US medical coding system gets upgrade

By Allison C. Gallagher -

MIAMI COUNTY — The U.S. medical coding system was updated last month for the first time in 36 years at hospitals and physicians’ offices across the country, a switch-over that in many ways was invisible to patients.

But the new coding system — called International Classification of Diseases, 10th revision, or ICD-10 — demands greater specificity not only about an individual’s health condition, but often about the circumstances that led to an injury or illness.

For example, if you have asthma, your doctor might want to know if someone who lives with you smokes or if there’s a fireplace in your house.

Some codes are so specific that they have been the butt of jokes: one code is for relationship problems with your in-laws, and others are for being bitten by an orca or sucked into a jet engine.

According to Upper Valley Medical Center Vice President and Chief Medical Officer Dan Bailey, DPM, the new system includes nearly 177,000 codes for various diagnoses and procedures, which is up from 17,000 codes in the former ICD-9 Coding Nomenclature.

Using the example of a broken bone, Bailey explained how ICD-10 requires doctors to note the type of fracture — closed, open, displaced, non-displaced; specific anatomic site; laterality; routine versus delayed healing; non union; mal union; and the type of encounter – initial, subsequent, sequel.

“The most common codes would mirror the frequency of any particular disease process, or injury occurs in a particular population,” he said. “Each specialty in medicine would have a group of most-used codes. As an example: fractures in the area of orthopedics.”

The change requires more detailed documentation, and will take more effort and time on the part of the physician, and more scrutiny on the part of the coders and billers.

One concern among some doctors is how the cash flow of individual practices will be pinched as a result of honest mistakes or delayed reimbursement.

“This is certainly a concern and will be directly related to the detail of documentation within the medical record,” Bailey said. “It could hurt or help the cash flow if the documentation is lacking or appropriately descriptive.”

Bailey said Premier Health and UVMC have been working on this project for several years, in part, due to the government delayed implementation.

“The training/education included everything from Steering Committee discussion to formal and specific ICD-10 training for staff and physicians alike,” he said. “The coding staff received intensive training, including a ‘coding boot camp’ at Sinclair Community College in order to prepare the coders for this significant change.”

By Allison C. Gallagher

Reach Allison C. Gallagher at or on Twitter @Troydailynews.

Reach Allison C. Gallagher at or on Twitter @Troydailynews.