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How to code a spacecraft injury

By Jay MacDonald · Bankrate.com
Friday, January 24, 2014
Posted: 6 am ET

If you've ever settled a bill at your doctor's office, you're probably well aware that how the physician codes your visit is almost as integral to a healthy outcome as the treatment you receive or the prescription you fill.

Medical coding essentially translates the services you receive into letters and numbers used by your health insurance company determine who gets paid how much and by whom. Miscodes can trigger all sorts of stressful havoc: overpayments, underpayments, balances due you instead of your insurer, etc.

ICD-1O: Not a 'Star Wars' droid

So it is with some trepidation that in October, the medical world will adopt a new, more detailed catalog of computerized billing codes known as ICD-10 that not everyone is prepared to embrace.

And if you thought the debut of the Obamacare online exchanges was frustrating, you might want to prepare for a similar helping of chaos on your year-end doctor bills.

The ICD-10, short for the 10th iteration of the International Classification of Diseases, is issued by the World Health Organization to help collect, compare and analyze illness and mortality data worldwide. The ICD code has been used in the United States for medical statistics since 1979 and for billing purposes since 2002.

Why the update? One word: capacity. ICD-9 had codes of up to five characters for 14,000 diagnoses and 3,000 specialty procedures; its replacement will add two more characters to handle about 68,000 diagnoses and 87,000 procedures. My wallet hurts just thinking about it.

But wait -- there's more. Where the original ICD, which was developed back in the 1800s, had fairly generalized diagnoses -- for example, one cause of death was "visitation by God" -- its totally awesome heir has codes for everything from drowning by jumping off burning water skis to being flogged by an Orca whale to being smote by a spacecraft.

Even opera, knitting injuries

You want more? Injuries while attending the opera, complications from knitting and even sibling rivalry made the new edition.

The switch, which will occur overnight, involves the entire health care system, including Medicare, Medicaid, hospitals, health insurers, physicians, health services providers and, presumably, water ski instructors.

Some physicians, like Dr. W. Jeff Terry, a urologist in Mobile, Ala., predict a Y2K-style Armageddon, especially for unprepared small medical practices. "If you don't code properly, you don't get paid," he told The New York Times. "It's going to put a lot of doctors out of business."

Some practitioners are even calling for a one-year postponement. The problem is, ICD-10 was already postponed one year so as not to interfere with the rollout of the Obamacare exchanges last Oct. 1.

Lee Browder, national director of the Professional Association of Healthcare Coding Specialists (code name: PAHCS), says there's little to fear and that the transition should be no more difficult than the introduction of the extra four digits on ZIP codes.

Unfortunately, I can't remember my ZIP+4, can you?

Follow me on Twitter: @omnisaurus.

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