[ed. How about patient anxiety? If there's an upside for anyone here other than insurance companies (who would deny your claim), I'm not seeing it.]
The nation’s health care providers are under orders to start using a new system of medical codes to describe illnesses and injuries in more detail than ever before. The codes will cover common ailments: Did a diabetic also have kidney disease? But also included are some that are far less common: whether the patient was crushed by a crocodile or sucked into a jet engine.The more than 100,000 new codes, which will take effect on Oct. 1, have potential benefits, as they will require doctors to make a deeper assessment of many patients.
But the change is causing waves of anxiety among health care providers, who fear that claims will be denied and payments delayed if they do not use the new codes, or do not use them properly. Some doctors and hospitals are already obtaining lines of credit because they fear that the transition to the new system will cause cash-flow problems.
“It’s a sea change for physicians,” said Dr. Pardeep Kumar, a 46-year-old internist here who is counting down to Oct. 1. “We will have to be very much more specific.” (...)
The codes, from the 10th revision of the International Classification of Diseases, or ICD-10, have significant implications for patients. For example, Dr. Kumar said, doctors may need to perform additional tests to help determine if a patient with high blood pressure has heart failure.
ICD-10 includes 68,000 diagnostic codes, compared with 14,000 in the current compendium. The number of codes for inpatient hospital procedures will expand to 87,000, from 4,000.
Consumers often need prior approval from insurers for expensive tests and medical procedures. To get approval, they need a valid diagnostic code.
Dr. Michael R. Marks, an orthopedic surgeon and coding expert in Connecticut, said that if doctors did not use the proper codes, insurers could delay approval. “The patient,” he said, “will get frustrated and ask: ‘Why has my M.R.I. not been authorized yet? Why has my surgery not been scheduled?’ ” (...)
As people make the change, doctors and hospital executives say, it is inevitable that some claims will be denied for services that were provided but not properly coded. Patients may see the denials in statements they receive from insurers.
Many doctors and hospitals say they will step up efforts to collect the patient’s share of the bill, including deductibles and co-payments, at the time of service.
by Robert Pear, NY Times | Read more:
Image: James Brosher 
