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Federally-Mandated Medical Coding Gums Up IT Ops

timothy posted more than 3 years ago | from the release-the-hobgoblin-of-little-minds dept.

Businesses 254

Lucas123 writes "The change over from a medical coding system in use since the 1970s to an updated version that adds more than 50,000 new 7-character codes is being compared to Y2K as an IT project that is nearly impossible to complete on time. ICD-10, which replaces ICD-9, adds far more granularity to medical diagnosis and treatment. For example, ICD-9 has one code for a finger amputation. In contrast, ICD-10 has a code for every finger and every section of every finger. An 'unfunded mandate,' the change over to ICD-10 codes is a multi-year project for hospitals, state Medicaid organizations, and insurance providers. The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records."

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Structured data makes this easier (4, Interesting)

Mjec (666932) | more than 3 years ago | (#36434156)

Surely if the specification lists the data in a structured way, they don't need to be hard-coded. Can't you just stick them all in a database and do lookups? Can't the authority give that the requisite structure?

Re:Structured data makes this easier (2)

Registered Coward v2 (447531) | more than 3 years ago | (#36434202)

Surely if the specification lists the data in a structured way, they don't need to be hard-coded. Can't you just stick them all in a database and do lookups? Can't the authority give that the requisite structure?

I'm not so sure of that - one of the big problems would be how do you integrate 9 and 10 digit data so historical records are accurate as well as what happens when systems expecting 9 digits now see 10? There's a huge set of 9 digit data that won't simply go away and systems need to be redone to account for two separate data types. Data entry also needs to still account for 9 digit codes as service delivery and data entry dates could be far apart.

I guess you could simply add a digit to the 9 digit codes to make them 10 digit but I bet that would result in code overlap as well - or simply make all the 9 digit data no longer recognizable by systems.

Re:Structured data makes this easier (5, Interesting)

Anonymous Coward | more than 3 years ago | (#36434644)

They're versions, not digits. ICD-9 diagnosis codes (for some reason the International Classification of Diseases also has a set of procedure codes) use up to 5 digits in the form [0-9VE]##.##. ICD-10 is of the form X##.###X, except for some codes that have a "placeholder" to pad the middle of the code [wikipedia.org] out to seven digits.

The real problem here is that insurance claim submission is real design-by-committee bullshit of the highest degree. It's an ANSI standard, a submember of ASC X12 so half the shit in there is unused crap needed for the other things X12 is used for, like wholesalers restocking their shelves or boats reporting their cargo, because apparently code reuse is so damn important to these people that the claim form has a section (completely unused for claims) for reporting credit card details. Of course, the insurance companies all took this design under advice and did their own shit with it. There's a code that identifies whether the insurance company is blue cross, medicare, medicaid and so on (that you have to put on the claim just in case blue cross forgot, and they apparently forget a lot, since if the clinic forgets to set this code properly, the insurance company uses every excuse possible to refuse to pay). Simple enough, right? Well when I started, we had an insurance company that used blue cross's servers for processing claims, so even though they weren't blue cross, this code had to be blue cross or BC's servers would shit themselves. Setting that aside, there's a completely separate code for what kind of provider ID you're sending (blue cross, medicare, medicaid and so on) because of course people are going to bill blue cross using medicaid IDs. Fortunately, the NPI did away with that bullshit (for the most part... medicaid here still demands provider IDs for checkups because they refuse to give up any hoops for doctors to jump through, and one of those was that the doctor had to use a different provider ID for checkups versus treating someone sick. Their computer system apparently cannot sort these claims out themselves... and yet if you bill a checkup on the wrong provider ID, the computer system can easily reject it. Hmmm...)

Ahem.... Anyways, instead of just adding a code to identify whether the diagnosis in question is using ICD-9 or ICD-10 (in the box the committee already created for the purpose of identifying the code being used), the committee got together and pretty much rewrote the whole damn thing. This is where IT got gummed up (it's getting better now). And believe me, you can talk about "legacy equipment" and other stuff til you're blue in the face, but claim submission is how doctors and hospitals get paid, that's where IT has been spending all of its time freaking out.

Re:Structured data makes this easier (1)

codegen (103601) | more than 3 years ago | (#36434782)

ICD-9 and ICD-10 are both 7 character codes. There are no lenth problems. The main problem is that about 15,000 codes have been dropped and about 65,000 codes have been added.

Re:Structured data makes this easier (1)

bill_mcgonigle (4333) | more than 3 years ago | (#36434788)

how do you integrate 9 and 10 digit data

ICD-9 and ICD-10 are revisions of the standard, not field lengths.

ICD-9 is 3-5 characters in length, ICD-10 is 3-7 characters.

IIRC, ICD-9 will start with 'E' or 'V', else it's ICD-10.

Re:Structured data makes this easier (1)

thesh0ck (1983948) | more than 3 years ago | (#36434826)

Create Database, import v9 data with a new field in databsse called 'version' that has a 9 in it. Put all new data into database with 10 in the version field.

The good news . . . (1)

Mondak (775074) | more than 3 years ago | (#36434854)

. . . is that you don't need to change historical data. There is a hard, day forward switchover date in October 2013. The lookup problem is that there is not a one to one relationship between the old codes and the new ones. The lookup would need to contain a level of intelligence that just simply isn't contained anywhere within the context of the data set. This means that every level needs to comply to get the data. You don't just need the space for the correct number of digits, or add logic to append a "19" or "20" in front of your year. - The doctor needs to be retrained (NOT an easy task since many already "know" everything they will ever need to know) to record the information from the encounter with the patient. - Then the coder needs to select the right codes (assuming the system they use can even handle the new codes). - The billing system needs to be capable of transmitting the new codes (new EDI x-12 rules go into effect in Jan 2012 to support this) - The payer's claim system need to be able to store the new codes - The contract between payer and provider on what amount will be paid for what service needs to be completely rewritten - The payer's examiners / adjudication process must be able to interpret the codes vs. the treatment codes to decide whether to pay the claim at all (Diagnosis = stubbed toe: treatment = removed kidney. . . no pay)

Re:Structured data makes this easier (2)

crashumbc (1221174) | more than 3 years ago | (#36434222)

You don't work in the medical field do you? ICD codes are built into a lot of medical applications. For a famous slash dot car analogy, this is like trying to convert a U.S. car manufacturing plant over to use all metric.

