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Pregnant Men, Turtle Bites, and ICD-10

From 2009 to 2010, British men by the thousands visited hospitals and required obstetric or midwife services. Have British scientists found a way for men to give birth? Or is it possible that something in the drinking water has given men the ability to carry child? Disappointingly, the actual cause for the influx of male pregnancies is attributed to a more mundane reality: coding errors.

In a letter published in the British Medical Journal, doctors highlight that over 17,000 men were admitted to hospitals for pregnancy-related services, most of which are believed to be due to mistakes in data entry:

“We suspect that the numbers may, at least partly, reflect data errors,” write Laura Brennan, Mando Watson and Robert Klaber. “Some of these may be due to similarities in the main specialty codes.”

 Which makes one wonder what else the numbers may partly reflect…

Physicians who reviewed the English National Health Service (NHS) statistics cited that one reason for the data errors is the system’s reliance on a three-digit medical code. A single, misfired keystroke is the difference between coding a patient’s visit as a trip to the ophthalmologist (460), or a session with a midwife (560).

These tales of men awaiting the speculum remind us of the U.S. healthcare industry’s recent struggles with medical coding procedures. Currently, health providers use the 9th version of the International Classification of Diseases (ICD), which has over 17,000 medical billing codes. But in January of 2009, the U.S. Department of Health and Human Services (HHS) announced a rule that by October 1, 2013, providers must adopt the newer ICD-10, which has over 140,000 codes.

Meanwhile, HHS recently proposed to extend the October 1, 2013 compliance deadline by one year to October 1, 2014. Some health industry groups, like the American Medical Association (AMA), lobbied for the extension, citing that the industry is already overburdened by the federal health reform law and health IT upgrades.

With coding error rates reported to range from 17.1% to 76.9% [1], critics argue that having almost ten times the number of codes under ICD-10 will only further complicate the matter and lead to more errors. Hospitals and providers will need to adequately train physicians, nurses, and administrative staff on the more complex coding system. They will also have to make major upgrades to their IT system, or even completely replace old ones. The AMA estimates the cost of implementing ICD-10 could range from $83,290 to more than $2.7 million per organization.

Supporters, on the other hand, contend that the industry must move on to the newer ICD-10 system (which was actually completed 20 years ago and is in place in every other developed country) that contains medical treatments and technologies not contained in the older ICD-9. Based on a patient’s ICD-10 coding, a physician will be able to distinguish whether a person was bit (W59.21), struck (W59.22), or harmed in any other way (W59.29) by a turtle. Who knew a turtle was so versatile in its ability to hurt an individual?

In the end, advocates say converting to ICD-10 will allow for better analysis of clinical data and improved accuracy in reimbursements. Because of ICD-9’s inability to update its codes, newer, complex, and thus more expensive medical procedures are oftentimes grouped with simpler, older ones, and vice versa. ICD-10 will allow providers to be more appropriately reimbursed for the actual care they deliver, and have far fewer of their claims rejected or returned for more information.

 

 


[1]O’Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM. “Measuring Diagnoses: ICD Code Accuracy Health Serv Res. 2005 October; 40(5 Pt 2): 1620–1639

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