International Classification of Diseases

Using numbered codes for diagnosis make cataloging disease and coding the cause of death easier and more accurate. These are the ICD codes (International Classification of Diseases). ICD 1 began in 1900 and the current ICD 9 is scheduled to be replaced by the ICD 10 in October 2015. The magnitude of the changes can be seen in the ICD 9 having about 16,000 diagnostic codes and the ICD 10 will have about 68,000 diagnostic codes. This was to be effective in October 2014. Because insurance companies, medical billers for large medical groups could not meet the deadline, Obamacare delayed the implementation to October 2015. The possibility for error has increased dramatically. Errors in coding can be interpreted as fraud, especially if there is a financial incentive, and can be prosecuted and lead to stiff fines or sanctions. Hence, the one year delay has added an additional year of practice for many physicians and surgeons who will close their offices on the date of implementation.

Using a numbered code for each medical or surgical procedure helps define the procedure for greater consistency. These are the CPT codes, Current Procedural Terminology, which define the time and work involved with each procedure required for the diagnosis and management of each recorded ICD code. These have been spelled out in great detail with E & M (Evaluation and Management) descriptions for all medical and surgical procedures. The risk for errors with CPT codes is much greater and the penalties more severe than for ICD errors since CPT codes are tied to reimbursement. If the doctor’s description of his/her medical evaluation or procedure doesn’t support the code, then he/she is guilty of fraud. Thus a doctor that is very busy and his dictation or record keeping is delayed, which can cause an oversight, an error in recall or a total omission should that chart not make it back to his desk, he/she would be guilty of fraud if that record were reviewed.

After the CPT codes were change about a decade ago, a physician in our community who had primarily a nursing home practice was reviewed. He would make rounds on these difficult patients with stroke, decubiti ulcers, dementia, and other debilitating diseases on a monthly basis as required by MediCaid. Many of these patients had lost their ability to speak. Hence, much of his medical history was obtained from the nurse or the patient’s record and he would record his exam. Some of these nursing home patients had severe contractures, buttocks with decubiti ulcers wrapped in soft cloths, taped, which made his physical examination difficult and less than complete.

When he was reviewed, as he faced the medical reviewer, a US attorney, and a peace officer, he was told that he used the wrong CPT codes and therefore, his reimbursement was greater that it should have been. He stated that he did not understand the new codes and left it to his staff to figure out which to use and he continued to do the same amount of work and continue the same charges he had used prior to the code changes.

He was then asked if he understood the codes after their explanation and he said “yes” and he was sorry and would not do that again. According to this physician he was then asked to sign an agreement that he indeed had used the wrong codes and would use the correct codes in the future. As he explained it to me some two or three later, he signed the admission of having used the wrong codes, and was promptly handcuff by the officer, and led off to jail. He spent the next 22 months in prison. Although he was relatively young, he should have been able to practice for another 20 or 30 years, except now as a felon, he lost his license, his home, and all his assets to attorney’s fees.

He did not think it was gluttony since his charges and work were the same, but the FEDS did. And he did time, is considered a felon, and no longer is a physician and no longer can vote.

Some physicians felt he did nothing wrong, he charged his usual and customary fee for his service, both before and after the code changes, did not commit fraud, but still became a government manufactured white crime criminal losing at least a half million dollars his father invested in his education and ended up as a day laborer.

Tune in next month for a continuation of coding in Section V.

So if you’re near the time to close your practice, seriously consider closing it on Oct 1, 2015.

I will be closing mine on the date that ICD 10 is implemented.

I don’t want to spend the last decade of my life in prison.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Medical Gluttony thrives in Government and Health Insurance Programs.