Re:Structured data makes this easier (3)

tbannist (230135) | more than 3 years ago | (#36434324)

So it's something sensible that should have been done a long time ago?

Re:Structured data makes this easier (0)

cpu6502 (1960974) | more than 3 years ago | (#36434370)

I don't see any "sense" in adding codes merely to tell the doctor which finger was amputated. All he has to do is LOOK and see for himself which finger is missing. This is typical government "make work" bureaucracy that makes no more sense than going-round and busting windows to boost construction jobs.

It's also what bankrupted the treasury and led to the downfall of the Roman Empire (according to one historical theory).

Re:Structured data makes this easier (0)

Anonymous Coward | more than 3 years ago | (#36434488)

I don't see any "sense" in adding codes merely to tell the doctor which finger was amputated. All he has to do is LOOK and see for himself which finger is missing. This is typical government "make work" bureaucracy that makes no more sense than going-round and busting windows to boost construction jobs.

It's also what bankrupted the treasury and led to the downfall of the Roman Empire (according to one historical theory).

No but it *might* make sense to tell the surgeon which finger should be amputated so he/she removes the correct one...

Re:Structured data makes this easier (2)

tbannist (230135) | more than 3 years ago | (#36434596)

Also the insurance company that has to compensate the guy who lost the finger(s) might like to know which one(s) were amputated and how much was amuptated. They pay different amounts for different fingers and different amounts depending on how many joints were lost.

Re:Structured data makes this easier (2, Insightful)

Anonymous Coward | more than 3 years ago | (#36434606)

I don't see any "sense" in adding codes merely to tell the doctor which finger was amputated. All he has to do is LOOK and see for himself which finger is missing. This is typical government "make work" bureaucracy that makes no more sense than going-round and busting windows to boost construction jobs.

It's also what bankrupted the treasury and led to the downfall of the Roman Empire (according to one historical theory).

I had a finger amputated. Tell me which one. Go on, just LOOK, after all, that's obvious, right?
Not like there's ever a situation where that information, individually or aggregated, might be useful to anyone in the spheres of research, information or analysis, without the patient in front of them, waving. And if it is, we can just line up all the amputees and they can look at them one at a time.
Alternatively, maybe it'd be handy to code this stuff up.
Just be grateful its ICD and not SNOMED CT, which contains over a million medical concepts.

Re:Structured data makes this easier (1)

Anonymous Coward | more than 3 years ago | (#36434904)

Ah, so you definitely don't work in the medical field, because you have no clue about this issue.
 
It's not "make work", it's a long overdue revision of the codes.
 
Here's an analogy; what if some doctor told you he thought the change to IPV6 was a "typical government 'make work' bureaucracy"? Your head would explode (we can only hope).

Re:Structured data makes this easier (0)

Anonymous Coward | more than 3 years ago | (#36434368)

They already use metric.

Not that good of an analogy (0)

Anonymous Coward | more than 3 years ago | (#36434398)

You don't work in the medical field do you? ICD codes are built into a lot of medical applications. For a famous slash dot car analogy, this is like trying to convert a U.S. car manufacturing plant over to use all metric.

The funny part is that US car makers are already converted over to metric.

I guess it wasn't that hard.

Re:Not that good of an analogy (1)

blueg3 (192743) | more than 3 years ago | (#36434794)

US cars use metric fasteners?

Re:Not that good of an analogy (1)

TheLink (130905) | more than 3 years ago | (#36434890)

Yep, they use metric for every 2.54cm of the car.

Re:Structured data makes this easier (1)

wisty (1335733) | more than 3 years ago | (#36434238)

How about code that interfaces the db? If existing code is hard-coded, how would you change that?

Re:Structured data makes this easier (2)

Richard_at_work (517087) | more than 3 years ago | (#36434428)

So thats it, its embedded in the core of the system so it is to never change again for the rest of mankinds existence?

Uhm, no - you eat the cost of changing over from poor prior decisions and design a system that is resilient to change this time.

Re:Structured data makes this easier (0)

Anonymous Coward | more than 3 years ago | (#36434660)

Do you have any notion of "eat the cost"? I work at a large medical institution (one of the monster sized ones) -- I saw a talk on the ICD-10 conversion by the group who's responsible for doing it -- I think they are underestimating it at 10's of M for our institution. I be it will end up costing multi-$B nationwide -- pick a number say $10B, we have maybe 250M insured, that's $40 per insured. Get out your wallet. I bet the $10B number is light and you'll end up with $200/person to support the coding change. As far "unfunded mandate" goes -- it'll get funded; funded from your paycheck.

Re:Structured data makes this easier (1)

mwvdlee (775178) | more than 3 years ago | (#36434684)

The question isn't so much whether or not to design a system to be resilient to change, it's about exactly how resilient it should be.
In Y2K, many year fields were update from 2 to 4 digits. When the year 10,000 comes, we'll have to eat the cost of our poor design choices again.
Obviously, it completely unrealistic to expect any current software to run in the year 10,000. Just as it was completely realistic back in the 70's and 80's to expect any current software to run in the year 2000.
Perhaps a bit extreme of an example, but it's kinda hard to predict what might change in the future.
Besides, as explained elsewhere, it's not just a search&replace of codes; systems may have to be changed to accomodate both code systems at once.
For all we know, in a few decades a new religion will have taken over the world, introducing a new calendar and there we are stuck using our badly designed Gregorian calendar classes and routines.

