New medical codes for injuries from duck bites to drone strikes create headaches for doctors

BY MALIA ZIMMERMAN – HONOLULU — Doctors already contending with reams of paperwork brought on by the implementation of the Affordable Care Act and its 30,000 new pages of rules and regulations say a 2008 federal law set to go into effect next year will compound their misery.

Under existing classifications through what’s known as ICD-9, patients in the United States with injury, illness or disease have their conditions classified into 18,000 medical codes.

A new coding system approved by President George W. Bush in 2008 called ICD-10 has 140,000 such codes, a 678 percent increase in what doctors must document, and will go into effect next October.

Doctors said the system has a code for just about everything.

“If a duck bites your nose, there is a code for that,” said Dr. Linda J. Rasmussen, an orthopedic surgeon on Oahu.

Between new requirements under the ACA and the coming ICD-10 requirements, Rasmussen said, “It is enough to pull your hair out.”

“The paperwork is crazy. Everything takes so much longer,” she said.

If it isn’t strange enough to have a code for a duck induced injury, there’s a code if patients have a bean stuck in their nose, walk into a lamppost, are hit by lightning not just once, but twice, collide with a dolphin or suffer burns because their water skis are on fire.

There’s also a code for civilians struck by a drone or involved in an accident involving spacecraft.

When the Bush administration adopted ICD-10, U.S. Health and Human Services Secretary Mike Leavitt called it a “giant step forward toward developing a health care system that focuses on quality and affordability through the implementation of health information technology,” and maintained the government will be able to more closely track reporting, compensation and health trends through a nationwide electronic health information system.

The system was supposed to be in place by 2011, but the Bush administration delayed implementation until October 2013, and then the Obama administration postponed the transition until October 2014.

Benjamin Domenech, a senior fellow at the Heartland Institute, said most of the increased number of codes is due not to new diseases or clinically necessary information, but to requiring excessive and often “ridiculous” detail.

The codes go into such specifics that those injured while water skiing barefoot, attacked by a vacuum or an ultimate Frisbee, wounded while weeding the yard or striking a pose during yoga class have their own designations.

Not to be left out are patients bitten by an alligator, bull, cat, moray eel or turtle; butted by a bull or goat; injured by a camel or giraffe or in a human stampede; attacked by a chicken,  duck,  goose,  macaw,  parrot or turkey; scratched by a cat or  hit by a “flying” horse.

George Alex, senior director of the ICD-10 initiative for consulting firm Advisory Board Company, there are 72 new codes related to birds and 312 codes related to animals. One angioplasty code under ICD-9 will become 854 different codes highlighting body parts, methods and instrumentation, Alex said.

Experts say the implementation and training of the new codes will be expensive.

Nachimson Advisors estimates the change will cost the average small practice about $83,000, a medium sized practice (10 physicians) some $285,195 and a larger practice (about 100 physicians) as much as $2.7 million. Hospitals may have to invest between $2 million and $5 million, and large health care organizations could spend as much as $20 million.

A 2012 report published by the Galen Institute said ICD-10 will also be costly by taking away time between doctors and their patients.

“Financially ICD-10 implementation will transfer limited health care money away from sick patients to administrators, businessmen, and IT consultants. In addition to carrying a hefty price tag, ICD-10 implementation will likely have a substantial opportunity cost on physicians trying to provide the best care for their patients as well,” wrote authors Tom Colburn and Jason Fodeman.

America’s Health Insurance Plans predicts the cost will be as much as $3 billion for the health insurance industry.

“It is very likely that these costs will be passed along to patients in the form of higher prices or insurance premiums,” Colburn and Fodeman wrote.

Colburn, a U.S. senator from Oklahoma and medical doctor, has introduced legislation known as the Cutting Costly Codes Act of 2013, along with co-sponsors John Barrasso, R-Wy., Rand Paul, R-Ky. and John Boozman, R-Ark.

The legislation is also pending in the U.S. House after being introduced in April by Rep. Ted Poe, R-Texas. It would delay the replacement of ICD-9 as impacts of new codes are studied.

The American Medical Association is among the groups that have voiced strong support.

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