Demystifying Medicine One Month at a Time

Tag: diagnostic

Why Many Docs Are Griping of Late

dosequisicd10October 1st marked a national transition to a new classification scheme for diagnostic codes in medical care and treatment. These codes are used to translate a diagnosis like strep throat into an alphanumeric code that can be used for

  1. research purposes, and of course
  2. billing (the most important aspect!).

When you visit a health care professional, the diagnosis is translated by a biller (now most often done by computer software) into one of these specific codes, which is then submitted to the insurance company for payment. You receive an explanation of benefits (“EOB”) with this information on it (which the insurance company is sure to remind you is “not a bill”), which is usually indecipherable.

The new scheme (ICD-10) has almost 70,000 diagnostic codes, many of which are of a level of specificity that seems absurd. The old scheme, ICD-9, had only about 13,000 codes.

Not only are there more codes, but they come with a wholly different alphanumeric system attached to them. Luckily, the software lets us ‘translate’ the old codes into the new ones, but often, there isn’t adequate specificity in the old codes to be valid with the new ones. This is where the headaches result.

If you follow health media, you’ll see some funny articles about the tranisition. NPR ran a cute story headlined “Struck by a Macaw? Now There’s a Code for That.” The Wall St. Journal‘s explainer was headlined, “70,000 ways to Classify Ailments.” Among my favorites: V91.07 — Burn due to water skis on fire. Or W56.11 — Bitten by a sea lion.

It gets weirder than that. There are codes for ‘injuries from falling space debris.’ Doesn’t seem all that likely, but you never know.

DIY Medicine Gets a Step Closer

As with other industries, the Do-It-Yourself movement has come to health care—and it’s getting stronger.

Unlike engine repair, craft brewing, or laying sheetrock, the barriers to entry for DIY-ers in health care are higher. The main barrier, medical knowledge, is lowering fast as autodidacts have more tools and information than ever before—as but two good examples, see Khan Academy or what’s known in the Twittersphere as #FOAMed–“Free Open Access Medical Education.”

Another big barrier has long been established by those that pay for health care–in the U.S., primarily insurers. They’ve had rules mandating that diagnostic testing be ordered by physicians, who then ‘control’ the results.c767d9a6

Last week, in a victory for self-motivated patients, the U.S. Department of Health and Human Services issued a ruling giving patients the right to obtain lab results on their own from freestanding diagnostic labs–without needing the interpretation or control of information from a medical provider.

This is not likely to have a huge impact, as many if not most medical practices have adopted electronic health records and it’s now common practice to share test results directly with patients.

But for laggards that have not implemented secure data-sharing policies, a major incentive is now there as patients will be able to collect data back from the lab on their own. Much better from the provider perspective to get out in front of an ‘abnormal’ result.

How about you? Do you get your results from your doctor automatically, or do you wind up having to hunt them down? Does this new ruling make you more excited to take control of your own health information?

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