PORTLAND, Maine - The year 2015 is one some physicians have been dreading. It's the year that medical codes - the descriptions used to document your health history and submit claims - get an upgrade. The current coding system was adopted in 1979 - the same year the "Pina Colada" song came out.
The new coding system will launch in the U.S. this October, and that means health care providers have five months left to cram tens of thousands of new medical descriptions into their heads. Some physicians say the change is a boon to higher quality care. Others say it's a bust.
The coding system is called the International Classification of Diseases, or ICD. While the current system - ICD-9 - came out in the 70's, ICD-10 actually came out in the 1990s. Since then, every developed country has adopted it, says Dr. Jackie Cawley, Chief Medical Information Officer at MaineHealth - every one, she says, except for the United States. "As far as we know, we are the last country. We're behind the rest of the world."
There have been previous attempts to adopt it, but every one has been delayed because it's a monumental and costly task. Every health system, every commercial insurer, plus Medicare and Medicaid, need to swap out one information system for another.
Then there's the training: ICD 9 has about 17,000 codes, says Cawley. ICD-10 has 140,000 - eight times as many. There's a code to describe nearly any medical scenario you can imagine.
Dr. Jackie Cawley: "Um, 'on fire while water skiing.' I thought that was kind of a neat one."
Dr. Samir Haydar: " 'Suffocation after being locked in a refrigerator.' "
Dr. Jackie Cawley: " 'Injured by paper' I think is one of them."
Dr. Samir Haydar: "And there's 'walking corpse syndrome.' Not sure what that is."
Dr. Jackie Cawley: "I think there was another one about orca."
Dr. Samir Haydar: "Yeah. 'Struck by orca.' "
There's also "injured while knitting" and "injured at an art gallery." These changes are a lot for doctors to absorb, but at MaineHealth, Dr. Samir Haydar has got their backs. He's the one that just chimed in with some of the more unusual new codes.
Haydar is the health system's official "physician champion" for the conversion to ICD-10. He's also an emergency physician at Maine Medical Center. "I think the switch is worth it," Haydar says.
The decades-old current coding system does get annual updates. Still, Haydar says health care has evolved to a point that it CAN BE difficult for physicians to adequately describe the care they're providing. These new codes offer a higher level of detail. Take a common condition like "asthma," Haydar says. "We take care of one patient, five patients, 10 patients, we're diagnosing them with asthma. Now, there's 12 different types of severity of asthma. So a lot more specific."
These differences - in asthma and other conditions- can have different outcomes. That's important for tracking public health data and hospital performance, says Haydar. He says that detail also helps provide quality care for a patient as they move through the health care system.
But some physicians, like Dr. James Kirsh, an independent family physician in Falmouth, are skeptical the new codes will do anything to improve patient care. "It's going to add layers of bureaucracy, time, and expense, that does nothing for the patient's well-being," Kirsh says.
It's a view that's shared by Dr. John Erickson, an internal medicine specialist at Intermed. He says learning to appropriately document thousands of new codes demonstrates the unnecessary complexity of U.S. health care. "It feels like it's driven largely by financial concerns of how we do our work, as opposed to the work that we do."
The codes are tied to reimbursement. If a health care provider doesn't accurately record the care they provide, they stand to lose reimbursement dollars. It's clinical coders, like Lynda Cyr of Maine Medical Center, who translate doctors' descriptions into numerical codes that are then submitted as insurance claims. What does Cyr think of the tens of thousands of new codes she'll need to use?
"Oh, I think it's awesome. I can't wait for it to happen," she says, with a laugh. "I can't wait. You know, you build a better story for the patient. You build a better story for the patient."
The official switch to ICD-10 is scheduled for Oct. 1.
