UNCLE SAM WANTS TO KNOW ALL YOUR MEDICAL RECORD

MEDICAL CODING REVISION STIRS DEBATE

The government is changing the coding system that doctors and hospital use to bill insurers with a complete overhaul promised within the next three years.  The final ruling on this is scheduled for the end of this year.  New medical developments emerge each year and the system can’t keep up with it.

The new system, ICD-10 will have at least 10 times the number of codes now present, which has 9200 codes.  There will be 150,000 codes for ailments and procedures doctors do.  Today there is one code for angioplasty.   The hospital will be able to choose 1170 codes for each patient.  There will be 68,000 diagnoses (up from 13,000), 87,000 procedures (up from 3,000).

The CMS, the federal agency that maintains the medical codes say it will allow doctors to give more details on your medical records.  It will be the next step in a nationwide electronic medical-information system.  Hospitals like it because they can describe advanced surgeries and procedures that will get them more money.  Hospital also will have less administrative costs because they will match the procedures with the diagnoses that pay the most.

Doctors who don’t work for the hospital will need to adapt to the new complex system.  It will cost them new software and they will need to higher more coders and nurses to their staffs to just handle all the new paperwork.  Doctors will of course spend less time with you.

 It is estimated that over 10% of claims will be returned because of errors.  Bluc Cross estimates there will be up to 25% billing errors the first year.  This means the insurance will not pay the claims for these 25% of claims and you the patient will be on the hook for the money.  Your Medicare currently pays half of all procedures done in hospital.

 

There will be more billing errors, you the patient will be overcharged, and the insurance company will be able to deny your doctor’s claim stating it didn’t have the proper code.  There will be more billing fraud and you and the doctors will not be paid quickly.  You will need to give the doctor more medical details, and each insurance company will want different details of your life.

With national health care coming, it will not matter, since the government will control all the details and the reimbursements.  It wills simply the life of your private doctor, who will be employed by the hospital, who will set the rules.  Surely he will not encourage his children to enter the profession.

Source: WSJ, Nov. 11, 2008

What do you think?  Your comments are always appreciated.

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