Re:Structured data makes this easier (1)

MichaelSmith (789609) | more than 3 years ago | (#36434250)

The article is actually pretty comprehensive and gives specific examples. I can easily see how this can turn into a nightmare. Everything in the hospital has to understand the new language. It has to be in the administrators excel spreadsheets, and the laptops used by the ambulance drivers, and the x-ray equipment. All the interfaces need to be validated because fuckups cost lives.

Re:Structured data makes this easier (-1, Troll)

dotsan (2265736) | more than 3 years ago | (#36434334)

Well, programmers tend not to allocate more space that absolutely necessary.
Thats why we see that junk. Look how much havoc [aeonity.com] that can cause..
Y2K is nothing compared to above.

Re:Structured data makes this easier (0)

Anonymous Coward | more than 3 years ago | (#36434532)

Link is goatse.

Re:Structured data makes this easier (0)

Anonymous Coward | more than 3 years ago | (#36434472)

Surely if the specification lists the data in a structured way, they don't need to be hard-coded. Can't you just stick them all in a database and do lookups? Can't the authority give that the requisite structure?

I work at a place where we are facing this. It isn't just one system. It is multiple legacy systems, some from vendors, some home-brewed, that are messaging each other back and forth. So sure, you're right, we'll get a time machine and go back in time and force all the builders of all of our legacy systems to code them perfectly so that it is just a single reference table lookup. No problem! I think every child should get their own pony too, while we're at it.

Re:Structured data makes this easier (0)

Anonymous Coward | more than 3 years ago | (#36434948)

In fact that is what is done in most cases. I've actually written claim form processing systems, though I no longer do. In the US there are basically two standardized medical claim forms. On the forms next to the procedure code is a field for which coding system is being used. If it's an ICD-9 a "9" goes in that field to indicate you will be using an ICD-9 code. Presumably a "10" will go in that field when ICD-10 codes are being used. From there it's a simple lookup on the appropriate table.

The real impact here should not be at the IT level. A well built system should be easily adaptable to this scenario. In fact the system I worked on previously was built knowing that ICD-10 was on the horizon. The guy who replaced me when I left has already implemented it. It took him (one person) about a day. It's the office administrators and the insurance claim adjudicators that are going to feel the most impact. There are entire degrees in medical coding. People are going to have to learn the new coding system. Programmers, System Admins, DBAs - we don't care if the code that gets selected is correct. We only care that the person responsible for selecting the correct code has the tools to do so.

One other thing. This has nothing to do with diagnosis. It's all after the fact sort of stuff. Doctors will do what doctors do and won't really care about this other than as it impacts their bottom line because they had to pay to (re)train their office staff and buy an upgrade to their software. It won't stop accidents from happening. It will make it easier to identify problems after the fact. It will also make it easier for insurance companies to verify that the procedures performed were actually necessary - thereby making it easier for them to challenge a medical claim.

International Standard (1)

rednip (186217) | more than 3 years ago | (#36434182)

Medicare, like any insurer may change it's paperwork in an effort to make the process more accountable. As it's an international standard that has already progressed to ICD-10-CM, it's probably about time.

I bet you anything (2)

Rosco P. Coltrane (209368) | more than 3 years ago | (#36434194)

the people who dreamt up the new coding system didn't even try to make it backward-compatible with the old one, hence the headaches and waste of money.

If ICD-10 was a superset of ICD-9, in a way similar to how UTF-8 is a superset of ASCII, the transition would be perfectly seamless and painless...

Re:I bet you anything (1)

Registered Coward v2 (447531) | more than 3 years ago | (#36434246)

the people who dreamt up the new coding system didn't even try to make it backward-compatible with the old one, hence the opportunity for systems houses and consultants to make a lot of money.

There, fixed that for you.

Re:I bet you anything (4, Interesting)

jhoegl (638955) | more than 3 years ago | (#36434340)

True.
As an IT guy who worked for a medical billing company I got to see the inner workings of the coding world.
It is interesting to see that it requires another human being to code from a doctors notes. And then many things came into play, such as alife medical, a EMR system that codes based off of what it reads. They even converted TIFFs with OCR so they could read it. Now with things like NextGen you can put it all into the system and let the system do it for you. No more "interpreting" what the doctor wanted to say. However, with this system it will be tough to find doctors who overbill or put in information that is untrue.
I would watch coders detect these things by finding a doctor attempting to charge for a procedure that did not even involve the issue. Can an EMR system do that? Hopefully, but it will probably be an after thought to the new coding.
And what about these certified coders? Do they have to retrain and re-certify? Probably.

That job was an eye opening experience into the Medical billing world. It was very interesting and I helped develop some of the very first medical billing methods.

Good. (1)

crow_t_robot (528562) | more than 3 years ago | (#36434212)

The new system sounds much better and appears to be more accurate.

An 'unfunded mandate,' the change over to ICD-10 codes is a multi-year project for hospitals, state Medicaid organizations, and insurance providers. The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records."

This is good as well. Insurance company profits are ridiculous and hopefully this will force them to invest a lot of those profits in the American economy to do this work. Complaining about expense when replacing systems in a organization that is fraught with malpractice (misdiagnosis, amputating the wrong limb, dispensing the wrong medication) is ridiculous. This is akin to the government complaining about the cost of replacing infrastructure when the alternative is your car plunging in the river on your morning commute.

