But these exploding numbers are misleading and shouldn’t imply a better understanding of disease classification. There may be some legitimate reasons for the exponential growth in codes, but they are hard to find. Coding has run amok. Imagine that you’re an emergency department doctor, looking to code the exam of a patient with burns caused by their water skis catching fire. Yes, this preposterous scenario that defies the laws of physics has its own code: Y93.D: V91.07XD. I would be curious to know how many times this code has been used so far. What if you work near an airport and are asked to evaluate a patient who has been sucked into a jet engine? Well, you would use code V97.33XD. ICD-10 does not, however, distinguish between types of jet engines. One code fits all.
Seriously, let’s move from trauma to rheumatology. In ICD-9, there are eight codes combined for RA and juvenile RA. The coding mavens have declared that just won’t work for the 21st-century rheumatologist. Rather than approaching the issue with logic and clarity, they chose otherwise. First, they selected a few of the least common systemic features of RA, such as myopathy, heart disease and vasculitis. To each of these ailments they added the affected joint(s) and the side of the body (the right, the left and unspecified), creating a mind-numbing maze of coding options. Would you believe there are now 268 codes for RA? Paradoxically, this highly redundant system remains woefully incomplete. In RA, ICD-10 lacks codes for ocular complications, atlanto-axial or cricoarytenoid disease, and CCP antibody status is completely ignored.
According to the website of the American Academy of Professional Coders, “computer science, combined with new, more detailed codes of ICD-10, will allow for better analysis of disease patterns and treatment outcomes that can advance medical care. These same details will streamline claims submissions, because these details will make the initial claim much easier for payers to understand.”6 Really? It seems the best interests of clinical practice and medical billing do not always intersect.
Is Boring Best?
Putting pen to paper makes us more creative. Templates dull our creativity. We are too preoccupied with checking boxes and entering the requisite data that allow us to move to the next screen. By eliminating the free-form note, we have lost our ability to highlight our impressions of the patient’s personality. Further, there is no box to enter descriptive adjectives. Pleasant or perky, surly or sedate will have no role in the soon-to-be transparent EHR.7 We used to embed these words as a form of code that provided future caregivers a glimpse into the temperament and the mood of the subject. Nowadays, boring notes might be better. Just ask my patient.
