Tuesday, September 13, 2011

My Life In Code

Just when you think being a doctor couldn't get any more complicated. Between the vanishing reimbursements from third party payers, the prevalence of malpractice lawsuits, and the almost impossible work-life balance that is heavily tilted towards work and no life, you would think somebody would give doctors a break. Nope. That's not in the cards, at least from the government. The new International Classification of Diseases 10 (ICD-10) is about to be revealed. If an entire mini-industry has developed around helping doctors fill out the paper work properly for ICD-9, ICD-10 is going to require a cloud stuffed full of supercomputers to fully comprehend.

The ICD codes are the way a physician classifies a disease process when filling out insurance paperwork. Whether it be diabetes, hypertension, cholecystitis, meningioma, or thousands of other afflictions suffered by the human body, the doctor has to properly find the correct ICD code in order for insurance companies to determine if the patient received the proper treatment. For whatever reason if the code doesn't match up with the treatment, the doctor can be denied reimbursement. Thus thousands of people in this country are employed for the sole purpose of finding the right code so the doctor will get paid. There are currently about 18,000 different codes in ICD-9. With the new ICD-10, the number of different human problems that has been classified has exploded to over 140,000!

Has the number of human diseases increased that much? No, but the inquisition and persecution of doctors has. The government and insurance companies will now be able to understand what they are distributing the payments to doctors for in much greater detail. For instance, there are separate codes for injuries caused by ducks vs. chickens vs. goose vs. parrot vs. macaw vs. turkey. Each aviary injury is further subdivided into nine finer codes. There are codes separating injury caused by being bitten by a turtle vs. being struck by a turtle.

Third party payers, to an unprecedented degree, will be able to snoop on your daily activities short of actually having a camera follow you around all day and night. There are separate codes for injuries suffered while attending an opera, visiting an art gallery, playing a trumpet, or exercising at a squash court. There are codes to show what a white trash klutz you are, whether you fall down in the bedroom, the bathroom, or in nine separate locations within a mobile home. There are codes for walking into a lamppost and codes for subsequent followup after you walk into a lamppost.

An artery repair after you injury yourself will now require the doctor to enter at least one of 195 separate codes since each artery in the body has an individual code attached. A bone fracture leads to the possibility of sifting through nearly 3,000 codes to find the correct one. If the wrong one is filed with the third party payer, the doctor will be denied payment for his services.

Is it possible to put the entire human existence into a book of codes? And do we really want this level of intrusiveness into our lives? Ostensibly the purpose of having a near infinite number of codes on human activity is to help the government understand possible sources of disease or injuries and develop strategies to prevent them. Think about the potential abuse this system could created. There will be virtually no vice that a human will escape from without driving up their insurance premiums. A previously healthy person can suddenly be reclassified with a potential problem like having a "bizarre personal appearance" or "very low level of personal hygiene." "1984" is upon us and it doesn't involve cameras on every street corner. Through a confluence of government, insurance companies, doctors, and lawyers, the personal lives of every person in America will soon be examined in excruciating detail, starting Oct. 1, 2013 when ICD-10 takes effect.

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