New Medical Codes a Potential Mess for Insurers, Patients

The nation’s health care providers face a massive new regulatory requirement on Thursday October 1. That’s when doctors and hospitals will be required to use elaborate new coding on insurance claims that will dramatically expand reporting on everything from the routine common cold to the rare case of injury caused by an Orca whale.

The change mandated by the Centers for Medicare and Medicaid Services promises to swamp doctors’ and hospital offices with additional work but also threatens to delay or even stop payments from insurers.

These new codes—roughly 68,000 in all – are to be used by the federal government and private insurers to determine the cost of each patient visit. The ICD-10 – the tenth edition of the International Classification of Diseases – replaces ICD-9 which was used for 30 years and has just 14,000 diagnostic codes. The new codes are dramatically more detailed than those in the past, with 100 different codes for gout and 200 for diabetes.

Critics of the new program include the American Medical Association, which has said that the new system hasn’t been tested enough and will lead to major billing problems. Already, some doctors and hospitals are obtaining lines of credit as they transition to the new system in case payments from insurers are delayed.

The risks for patients are high as well since consumers often need prior approval from insurers for expensive tests and medical procedures. To get that approval, they will need a valid diagnostic code.

Promoters of the change say that the old codes were out of date. Healthcare providers have been racing to meet the deadlines, hiring coders and training medical professionals in advance of the deadline.