Bit by a squirrel? There’s now a medical code for that (W53.21XA)

Posted at 5:45 PM, Oct 01, 2015
By Jen Christensen


(CNN) — If you get hurt in a close encounter with a sea lion, injured at the library or burned when your water skis catch on fire for the second time, you are now in luck. Before today your doctor had no way to code for these specific injuries (W56.19XA, Y92.241 and V91.07XD, respectively), but now these unusual circumstances — along with over 137,000 new classified ways to get injured, sick or die — will be represented in the way the medical system records what ails you.

How medical billing changes impact you

For one thing, it’s likely made your doctor nervous and it likely should. It’s the biggest change to happen to the medical profession in years and virtually no one outside of the profession has heard about it. This government-mandated change has the potential to make you wait a little longer for a doctor’s appointment or delay the insurance approval for the MRI you need. It could also improve the quality of your medical care.

“When Obamacare launched, it came with all these headlines, but it only impacted a few million people. These are changes that impact every single individual who uses the health care system,” said Dr. Michael Marks. “Some people have compared this change to Y2K, but nothing happened with that; it was all a big build up to nothing. But this is real, and I don’t know if everyone really is ready for it.”

As an orthopedic surgeon, Marks works in a part of the medical profession that will see the most code changes, and he’s been traveling the country trying to help other doctors get ready for the shift in the way they will do business. The last time codes changed, he said, it took so much additional time to record the data it impacted his productivity. Rather than see six patients an hour, even after they got the hang of the new system, he could only see five. Marks has told doctors they may want to put up signs in their offices letting patients know that due to these billing changes things may go a little slower around their offices, at least at first.

But if lightning strikes you not once but twice, now there’s a new code for that (T75.01XD). If you’re struck by a macaw, don’t worry, we’ve got you covered. That’s W61.12XA. If you’re bitten by an orca once (W56.21XA), or the killer whale comes back for more (W56.21XD), you’re good. And those distinctions, as silly as they may sound, could mean more specifically targeted care.

Why doctors need such detailed codes

The theory is that the data helps the experts better understand health trends and better anticipate outbreaks. The codes are used worldwide so they are relatively standardized no matter if you go to the doctor in Arizona or Antarctica, where that killer whale code may come in a little handier. Experts at government agencies such as OSHA can use the information to better understand how people get hurt at work, for instance, and could make changes to make the office safer. Now designers will be able to look at the number of right foot injuries versus left foot injuries in car accidents and see if they should adjust that part of the car to make the equipment safer. The old system doesn’t distinguish between the right or left feet.

The system doctors have been using — known as ICD-9 — was created in the 1970s. The new codes will now get at the frequency with which someone was hurt, it will better document the severity of the problem and will document the complications that may arise due to the injury or illness. The old codes didn’t get at that kind of detail. The new codes will also make it easier to measure the quality of care and the results of particular treatments.

“This will help doctors’ better target treatment to individual consumers,” said Clare Krusing with the American Health Insurance Plans, a trade association for the insurance industry. Krusing thinks the data will help doctors better zero in on the gaps in care and help patients better manage their chronic conditions or “keep something from happening in first place.”

Merchants and medical data, an historic quest

The quest for better medical data has been a long one dating back to the 17th century. An English merchant named John Graunt used data from parish death records to create the London Bills of Mortality to better understood the spread of bubonic plague. Why would a merchant want that data as opposed to a doctor you may ask? Graunt’s fellow London merchants wanted to know if their customer base was increasing or decreasing. Medical professionals, not just merchants, wanted that data too and for hundreds of years they’ve been arguing for a more uniform system. Even the famed 19th century nurse and medical reformer Florence Nightingale argued that consistent comparative information would empower patients who would better understand the treatment they were getting and let them see if it was really working.

In the 20th century the League of Nations and later the World Health Organization created the codes that became the early versions of what doctors use today. The first ICD came in 1900 and there have been several versions and for the past 30 years doctors have used the ICD-9. The ICD-10 was actually adopted by the WHO in 1994 and the United States was supposed to be working with the codes earlier, but the launch was delayed twice to give providers more time. Even the October 1 launch comes with a small grace period for government insurance.

“But to be clear, this is not a grace period in the sense that providers are exempt from using the right code. It is really more of a time for a review process,” said Krusing. Meaning doctors get a little bit of time to get used to the new system, but they’ll have to correct and resubmit the right ones.

Get used to the change, for now

Doctors and hospitals throughout the country have been training staff and buying new computer programs to handle the changes. Marks, the orthopedic surgeon, has traveled across the country talking to his fellow doctors about the changes. He has advised them they may want to take out a line of credit just in case too many of the claims get rejected due to coding errors.

Even offices that think they are prepared may not be. A large orthopedic practice group Marks knew tested the new system they had and found that 80% of the new codes came up incorrect in their system.

“This is going to take some time to get used to for sure,” Marks said.

But in the meantime if you do get bit by a squirrel (W53.21XA) or are involved in an unspecific spacecraft accident (V95.40XA) or you get hurt walking into a lamp post (W22.02XA) your doctor will be able to bill your insurance for it. At least until around 2017; that’s when the WHO plans to revise the codes again.

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