks Of The Metric System.

Skeptical Scalpel said...

I'm not sure how much Obama is involved with decisions like whether ICD-10 is good or bad.

Dave said...

The article doesn't contradict the specific of what you wrote, but it effectively obliterates your premise. When ICD-10 proponents themselves are claiming Obamacare was a major push for them, it's impossible to also claim PPACA has so little to do with ICD-10 that Rand's criticism of Obama on those grounds is invalid.

I'm sure you are entirely correct Obama has little knowledge of ICD-10 itself, given the massive, unwieldy federal bureaucracy (which was another of Rand's points). Like most politicians, I doubt the guy can do much more than spell his own name without a staffer to hold his hand. But again, either Obama is responsible for what the Obama admin does or he isn't the fergoshsakes President -- it is certainly within his power to kill the U.S. adoption of ICD-10. Obama has much less to do with numerous things he does claim credit for.

Skeptical Scalpel said...

The decision to go with ICD-10 was made before Obama was elected. I suppose if he had scrapped the new codes, you could say he was against progress and the state of the coding art in the rest of the Western world.

DD said...

ICD codes have obviously been around for many years and appear to have been invented so that healthcare money goes where it rightfully should--> to the insurance companies (kidding). The complex, unwieldy ICD coding system sometimes makes it more difficult for providers to get paid. (e.g. if your billing person or entity does not use the correct code or modifier etc.) it can be a costly nightmare. I doubt it is political. I am not sure why a more efficient, simple way of coding has not been developed. Is the impediment to the creation of such a process the insurance companies' desire to maintain their stranglehold on health-care dollars? Who knows. We know the money is not going into the pockets of primary care doctors or physician extenders.

Skeptical Scalpel said...

DD, well put. Somewhere along the line, all of the clerical responsibility was shifted from the insurance companies to the doctors. I was practicing then, but I can't pinpoint how and when it occurred.

Anonymous said...

There's a lot of misconception about ICD codes. They don't exist for billing. They exist for statistical purposes in order to categorize health events. Unfortunately, insurance companies and CMS turned them in to billing codes. So yes, ICD-10 is going to be a pain to deal with, for both caretakers and coders alike, but if you really look at ICD-9, you can see just how woefully inept it is at classifying diseases and procedures. It's about time we catch up with the rest of the world.

Skeptical Scalpel said...

Yes, you have a point. ICD-9 is inadequate. But you must admit, some of the ICD-10 codes are absurd. Because it that, the credibility of the entire list of codes is questioned.

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