If you’re pecked by a turkey this holiday weekend, the nation’s health care system is ready to document it.
This is the first Thanksgiving when doctors and hospitals are using a new and vastly expanded set of medical codes that include everything from W61.43XA for “pecked by turkey” to Z63.1 for “problems in relationship with in-laws.”
The new, more precise coding system should allow for better tracking of health care quality and public health outbreaks — not just sibling rivalries, football injuries and other holiday hazards depicted by the new codes.
The shift is a big deal for doctors and hospitals, since the codes are central to how they get paid, and has created work for consultants including two of the largest companies Minnesota. But not everyone is giving thanks.
“The number of diagnoses we have is absolutely exploding,” said Dr. Lee Beecher, a psychiatrist who runs a health care think tank based in Maple Grove called the Minnesota Physician-Patient Alliance. “It gets ridiculous at times.”
Mandated by the federal government, health care providers in October moved to what’s called “ICD-10” — the abbreviation for the 10th edition of the International Classification of Medical Diseases.
There’s disagreement about the price tag on the change, with supporters citing per-doctor costs of less than $5,000 and critics saying large physician groups could spend up to $8 million.
Whereas doctors in the past worked with about 14,000 diagnostic codes, the new system now offers roughly 70,000 codes for describing illness. The number of codes for documenting hospital procedures has grown from 4,000 to about 73,000 codes.
The growth makes sense, proponents say, considering how health care has changed since the previous coding system was created in the 1970s.
Most industrialized countries previously adopted ICD-10, making the United States one of the last to stick with the old codes, said Laurie Johnson of Panacea Healthcare Solutions Inc., a consulting firm based in St. Paul.
Some users exasperated this fall by the new system have lampooned codes that describe external causes of injury — things like “bitten by orca” or “walked into lamppost” — but Johnson said most doctors don’t typically use those codes. They are useful for trauma registries that track causes of accidents, she said, as well as workers’ compensation and automobile insurers.
Doctors and hospitals use the codes when submitting bills to health insurers.
“Typically, physicians under [the old system] used maybe 20 to 30 codes — that was their book of business, if you will,” Johnson said. “They’ll use even a smaller percentage of ICD-10. They may use 50 codes.”
Even so, the Optum division of Minnetonka-based UnitedHealth Group has served as a consultant to many health care providers about the ICD-10 shift.
Specificity with the new codes will allow for detailed evaluation of whether treatments work, and could highlight new areas for research, said Deb Adler, a senior vice president at Optum.
Maplewood-based 3M developed a portion of the new codes under contract with the federal government. The manufacturer also outfits hospitals with coding software that had to be updated for the change.
What’s the use of knowing about sibling rivalries or troubles with the in-laws?
The codes could help the medical record better document the complex mix of factors behind mental health issues, said JaeLynn Williams, vice president and general manager of the 3M Health Information Systems Division.
Pecks by a turkey?
Think of all the turkeys that had to be destroyed in the past year due to avian flu, Williams said, and the remote — but real — chance of transmission from turkeys to people.
With the new codes, public health officials “can quickly identify, track and monitor potential disease outbreaks resulting from being pecked by, struck by or just barely coming into contact with turkeys,” she said. “When we think of the possibilities of big data, and looking through big data for important trends and patterns … the somewhat humorous codes about turkeys and families actually can be used for some very important outcomes.”
3M is part of a coalition of hospitals and insurers that pushed for adoption of ICD-10. The group noted in background materials that even the old system had some oddball codes including “accident involving spacecraft.”
Emergency rooms tend to see fewer patients than usual on Thanksgiving Day, but doctors at Methodist Hospital in St. Louis Park could find themselves using new codes W26.0 for “contact with knife” or W29.0XXA for “contact with powered kitchen appliance.”
Last year, about 5 percent of those seeking emergency care at the hospital on Thanksgiving have a chief complaint of laceration, said Nate Kliniske, senior director of hospital operations. That’s a bigger share, he said, than on a typical day.
The new codes should be helpful in understanding how to best provide health care for a large population of patients, said Dr. Andrew Laudenbach, a physician at Hennepin County Medical Center in Minneapolis. The change is a good thing, overall, Laudenbach said, but he admits some physicians haven’t been thrilled with it.
“I think it’s the insurers that find it most useful,” he said. “With me and the patient, whether I say ‘finger laceration’ or the specific digit … doesn’t really help that interaction.”
The Minnesota Hospital Association supported the switch to ICD-10, but the Minnesota Medical Association joined other physician groups in seeking to delay it.
The American Medical Association argued that adopting the new codes would cost more than $225,000 for a small physician practice and up to $8 million for a large practice.
Beyond the cost, the expanded set of medical codes furthers the trend of doctors spending more time entering data into computerized medical records, said Beecher, the psychiatrist with Minnesota Physician-Patient Alliance.
“The doctor’s attention is in satisfying the demands of the electronic medical record, the checklists, the things that you’re required to do,” Beecher said. “With ICD-10, there will be even more requirements”
“We end up treating the computer,” he said, “rather than the patient.”