Know someone who drowned from jumping off burning water skis? Well, there's a new medical billing code for that.
Been injured in a spacecraft? There's a new code for that, too.
Roughed up by an Orca whale? It's on the list.
Next fall, a transformation is coming to the arcane world of medical billing. Overnight, virtually the entire health care system — Medicare, Medicaid, private insurers, hospitals, doctors and various middlemen — will switch to a new set of computerized codes used for determining what ailments patients have and how much they and their insurers should pay for a specific treatment.
The changes are unrelated to the Obama administration's new health care law. But given the lurching start of the federal health insurance website, HealthCare.gov, some doctors and health care information technology specialists fear major disruptions to health care delivery if the new coding system is not put in place properly. It's also heavily computer-reliant.
They are pushing for a delay of the scheduled start date of Oct. 1 — or at least more testing beforehand.
“If you don't code properly, you don't get paid,” said Dr. W. Jeff Terry, a urologist in Mobile, Ala. “It's going to put a lot of doctors out of business.”
He is one of those who believe staffs and computer systems, particularly in small medical practices, will not be ready in time
The new set of codes, known as ICD-10, allows for much greater detail than the existing set, ICD-9, in describing illnesses, injuries and treatments. That could allow for improved tracking of public health threats and trends, and better analysis of the effectiveness of various treatments.
Officials at the Centers for Medicare and Medicaid Services declined to be interviewed about the new codes. But a spokeswoman said the start date will remain Oct. 1.
In a letter in November, Kathleen Sebelius, the secretary of health and human services, told Sen. Jeff Sessions, R-Ala., that the Medicare and Medicaid officials were working diligently to help doctors get ready.
“ICD-10 is foundational for building a modernized health care system that will facilitate broader access to high quality care,” she wrote.
Still, the troubles with HealthCare.gov have given new ammunition to those urging a go-slow approach on ICD-10 and have made it harder for the government to stand behind assurances that the transition will go smoothly.
“Failure to appropriately test ICD-10 could result in operational problems similar to what the department experienced with the rollout of HealthCare.gov,” the Medical Group Management Association, which represents the business managers of medical practices, said in a letter this month to Sebelius.
The Medicare and Medicaid office now appears to be open to greater testing of the system. Also this month, the Obama administration relaxed some deadlines for parts of the health care law and some deadlines under a separate law for enacting electronic medical records.
“I think that people at CMS understand the stakes with respect to ICD-10 in a heightened way as a result of HealthCare.gov,” said Linda E. Fishman, senior vice president for policy at the American Hospital Association.
Dr. John D. Halamka, chief information officer at Beth Israel Deaconess Medical Center in Boston, said the need to prepare for ICD-10 and the Affordable Care Act and to achieve what's called “meaningful use” of electronic health records all at once could overwhelm computer staffs throughout the health care industry.
“It's just this collective sum of activities that exceeds the capacity of the system to absorb it simultaneously,” he said.
He said his hospital was spending $5 million this year on ICD-10, $7 million for the Affordable Care Act, $2 million on meaningful use, plus $3 million to comply with a federal health care privacy law.
“Basically, I'm not doing anything but federal regulatory mandates,” he said.
ICD-10 has already been postponed by a year. Some health care executives say predictions of a fiasco Oct. 1 will prove as erroneous as those that said civilization would collapse on Jan. 1, 2000, because computers could not handle years beginning with a 2 instead of a 1.
“It's not going to be a shock to the industry to confront this,” said Christopher G. Chute, professor of biomedical informatics at the Mayo Clinic. “We've literally had seven or eight years to anticipate it.”
A survey by the American Hospital Association in May found that about 94 percent of hospitals were moderately to very confident about being ready on time. Both the hospital association and America's Health Insurance Plans, which represents insurers, said that their members had spent a lot of time and money getting ready for ICD-10 and that the changeover should not be postponed again.
ICD-10 is the 10th revision of the International Classification of Diseases, which is issued by the World Health Organization, though countries can modify it.
Having a common global code allows for easier collection, comparison and analysis of the causes of death and illness. Most other countries have already adopted ICD-10, at least for recordkeeping and in some cases for reimbursement.