Coding Complexity: US Health Care Gets Ready For The Coming Of ICD-10

Abstract

A data deluge is fast approaching for health care providers, including Robert Callahan, a family physician who shares an office with two other family doctors in a brick house on a busy commercial strip in Newark, Delaware. Behind the front desk are shelves crammed with paper charts dating back thirty years to the time when one of the doctors opened the office. Callahan, 38, is a quiet, serious man who left the Air Force four years ago to practice here. After all of his medical and military training, he’s nowpreparing to take onhis next challenge: a federal requirement that all physician practices, hospitals, and health plans switch from the current system of classifying diagnoses and procedures—known as ICD-9—to a dramatically different and expanded ICD-10 coding system on October 1, 2013. At that time, the number of diagnostic codes— in effect, the alphanumeric name badges that diagnoses carry for insurance billing and other purposes—will increase from about 14,000 to 69,000. Simultaneously, the number of codes for procedures that can be performed on an inpatient basis in hospitals will jump from about 3,800 to 72,000. The shift will affect just about every aspect of clinical and business operations, since the codes document what clinicians do with patients and are embedded in nearly all clinical information and billing operations nationwide. doi: 10.1377/hlthaff.2011.0319 HEALTH AFFAIRS 30, NO. 5 (2011): 968–974 ©2011 Project HOPE— The People-to-People Health Foundation, Inc.