The Craziness of ICD-10

So the question becomes, does ICD-10 become yet another straw designed to break the camel's back?

At our faculty meeting last week, representatives of the medical college and the hospital came to update us on the changes coming into effect with ICD-10.

The compliance officers went through the changes in regulations -- for inpatients and outpatients -- which we've all heard before, the changes in the rules, and how ICD-10 leads to greater specificity for billing. Almost to the point of ridiculousness.

Medical websites, articles, and blogs have been full of examples of hilarious insane ICD-10 codes, new ones that many of us will (hopefully) never use in a lifetime of practice.

If there exists one for fall from nonmilitary spacecraft, does that mean that there are military spacecraft? Are we sending Marines into space?

I'm sure someone has a practice where their patients are frequently coming in after being bitten by Orcas, and it's nice to know there's a code to bill for that if I need it, but all of this leads to a level of mental exhaustion, that we're all being put upon, asked to do something else that adds no real value to our care of patients. And this time the troops got their hackles up.

One of my partners sent around an email after the meeting, a long diatribe about how we've allowed this stuff to happen to us for far too long, can't this be taken out of our hands, why are they bothering us, we have doctoring to do.

This is yet another example of the system getting ungainly and impractical around us, as government regulators and insurance companies demand we do stuff that doesn't help us take care of patients, and in fact steals our valuable time and mental energy from what could be real efforts to transform and improve the healthcare system in this country.

As part of the transformation over to ICD-10, our electronic health record (EHR) has created a conversion calculator so that if you put in plain old hypertension, the EHR presents you with all of the options necessary to get you to the granularity needed for final billing with the ICD-10 code.

They have done an excellent job, it's pretty seamless, but it makes you realize how inane this all is. We are presented with dozens of radio buttons to click, a confusing arrays of choices to decide the specificity of the code, which I think may lead us to end up choosing "whatever NOS" just to get it done.

Gout, that scourge of modern civilization and excess, leads the way, with 750 iterations, which joint, side, etiology, duration, etc. all for the sake of what?

Here's how it looks when you try to use "gout" to bill:

I love the line in there: "Select a more specific diagnosis in order to bill for your work."

If this granularity of detail made it easier for us to take better care of our patients, then I would be all for it. If somehow being able to collect all the data on all of the patients with gout in their left elbow without tophi let us learn something about patients with gout or our practice of medicine, then maybe there's some worth to the system.

Otherwise, it seems like they're just wasting our time.

Is there something we can do about it? Can we write to our Congressmen? Can we demand of the people negotiating our contracts with the insurance companies, or the federal government, that they trash this nonsense in favor of a system that really has added value?

Can we really stand up and say were mad as hell and we're not gonna take it anymore? Or is no one going to listen?

I worry that if we say we won't do this, they'll say, "Well, then, you won't get paid for your office visits." But that kind of wholesale rebellion is unlikely anyway. Maybe we should just go back to bartering for our services -- perhaps we'd all be better off.

The medical chart was created as a communication device -- the way for us to keep a record of our interactions with our patients, for us to communicate with other providers about what we've done, and ultimately, a safe repository of our opinions and actions, which had utility in the larger scale of taking care of patients.

Billing for patients care has evolved over the years as well, as insurers demanded that we justify and specify before we get paid.

The advent of the electronic health record has in some ways made it easier to document, but I think we can all agree that it has not led to a better communication tool, a better medical record. I'm definitely not saying that our old handwritten illegible notes with minimal content were all that good, but the clunky redundant behemoths that we end up creating by clicking all these boxes clearly are no improvement.

Similarly, the International Classification of Diseases newest improvement probably won't do much towards alleviating billing fraud, improving the care of patients, getting faster reimbursement from payers, or much of anything, but it sure is adding a lot of annoying tasks to our days.

Nietzsche said, "That which does not kill us makes us stronger."

Well, this stuff is killing us. And I feel no stronger.

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