Re:Good. (1)

jhoegl (638955) | more than 3 years ago | (#36434348)

Actually Insurance companies wont be involved in re-engineering the medical coding.
They just get the bill.

Re:Good. (5, Informative)

Anonymous Coward | more than 3 years ago | (#36434350)

The misattribution of the reason for rising costs in health care is unfortunate. The fact that government as a payor is in this system is one of the main reasons costs rise as such a rate.

I work on the revenue side at a fairly large health system, and due to our population we have approximately 50% of our patients privately insured, and close to 50% are government insured. (There are very few people coming in the doors who truly have no coverage, despite what the politicians would have you believe). The privately insured generally repay approximately what's billed, but for the government paid accounts, we would do well to recover 50%, 40% is a better guess. This is because the government solves its own budgetary problems by withholding increases to its medical payouts. In this area, we're still being paid at 2002 rates in 2011. We never withhold a needed service, so we just eat the cost.

But we have to make the books balance somehow. We're non-profit, but we still have to keep the lights on. Charge rates have to go up across the board, and the money lost on literally every government paid patient who walks in the door is then made up by the privately insured. You hear about $8 tylenol being billed, well, tylenol has to cost $8 because you're actually buying a whole bottle and sharing it with everyone else.

I think we're going to continue to have a huge gap of misunderstanding while people continue to emote over "big business" and "fat cats" and "obscene profits" without understanding what the real financial issues are on the ground.

Posted as AC due to PHB concerns.

Re:Good. (1)

gtall (79522) | more than 3 years ago | (#36434352)

The insurance companies will only use this as a reason to raise rates. I presume in the long run it will make the system more efficient, but I do not believe it will make it cheaper simply because the insurance companies will eat any efficiencies and fail to pass them on to the consumer or the taxpayer.

If insurance companies were good for the health system, it would be fixed by now. They aren't and they need to be kneecapped.

Re:Good. (1)

JDevers (83155) | more than 3 years ago | (#36434818)

As a quick note, misdiagnosis and malpractice are very rarely related. The other two things you list are gross misconduct. The wrong amputation is pretty rare but a devastating event. The wrong medication is much more common, but is rapidly becoming LESS common at least in hospitals with multiple error checks in the system to prevent it. Many modern medication administration records software systems force the administrator to verify identify via barcode scanners etc and then verify the drug using the same method. Orders entered into the system are verified by multiple sets of eyes. It DOES still happen, but isn't nearly as common in most settings. The ER and places like nursing homes are more likely. Even then the most likely situation is a pharmacist incorrectly filling a prescription to be taken home. It can range from life threatening to unnoticed in its effects. Misdiagnosis is very common and related to the difficulty in not only correctly diagnosing ailments but also actually getting correct descriptions of symptoms from patients. Most people do a piss poor job of describing what is wrong with them and many different diseases cause similar symptoms. These two things combine and most doctors start with the most likely explanation first and play a game of elimination from there. Humans are not computers, we can't give exact error codes that can then be immediately identified.

Gross misdiagnosis is another story and is related to incompetence and could be considered malpractice, but it also isn't that common.

Re:Good. (1)

jimbolauski (882977) | more than 3 years ago | (#36434888)

This is good as well. Insurance company profits are ridiculous and hopefully this will force them to invest a lot of those profits in the American economy to do this work. Complaining about expense when replacing systems in a organization that is fraught with malpractice (misdiagnosis, amputating the wrong limb, dispensing the wrong medication) is ridiculous. This is akin to the government complaining about the cost of replacing infrastructure when the alternative is your car plunging in the river on your morning commute.

Insurance companies are not the villains making an obscene 5% profit, they will probably increase profit once this system is in place as they only have to change a few programs, over billing and other risks will be mitigated due to better identification of injuries. Hospitals and other health care providers are the one's who will feel the pain as they have to update all their systems many of which hard coded the values in and so every program has to be updated and tested to the medical standards (which is why the values were hard coded in the first place).

Re:Good. (1)

CrimsonAvenger (580665) | more than 3 years ago | (#36435016)

Insurance company profits are ridiculous

Insurance company profits are less than 4%.

Which means that the only reason to invest in their stock is that they're not likely to tank anytime soon. It's not because of the huge profits they make.

"Meaningful use" too (1)

Anonymous Coward | more than 3 years ago | (#36434216)

TFA makes no mention of meaningful use, which is really taxing things... while it was marketed as being a way for health systems to earn monetary incentives by upgrading to EMRs, in reality what's going to happen everywhere, to every health system in the coming years is that one size fits all criteria is being foisted upon them in the form of very costly IT projects.

While there is a monetary payment from the government for the first few years for being in compliance, the cost to obtain financial reward X is significantly greater than X, but you have to do it anyway because non-compliance will result in heavy fines eventually.

And all these expenses are being piled on in economic times when health systems are already being crushed financially due to the state of the economy (lower patient volumes in general), terrible medicare/medicaid payouts, and the weight of supporting the government-insured, under insured, and uninsured (in that order) in general.

I know it's no surprise that national-level HIT management by the federal government has turned out to be not so grate akshully, but it is worth pointing out that Meaningful Use in the health care reform legislation is much worse than ICD-10

My last project involved ICD 9-10 Transition (0)

Anonymous Coward | more than 3 years ago | (#36434226)

In my last project i was involved in making a tool called HPower10 which will allow organizations to effectively migrate from ICD 9 - 10. Similarly i was also a part of a HIPAA 4010-5010 migration tool. You can find more details here: http://www.hexaware.com/icd-transition.htm

Big $$$ (1)

Subratik (1747672) | more than 3 years ago | (#36434230)

I'd love to be apart of that product manager's commission :( so what if it's going to take 5-10 years...

