There are plenty of questions – and a fair amount of controversy – surrounding the ICD-10 coding system set to take effect October 1. But in the midst of this often-confusing scenario, one thing is clear: At least one new code won’t affect folks in Memphis – at least not anytime soon.

That’s because new code V80.730A refers to an “animal rider injured in collision with trolley,” and as Memphians are well aware, the city’s trolleys are on hiatus.

So Bluff City residents and visitors are safe on that front, or at least until the Main Street trolleys once again are rolling. Until then it’s unclear whether unfortunate riders – or animals – injured by the big green buses rumbling along the city’s trolley routes will be detoured to other codes, so it’s best to play it safe and look both ways before crossing the street.

As for the more than 55,000 new designations soon to be available, the specificity of some codes makes one wonder just how many patients had to identify a cause before a code was developed for it. For example, there must have been a significant number of injury victims flooding doctors’ offices and suffering from a seemingly unlikely, but apparently frequent, accident that led to code V9107XA, or “burn due to water skis on fire.”

Or take, for instance, any unlucky soul who perhaps during the heyday of this city’s once-bustling airport managed to survive an altercation with a jet engine. Bad enough luck the first time around, but just in case it happens again, now there’s a code for it: V97.33XD “sucked into jet engine, subsequent encounter.”

And you thought escalating baggage fees posed a travel hazard.

Then there’s code W22.02XD, which could apply to overly enthusiastic revelers on Beale Street who just don’t know when to say when: “walked into lamp post, subsequent encounter.”

Regardless of the unintentional humor found in some of the new codes, the new designations are coming and they’re coming fast. For the first time in three decades, physicians in the United States will be required to use updated codes to designate patients’ conditions when the transition occurs.

Scott Morris, MD, founder and CEO of the Church Health Center, said his facility is diligently preparing for the new system.

“Whether it’s worth the effort is still to be seen. Having 70,000 choices seems like a little overkill to me,” Morris said. “While I do believe this will allow doctors to be paid for their work around prevention, it still will be necessary to encourage physicians to focus on prevention rather than technology in order to have improved health outcomes."

And while the new codes will make classifying patients’ conditions much more precise, the sheer volume of the new classifications can be daunting.

“It isn’t like this is a big surprise, because doctors and healthcare facilities have known about this change for some time," said Denny Flint, managing partner of The Talon Group, a Parker, Colorado-based consulting firm for healthcare practices. "You can go back almost 20 years to HIPPA regulations in 1996 and see how diagnostic procedures and the increasing use of data to identify conditions have been evolving. Still, this is the first time in 30 years that doctors in the U.S. have had to work with a new coding system, and it’s not a small change.

"They’re going from nearly 14,000 codes now under the ICD-9 system to more than 70,000 with ICD-10. At first glance, that can seem overwhelming.”

It can also be expensive.

In addition to healthcare practitioners who will have to make sure patients’ conditions are coded properly, many support staffers must be educated to recognize the new codes, and technology must be updated to make sure that the proper codes are entered for the appropriate conditions.

“This is an enormous change for every medical institution in America, and the Church Health Center is no different,” Morris said. “It is taking a great deal of effort and cost for us and everyone else to get ready for the change.”

Flint agreed.

“To be sure, there are some interesting ones in there, and doctors will find that broad classifications that they once used are now a lot more detailed,” Flint said. “A good example is a patient who comes to a doctor’s office suffering from a bite from a macaw. Simple enough to code in the past, but under the new system doctors will have to enter a code specifying whether the macaw that bit the patient was blue, or green, or yellow. There are codes for everything.”

But cracking those codes will take time.

In recognition of that, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) recently released a joint statement in which the two organizations pledged to help physicians get up to speed on the new system.

“ICD-10 implementation is set to begin October 1, and it is imperative that physician practices take steps beforehand to be ready,” AMA President Steven J. Stack, MD, said in a statement. “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials and penalties under various Medicare reporting programs. The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”

The free help includes a series of webinars and training sessions, along with a website – www.roadto10.org/ – devoted to helping doctors navigate the new system.

Flint said he has encouraged doctors to take advantage of all the assistance offered, become comfortable with the documentation, and make sure technology is ready for the new system. And while he emphasized the importance of adhering to ICD-10, he also acknowledged the occasional and perhaps unintentionally humorous results of doing so.

“These codes are much more specific and examine how, why and where accidents occur," Flint said. "The new codes will help us determine why people are sick from specific conditions in specific areas, and that’s of great value in addressing patient populations. At the same time, you just have to smile at some of them. My personal favorite code is R46.1: bizarre personal appearance. I can imagine there are a lot of interesting stories that could be attached to that one!”

Dr. Scott Morris

RELATED LINKS:

Centers for Medicare & Medicaid Services, www.cms.org;

American Medical Association, www.ama-assn.org;

The Talon Group, www.the-talon.com;

Church Health Center, www.churchhealthcenter.org