ICD-10 Humor: A man walks into a lamppost...

Carl Natale
by Carl Natale

What is the ICD-10 code for injured pride when the Wall Street Journal pokes fun at the level of detail in ICD-10? Someone at the Centers for Medicare & Medicaid Services (CMS) must be nursing a bruised ego after reading "New Medical Codes Provide Precision."

What if a squirrel bites you while water skiing?Anna Mathews' story focuses on the granularity by highlighting some of the injuries (water skies on fire, squirrel bites and chicken coop accidents for example). It's well written and entertaining but has a bit of that "Oh those wacky bureaucrats" flavor to it. Which is better than the overviews I'm used to finding in more mainstream publications.

ICD-10 codes as punchlines

The Twittersphere is busy with quotes from the story. ICD-10 codes are punchlines for jokes that you can tell at parties with non-healthcare friends. Everyone will laugh when they learn the medical profession will be tracking how many people get struck by turtles.

Do a search for #ICD10 or some variation on Twitter, and you will find countless tweets celebrating the comical injuries that can be succinctly documented. Everyone is getting a good laugh. The more serious comments express outrage over having three codes for someone walking into a lamppost. It's another example of government overreach you know.

There may be a serious need

I remember what Daniel Duvall, medical officer for the CMS Hospital and Ambulatory Policy Group, said about why all those codes exist. He said that private organizations representing medical specialties wanted codes that recognized specific diagnoses for their reporting and tracking. Maybe urban emergency room doctors are trying to figure out if lamppost accidents are a problem. Or a symptom of problems such as alcoholism or domestic abuse.

Mathews somewhat backs up Duvall's assertion  while talking to Kai Ryssdal in a Marketplace interview. After some fun at the expense of burned water skiers and victims of lamppost encounters, Mathews sort of explains why:

"Well, what the federal agency said when I talked to them was that it would lead to better tracking of what's actually being done, which is good for research. From a public health perspective, what they said is it's helpful to be able to know where injuries occur so that public health researchers can work on ways to prevent them."

I realize this ultimately comes from government bureaucrats, and I should be skeptical. But someone reminded me of an interview I had with Jim Jacobs, senior vice president and product management and health information management for QuadraMed. He explained the need for extreme specificity. "If you want to understand outcomes and understand the protocols that are working, the protocols that have measured benefits, then you need quite a bit of specificity."

You also need to read this very thoughtful post on why too much information can be counterproductive. It's a strong analysis of how medical information is collected and reported.

Putting it in perspective

There are physicians who say there's nothing funny about having to remember 140,000 codes. I want to point out some perspective on this from a Canadian neurosurgeon:

@Skepticscalpel Interesting. I've actually been coding with ICD-10 for 3 years now, but I only use around a dozen codes on a regular basis. (@gpsforthebrain)

She didn't say whether burns from waterskiing was one of them.

Then there's the financial perspective

In the Marketplace interview, Ryssdal asks the question that needs to be asked more often. "Is this going to do anything to make health care cheaper or more efficient?"

Mathews says that depends. Some professionals say payers will use the data to create "improved payment strategies." Improved for whom? Once all this shakes out, I can't imagine that patients won't be paying more for healthcare.

Although Jacobs told me that the increased data could reduce unnecessary medical tests. And that would reduce costs for everyone.

One last point. The Marketplace interview ended with a discussion about how insurance companies will know more about patients thanks to ICD-10 granularity. It is possible that the information can be used to justify charging higher healthcare insurance premiums. Which is supposed to be illegal in 2014.

What's the ICD-10 code for being sick of rising healthcare costs?