Re:Big $$$ (-1)

Anonymous Coward | more than 3 years ago | (#36434316)

Did you even bother to RTFA? I'm really sick of morons like you.

Re:Big $$$ (1)

Subratik (1747672) | more than 3 years ago | (#36434522)

**Christine Armstrong, a principal at Deloitte Consulting, said in a report that ICD-10's complex code and its impact on EHRs, various billing systems, reporting packages and other decision-making and analytical systems will prompt major upgrades or the replacement of current systems. The changeover will probably cost larger hospitals between $2 million and $5 million, and large care groups as much as $20 million, said James Swanson, director of client services at Virtusa, an IT services and consulting company. ** Did you even get what I was saying? Anybody affiliated with leading ANY of those IT projects is bound to make over 300,000$ a year. Maybe you've become what you most hated, noob.

Re:Big $$$ (1)

Subratik (1747672) | more than 3 years ago | (#36434582)

To elaborate, did you actually think someone was going to replace and upgrade this stuff for free? No, they just 'diverted' resources... Just because it's unfunded doesn't mean the people who are in the head aren't going to make it out with fat pockets. IE. Leaders of Non-Profit Organizations :) ---"It is pretty costly. A lot of other capital programs and initiatives are being deferred so these hospitals can work on the ICD-10 switchover," he said. "It crosses over so many different information systems. It's very broad in its scope." --- Oh yeah, you mean like the consulting pm's who are gonna bend over backwards for this headache aren't gonna get paid the usual sum of over 500$ per hour?

Re:Big $$$ (0)

Anonymous Coward | more than 3 years ago | (#36434780)

Shut up idiot. I was just trolling and you actually replied. LOLZ!!!!onehunderedeleven!!!
 
Woosh!!!
 
hahahaha. LOL!!

Re:Big $$$ (1)

KUHurdler (584689) | more than 3 years ago | (#36434770)

Did anyone else find it funny that we're talking about 9 vs 10 digits in the same summary as finger amputations?

Makes a lot of sense (2)

swbozo (604409) | more than 3 years ago | (#36434232)

It may be an "unfunded mandate", but it will probably help eliminate thousands of medical errors (mistaken amputations, incorrect medicine given to patients, etc.)

Re:Makes a lot of sense (1)

Registered Coward v2 (447531) | more than 3 years ago | (#36434276)

It may be an "unfunded mandate", but it will probably help eliminate thousands of medical errors (mistaken amputations, incorrect medicine given to patients, etc.)

Not really - the mistakes are made prior to the coding. Now you can just be more accurate about what was mistakenly done so you get paid for it.

Re:Makes a lot of sense (1)

swbozo (604409) | more than 3 years ago | (#36434362)

I'm not referring to misdiagnosis, but rather situations where the medical staff (pre-op and post-op nurses), for example mark the wrong limb for amputation. Having the code would make it possible for systematic checks to occur (say, a bar code not matching the medical procedure listed in the patient's file.)

Re:Makes a lot of sense (0)

Anonymous Coward | more than 3 years ago | (#36434400)

Coding is used after the fact, not before. It's for record-keeping and billing.

  MDs rarely have any ICD-9 codes avail when going into surgery. When filling out the post-op paperwork, they are added.

Re:Makes a lot of sense (0)

Anonymous Coward | more than 3 years ago | (#36434438)

There are already bar codes, double and triple checks by various personnel, and in some cases the patient actually marks with a sharpie which knee it is they will have surgery on, for example. Everywhere in the case the "laterality" (can't recall what the technical word is) is spelled out. It's really amazing that any of those errors occur. This was always rare but exponentially less so 30 years ago, today it is exceedingly, exceedingly rare.

In any case, providers don't use coding, coding is done after the time of service for billing/records purposes.

Re:Makes a lot of sense (4, Informative)

Anonymous Coward | more than 3 years ago | (#36434360)

No. Not at all.

Coding, is just a manner of recording in a concise format, what diagnosis was made, and what treatment was given. This way the data can be used for billing and statistics.

I have never, ever seen medical codes (be them ICD9, ICD10, SNOMED) ever used by doctors, medical technologists, or anyone with any direct influence over patient care. They aren't used in X-ray equipment (so there's no risk of incorrect examinations or incorrect interpretation), blood-work analysis machines, etc.

Being an MD, and part-time software developer, I've done a lot of work with medical databases. I looked at coding of educational files, and being able to import selected educational cases directly out of the hospital's electronic record system, in anonymised fasion, into an educational system. The first thing I noticed was that the coding (in this case ICD9) was extremely inaccurate, and often wildly misleading - fewer than half the codes I looked at were correct. The reason was that the coding was done by clerical staff, who read through the charts, and worked out what codes to use. These clerical staff weren't doctors, nurses, or other people trained in medical diagnosis. As a result, they would frequently misinterpret the charts and the wrong codes would be sent to billing and for government health statistics.

Hard? (0)

Anonymous Coward | more than 3 years ago | (#36434234)

How hard could this be? Isn't there a conversion table so you can (using the finger example) - mark all legacy data as the first finger, first joint - with a migrated data flag so you know it's probably not digit accurate?

Do they seriously have to review each record to get it right for old data? If so - that is unreasonable.

Re:Hard? (1)

TimeOut42 (314783) | more than 3 years ago | (#36434834)

So, you are recommending putting bad data into the database as a better option? GIGO....

HOLD ON A SECOND HERE !! (0)

Anonymous Coward | more than 3 years ago | (#36434242)

Are you telling me this is going to happen ?? Think of the children !! Why am I not surprised /. is supporting this ?? It's true. /. are co

HOLD ON !!

