Yep, There’s a Billing Code for That

If you think you’re waiting even longer at your doctor’s office these days, you might be right. And it might be due to the overhaul of the medical billing code system that requires providers to enter an alphanumeric descriptor/diagnosis for every problem they treat.

As of this month, doctors, hospitals and health insurers must use the ICD-10, the coding system that has been in the works for a long time and has been delayed due to its astonishing specificity. According to (KHN) the number of codes doctors must use have increased from about 14,000 to nearly 70,000; hospital codes for medical procedures have boomed from about 4,000 to around 72,000.

Let’s say you’re boating in the San Juan Islands, get tossed into the water and slammed by a whale. Yep, we got that — W56.22xA (“struck by orca”). Let’s say you’re skating toward the net in your recreational hockey league game and some yahoo defender employs a weapon to stop you. Yep, we got that — Y08.01 (“assault by hockey stick”). Let’s say you were in the backyard coop, collecting eggs for breakfast and got attacked by an aggressive hen. Yep, we got that — W61.33 (“pecked by a chicken”).

The update from ICD-9, the previous set of codes, was necessary because the old ones have been used since 1979, and didn’t reflect the complexity of modern medicine. Lots of people think the new ones are more than a bit of an overreach. If you break your shinbone, it’s not a generic orthopedic event — your doctor must sort through dozens of codes for a fractured tibia to find the one that describes yours best. If you eat a toxic mushroom, there are 18 potential codes to describe that misadventure.

“Government and private insurers can reject claims that aren’t specific enough, use the wrong codes or have a mismatch between a diagnosis and procedure code,” KHN explained.

The code changeover is even more fraught in certain states because their billing systems were antiquated: California, Louisiana, Maryland and Montana got permission from the feds to use the old codes, at least for their Medicaid billing, until their systems can be upgraded, maybe a couple of years.

The ICD-10 codes are derived from the International Classification of Diseases, an initiative of the World Health Organization that includes codes for injuries, diseases, their causes and symptoms, as well as patient complaints and socioeconomic circumstances.

If most people and practitioners roll their eyes at what seems more like a comedy routine than medical record-keeping, public health officials, according to, welcome the granular view the ICD-10 affords. They’re optimistic that they will help them track illnesses and patterns, and get a better sense of what’s working and what isn’t in the U.S. health-care system.

“For instance,” Sean Cavanaugh, director of the Center for Medicare, told Marketplace, “we recently had a … threat of a problem with ebola. And the [old set of codes] does not have a code that’s specific to ebola.”

But the American Medical Association (AMA) is concerned that although Medicare allows a one-year reimbursement grace period for doctors who made honest mistakes in coding, not all private health insurers and Medicaid necessarily do.

“Questions remain if physicians will be forced to follow patchwork of disparate coding standards for each payer. The resulting confusion and inconsistency in claims processing would create unnecessary administrative costs and take resources away from patient care,” Steven J. Stack, AMA president, said in a written statement.

What’s the code for a prehistoric-looking, 8-foot reptile sinking its teeth into your leg? Depends — was it an alligator or crocodile? What’s the code for banging your elbow on a chair in a public venue? Depends — was it at the opera house or the library?


Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
Washingtonian Top Lawyer 2011
Avvo Rating 10.0 Superb Top Attorney Best Lawyers Firm
Contact Information