Big Brother on Z79.52

As a medical coder, I've been ready for the new ICD-10 code set for three years. Bring it on, I say. Because I'm sick of the training, re-training, and refreshers. I got it already. Jeebus.

During that hang time, each year, the American Medical Association begged, pleaded, sobbed, cajoled, and lobbied on behalf of providers in the country to put off this huge undertaking of getting on a coding system that the rest of the world has been using for decades.

The AMA cited cost as the overarching obstacle for providers; training, updating EMRs, extra staff to field denials, or the new code system doesn't go with my tie. 

But, that is the AMA. They want to protect providers and I am on board with that no matter how many ICD-10 refreshers I am subjected to.

I'm more dubious about the much larger picture this new code set provides to insurance carriers and just what those carriers will do with this shiny new influx of medical information. 

For example, right now, V58.69 is indicated for long-term use of medications. The medications that fall into this category can be methadone, opiates, and other painkillers. It's ambiguous. The medication could be anything 'not elsewhere classifiable'. 

Not anymore. With ICD-10, a code can be assigned that specifically states long-term use of opiates. No more hiding that monkey. 

Obesity, too. Right now, the code is either 278.00 for obesity and 278.01 for morbid obesity. It's not specified as to why a person is obese. 

Not anymore. With ICD-10, there are codes that indicate if the obesity is due to medication being taken by the patient or due to excess calories. 

For nicotine dependence, there used to be one code routinely used: 305.1. Now, there are different codes to indicate if it's cigarettes, chewing tobacco, or other. (Other being patches, gum, lozenges, or e-cigs). It's all out there now. 

Right now, carriers are assigning risk pools with the ambiguous system we have in place because that's all they have.

Not anymore.

This new coding system is going to seriously change the landscape of assigning patient risk that, in turn, drives premiums.

It's going to be interesting to see what happens because this new system has been lauded as the best thing since the birth of the HIPAA fairy.