Scratch that. I was reading the text on the stall;s wall here.

meh. (4, Informative)

Ephemeriis (315124) | more than 3 years ago | (#36434254)

The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records.

For the most part, this isn't my problem.

ICD-10 has been on the radar for a while now. At least a couple years. And it's Federally mandated. So we didn't have any problem adding the necessary funds to our budget this year.

Each of our HIS vendors has already got ICD-10 stuff ready to go. We'll have to pay them for their time, or a software release, or whatever... But, as far as my own labor is concerned, it'll basically involve giving them remote access or throwing a disc in the drive.

Most of the labor involved is in our coding department. They're going to have to send folks out to get (re)trained in the ICD-10 stuff. They are, understandably, a little stressed. But they've been working on this for a while, too.

And it hurts too (-1, Troll)

dotslashfan (2265708) | more than 3 years ago | (#36434270)

Due to that update, one guy [aeonity.com] almost lost a hand, as he was mistakenly sent to amputee it.

Don't visit the link above, everyone. (0)

Anonymous Coward | more than 3 years ago | (#36434354)

Don't visit the link above, everyone. -sigh- Especially at work.

Re:And it hurts too (0)

Anonymous Coward | more than 3 years ago | (#36434374)

Asshole

It doesn't exactly sound like a waste of time (0)

Anonymous Coward | more than 3 years ago | (#36434272)

At the risk of sounding like I'm sending in a Whaaaaambulance, this seems like a worthy project. Seriously, is anyone suggesting that we should still be stuck in the 70s with healthcare diagnostics? It would be a frigging laugh if someone suggested that since it's too difficult for IT to do, healthcare diagnostics should not try to catch up to where it should be.

And really? The Feds needed to mandate this to get it done? With all the noise about how private healthcare really has out backs and we don't really need government healthcare, this seems like a pretty good example of exactly why we DO need government healthcare.

No sympathy for the whiners.

Re:It doesn't exactly sound like a waste of time (2)

crashumbc (1221174) | more than 3 years ago | (#36434418)

FYI, this really doesn't affect the diagnostics. 98%+ of it has to do with billing. Just because there was only one code for amputating a finger doesn't have anything to with the doctor doing his job. He does cuts it off describes what was done in the chart(or EMR) then after the person is discharged a person in a little room called a "coder" goes through the chart and enters the billing code(ICD-9 currently) in the bill that gets sent off to the insurance company.

Re:It doesn't exactly sound like a waste of time (1)

Qzukk (229616) | more than 3 years ago | (#36434456)

The Feds needed to mandate this to get it done?

Stuff like this is like infrastructure, the private companies will wait until it is completely disintegrating then try to get someone else to pay for it instead of spending money that could better be used for bonuses on capital improvement projects. ICD-10 was finished in 1992 [wikipedia.org] . So we're not stuck in the 70s, we're stuck in the 90s.

It doesn't help that all the private insurance companies have hitched their trailer to Medicare and do "whatever Medicare does", whether it's with regards to pay (doctors tell me that almost all private insurers pay a set percentage of whatever Medicare pays, which is why they're scream so loud every time Medicare cuts come up) or whatnot. At this point it doesn't take a law for the feds to "mandate" anything, if Medicare does it, monkey see monkey do.

And it slows things down (1)

m0s3m8n (1335861) | more than 3 years ago | (#36434282)

As the spouse of a Physician (hospitablist) and a System Admin for a medical practice, I can tell you first hand that is a cluster f&*%. The effect this crap is to slow down physicians with tasks that they really should not be doing, (read data entry). That is exactly what these regulations are doing. And to keep productivity up, some doctors are resorting to hiring scribes who follow them around, just increasing costs that will get absorbed somewhere. It all looks good on paper but the effect is reducing productivity of the people on the front lines.

Re:And it slows things down (3, Informative)

BlackHawk (15529) | more than 3 years ago | (#36434518)

As someone who's working with this stuff right now, I can say if it's slowing you down, you're not taking advantage of the available tools. They're out there. Keep looking. Moreover, "data entry" is one way of looking at it. A different way to call it is "documenting what they're doing with sufficient detail". That was the entire point of these kinds of standardized coding systems: to (as best as we can) remove the fuzzy documentation in the systems before, and to remove the idiosyncrasies from medical records. With the proper coding systems in place, a patient in Allentown who moves to Duluth can have his PHI moved to the new caregiver and be (for the most part) confident that the Iowans will be able to understand what the Pennsylvanians did for him before. Yeah, there's going to be transitional pain. There always is. But as has been pointed out in other posts, it's not like ICD-10 ambushed anybody. Frankly, if you haven't been moving toward ICD-10-capable systems for at least 2 years, you've been slacking. There's a penalty for that at crunch time.

Nearly Impossible? (1)

vlm (69642) | more than 3 years ago | (#36434302)

being compared to Y2K as an IT project that is nearly impossible to complete on time.

That sounds like good copy to a lowly journalist, but as someone "who was there" during Y2K, what was "nearly impossible"? We knew it was coming, we planned, the bosses mostly used it as an excuse to semi-fraudulently ram upgrades thru and as a powerful weapon to grab more budget money. It was way, big time, trivial.

Besides, just think about it. The entire world's IT department, all those guys who can't close open relays, blah blah blah all somehow 100% successfully did the nearly impossible... yeah uh huh.

Re:Nearly Impossible? (1)

BlackHawk (15529) | more than 3 years ago | (#36434552)

Amen to this. I got hired on by a company on Madison, WI in January of 1999 and was told on my first day that "this Y2K thing" was my first priority, since my predecessor had put in maybe 3 hours of work on the project. Oh, and I had to do it while getting our network up to date. Frankly, it was a cinch, once they'd approved the budget. *That* took until June, too, so I really did the entire project in 6 months.

