Paperwork reduction bill is caught in coding crossfire

The measure would allow HHS to replace Medicare's ICD-9 coding system with a more complex version.

By Markian Hawryluk, AMNews staff. April 14, 2003.

Washington -- A bill designed to reduce the hassle factor for physicians in the Medicare program may wind up causing more headaches than it cures.

The House Energy and Commerce committee added a provision to its regulatory reform bill that would authorize the secretary of Health and Human Services to move forward with a new coding system that would become the standard for health care data collection and billing. That move could increase the number of codes physicians have to deal with from the current 4,000 to about 200,000, and require wholesale changes to computer systems, fee schedules and contracts.

Although the change has been contemplated initially only for inpatient diagnoses and services, there is considerable interest in extending the coding system to all sites of services, even physician practices.

Hospitals have complained that the current coding system for inpatient diagnoses and services, the International Classification of Diseases, 9th revision, is becoming increasingly unworkable. The system is more than 20 years old and has not kept up with developments in medicine.

For example, many procedures that can now be performed through a variety of approaches, including laparoscopy, were done only through open surgery when the ICD-9 system was developed. Some of the system's categories of diagnoses and procedures do not have enough codes to accommodate the advances. Many catch-all "other" categories must now be used for a number of procedures or diagnoses that can vary tremendously in the amount of resources they require, said Sue Prophet-Bowman, director of coding policy and compliance for the American Health Information Management Assn.