The Health Blog at the Wall Street Journal picks up on some influential health bloggers here and investigates nice credit to the bloggers ( KevinMD and Dr. Secretwave101 ) too! This somewhat shows how complicated the billing process is today for healthcare. There are thousands of codes used to diagnose and other codes, CPT that are used in conjunction for the payment to the physicians and hospitals. This is why businesses such as clearinghouses are used to make sure the accuracy is there in the submission so payment is not held up.
Each quarter, new codes come out and some are retired. This is a massive project to stay on top of and if not current, claims get rejected and stalled for use of a code that no longer is active. One more headache to for the current system, just to get paid. No wonder many physicians like cash!
As the coding system evolves, the codes get even more complicated, for instance diabetes is one as an example. There used to be a general amount of codes, but now there are about 20 or so that relate to diabetes with pregnancy as an example, so for the proper code to be entered, a bit of study and research is required to make sure the proper diagnosis of pregnancy is correlated with the proper diabetes diagnosis. The changes are usually reflected in a .0 add on, so code “000” that used to be one is now listed as 000.1, 000.2, 000.3, 000.4, 000.5 and so on and the .0 extensions keep coming. So in the past, perhaps 000 was fine, but now it should be coded as 000.09 for a simple example.
The prognosis for coding as in it’s current state will more than likely continue to grow so the “exact” area is pinpointed. Next step, enter personalized medicine to run queries against this information, this is probably where the detailed codes may show some benefit though when identifying patients for clinical studies as an example, or in exploring the DNA defined treatment plans that are emerging…it’s coming. BD
So we’ve got this patient here who was injured in this spaceship accident. You know, just a routine, uh, orbital mishap. But how do we account for that? Oh, right, it’s ICD-9 code E845 — “Accident involving spacecraft.” Apropos of nothing in particular, this billing code popped up on a couple of medical blogs last week (KevinMDandDr. Secretwave101). Intrigued, we did a little reporting.