Re:Nearly Impossible? (0)

Anonymous Coward | more than 3 years ago | (#36434958)

Is Epic still using that godawful char-pointer-based database system as a backend instead of an RDBMS?

Procrastination hurts (5, Informative)

RKThoadan (89437) | more than 3 years ago | (#36434308)

While this is definitely a huge pain, I have little sympathy for those complaining about the timing of this when the standard was finalized in 1992.

Cry me a river (4, Interesting)

Enry (630) | more than 3 years ago | (#36434314)

ICD-10 has been out for nearly 20 years. There was a 5 year timeline to get ICD-10 implemented, and there was likely a few years of discussion with major Medi* billers before that to let them know this was coming along.

Much like the FCC and HDTV, health care companies must have ignored the mandates until it was too late, whined and cried about how they couldn't meet such a strict deadline and pretty please can we extend it for another 5 years. Repeat until our health care records system is completely unusable.

Though, wow, I would have thought VistA would have ICD-10, but it's being bolted on now. Strange.

Re:Cry me a river (2)

crow_t_robot (528562) | more than 3 years ago | (#36434356)

It appears to me that most hospitals/medi orgs were dragging their feet to see how it would play out:

"Quite frankly, the hold up is it's a big undertaking and it took them a while to get under way. Everybody's started, but a large percentage of hospitals are in the heavy analysis stage or they're just starting," said Casey Corcoran, vice president commercial solutions for healthcare at General Dynamics Information Technology, a vendor offering ICD-10 consulting services.

"heavy analysis": heavy procrastination

Re:Cry me a river (3, Insightful)

Gideon Wells (1412675) | more than 3 years ago | (#36434526)

More and more I keep hearing "unfunded mandate" or "harsh deadline", but experience is translating it as "I waited till the last minute and now I'm screwed."

Re:Cry me a river (0)

Anonymous Coward | more than 3 years ago | (#36434852)

You are right on with your comment -- the WHO approved ICD-10 years ago and the US is one of the last countries to implement. The implementation date in the US has been pushed back a number of times. Hopefully the government claims systems will be updated to accept the new ICD-10 codes on the same timeline.

Re:Cry me a river (1)

Anonymous Coward | more than 3 years ago | (#36434738)

To be fair, WHO based ICD-10 has been out for 20 years. ICD-10-CM (the American verison) is fairly new and is something like 4x the size of WHO's set.

What is the ICD-10 code (0)

Chrisq (894406) | more than 3 years ago | (#36434322)

What is the ICD-10 code for being a dickless idiot. They could save time by automatically adding it to the record of all Federal employees. OK - maybe not the FBI - honestly I didn't mean you, I was just sayi.....

Re:What is the ICD-10 code (2)

weeboo0104 (644849) | more than 3 years ago | (#36434910)

What is the ICD-10 code for being a dickless idiot. They could save time by automatically adding it to the record of all Federal employees. OK - maybe not the FBI - honestly I didn't mean you, I was just sayi.....

The ICD-10 codes for being a dickless idiot would be:
Q56.4 Indeterminate sex
F79.1 Unspecified mental retardation with significant impairment of behaviour requiring attention or treatment

'unfunded mandate' (-1, Troll)

cpu6502 (1960974) | more than 3 years ago | (#36434326)

And this is why Government interference has made health costs skyrocket. My great-grandfather practically lived in a hospital during the late 40s and early 50s (he was paralyzed). Back then it was possible because the cost of the room was no more expensive than renting a hotel room. He was a poor farmer, but still able to pay the bill out of his own pocket.

So what's changed since then?
- Government regulations that require TONS more paperwork (like ICD-10), additional labor just to do that paperwork, and thereby cause costs to skyrocket.

Re:'unfunded mandate' (0)

Anonymous Coward | more than 3 years ago | (#36434894)

What's changed is skyrocketing medical malpractice insurance brought about by money-grubbing malpractice lawyers, drug companies spending billions on advertising to the masses that increases drug costs, patients who come in demanding specific high-cost tests (MRI, etc), and insurance companies who are determined to pay as little as possible for medical care, forcing the hospitals to absorb or pass on a lot of costs, and the great uninsured masses who go to the emergency room to see someone about their cold. It's not government interference that's driven health care costs up; it's the corporations.

Stop using crap languages and hardware (1)

exabrial (818005) | more than 3 years ago | (#36434338)

If you really have a problem with extending a field by a few bytes, you're using the wrong language. By now, you should expect the world is going to change constantly. If it's a surprise to you at this point congress is going to re-invent healthcare ever two years to boost their ratings, please beat yourself with your keyboard.

Let me guess, the people complaining are using z/os hardware and wrote everything in cobol accessing a ADABAS database. Some idiot business manager said, "It ain't broke, lets not upgrade" and decided to continue using their billion dollar IBM dildo for the next 15 years.

Re:Stop using crap languages and hardware (1)

bill_mcgonigle (4333) | more than 3 years ago | (#36434746)

When I left the hospital IT in the last decade, they were still writing everything in a niche language developed in-house by a power company in the next state. Nothing in the way of data integrity developed since the 60's with relational databases, and all of the productivity of a 40 year old language. This was the largest healthcare organization in the state.

Oh, they were going to upgrade to Visual Basic for some of the new code when I bolted for the door. Those who understood computer science were reviled for proposing technology the bosses couldn't themselves operate (monetary and patient-safety business cases were dismissed as irrelevant).

Last I heard from the grapevine they were going to trash the whole thing and fork-lift upgrade to a vendor's product. At least that vendor would have had to compete on his merits in the marketplace.

Oh, yeah, the point: don't try to apply normal IT thinking to healthcare, it's about politics, not IT.

Re:Stop using crap languages and hardware (0)

Anonymous Coward | more than 3 years ago | (#36434784)

Some idiot business manager said, "It ain't broke, lets not upgrade" and decided to continue using their billion dollar IBM dildo for the next 15 years.

amen !

Funny.... (0)

Anonymous Coward | more than 3 years ago | (#36434346)

Not so hard as they say, ICD10 to ICD9, I did it before from pseudo ICD9 to real ICD9, just gimme a job. I think the real problem is within health professional workers. :)

Rest of the world already uses it for years (0)

Anonymous Coward | more than 3 years ago | (#36434384)

I quite don't understand the whining here. Germany for example is using ICD-10 (first in a slightly modified version, now the standard one) since 2000, over ten years!

As always the USA are only very slow in adoption but other countries have shown that it can be done and that it does not warrant the whining we are seeing here.

So shut the fuck up and just do it already. And after that continue with adoption of metric units.

dear healthcare companies, providers, etc.: (1)

circletimessquare (444983) | more than 3 years ago | (#36434396)

maybe we can use this to pinpoint where you assholes waste so much cash

is that why you whine about it?

Re:dear healthcare companies, providers, etc.: (0)

Anonymous Coward | more than 3 years ago | (#36434640)

maybe we can use this to pinpoint where you assholes waste so much cash

is that why you whine about it?

More likely, this will be used to second guess doctors' clinical judgment in order to save a few bucks.

Re:dear healthcare companies, providers, etc.: (1)

circletimessquare (444983) | more than 3 years ago | (#36434796)

yeah, save a few bucks: what the fuck do you think is wrong with that goal? do you know how financially wasteful our healthcare system is?

Re:dear healthcare companies, providers, etc.: (1)

silas_moeckel (234313) | more than 3 years ago | (#36434874)

On the golf course?

Not directly but by buying whatever sales guy got chummy with the PHB and insists will fix everything. It generally cost more does less, is a giant pita to make work and follows no standards even there own.

And it hurts too... (-1, Troll)

dotsan (2265736) | more than 3 years ago | (#36434406)

Due to that update, one guy [aeonity.com] almost lost a hand, as he was mistakenly sent to amputee it.

Re:And it hurts too... (0)

Anonymous Coward | more than 3 years ago | (#36434452)

Giggles. That made my day. Thank you.

Re:And it hurts too... (0)

Anonymous Coward | more than 3 years ago | (#36434824)

Do not click the link, it is goatse.

Re:And it hurts too... (0)

Anonymous Coward | more than 3 years ago | (#36434882)

Motherfucker. Some of us are at work and don't want to have a drilled out anus pop up on their fucking screen. Christ.

Re:And it hurts too... (0)

Anonymous Coward | more than 3 years ago | (#36434952)

How many times are you going to spam this link? Like we don't know where that goes......

Replacing 70s systems with 90s system (1)

entirely_fluffy (756018) | more than 3 years ago | (#36434436)

ICD-10 is not exactly new: from http://en.wikipedia.org/wiki/ICD-10 [wikipedia.org]

.

"Work on ICD-10 began in 1983 and was completed in 1992"

Total Bullshit (4, Interesting)

Saerko (1174897) | more than 3 years ago | (#36434468)

As pretty much everyone else has already said, if you don't have a system that can quickly and easily update from ICD-9 to ICD-10, you're so far behind the IT implementation curve that you should be drug out into the street and shot.

It's 2011. They've had many, many years to upgrade, and now they're poised to paid by the government to do so. Hell, my employer stands to gain $50 million dollars over the next couple years from implementing key portions of the HITECH provisions in ARRA. For those reading, that's more than half of my (quite large and well-funded) health system's annual budget.

For our part, we just slapped down a couple hundred thousand for a product that hot-swaps our ICD-9 coding for ICD-10, and also tosses in a problem list that physicians can use that's tied to these coding schema, potentially improving efficiency and accuracy as well. The only excuse, and I mean ONLY excuse for ICD-10 being a problem is poor IT leadership within the health system/hospital--a failing which is incredibly, unbelievably common.

I'm lucky, I work in an IT shop that actually has its shit together.

Re:Total Bullshit (0)

Anonymous Coward | more than 3 years ago | (#36434962)

Very well said! I was going to call BS, because anyone that can't do this is, as you said, very far behind the curve and doesn't have their shit together. To me, this looks like the sorrier IT groups are just using this as an excuse to thieve more money away from the rest of the organization (whose job is, presumably, to better people's lives, rather than give money to shitty CIOs and their minions).

I'm sick of the incompetence that pervades so much of the IT workforce.

So... (1)

MadKeithV (102058) | more than 3 years ago | (#36434620)

What they are saying is that ICD-10 is implemented through ID-10-T managment?

Think positively (0)

Anonymous Coward | more than 3 years ago | (#36434656)

I try to think of these kinds of things as "job security". Yes, they're a headache for all involved. Self-centered and a bit callous, I know, but then again those traits are the basis for modern capitalism.

I know what will fix this... (0)

Anonymous Coward | more than 3 years ago | (#36434682)

...XML!

Typos (0)

Anonymous Coward | more than 3 years ago | (#36434930)

"Federally-Mandated Medical Coding"? Why are you hyphenating with an adverb ending in -ly? What is with this trend? It's redundant. Either drop the hyphen or drop the -ly. Or "Federal Lee-Mandated" if someone in the federal government named Lee is doing the mandating.

And "The change over from..."? In this context, "changeover" is one compound word.

Job creation (0)

Anonymous Coward | more than 3 years ago | (#36435002)

This is one of the ways that the government "creates" jobs. Now we just need for them to mandate telephone sanitizers.

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