The Affordable Care Act (ACA) or Obamacare was implemented on January 1, 2014 and this legislation is bound to increase the need for medical coding specialists. The major objectives of this legislation are to provide medical coverage for Americans who do not already have it and make healthcare services more affordable. This means more people obtaining healthcare services and healthcare providers seeing more patients. In such a scenario, providers require the service of skilled coding professionals in order to maximize their reimbursement and improve their revenues. ACA requirements such as ICD-10 and provisions such as coverage expansion are likely to persuade physicians to look for skilled medical coders.
ICD-10
Unlike the ICD-9 coding system, ICD-10 system is more specific and comprised of more number of codes. Let’s take the case of dislocation of ankle. The ICD-9 code for this condition is:
- 837: Dislocation of ankle
The ICD-10 codes for this condition are as follows.
- S93.04: Dislocation of right ankle joint
- S93.04XA: Dislocation of right ankle joint, initial encounter
- S93.04XD: Dislocation of right ankle joint, subsequent encounter
- S93.04XS: Dislocation of right ankle joint, sequela
- S93.05: Dislocation of left ankle joint
- S93.05XA: Dislocation of left ankle joint, initial encounter
- S93.05XD: Dislocation of left ankle joint, subsequent encounter
- S93.05XS: Dislocation of left ankle joint, sequela
- S93.06: Dislocation of unspecified ankle joint
- S93.06XA: Dislocation of unspecified ankle joint, initial encounter
- S93.06XD: Dislocation of unspecified ankle joint, subsequent encounter
- S93.06XS: Dislocation of unspecified ankle joint, sequela
Sometimes, each of these systems considers the same condition in a different way. For example, asthma is categorized as either intrinsic or extrinsic in ICD-9 system and there are separate codes for chronic obstructive asthma.
- 493: Asthma
- 493.0: Extrinsic asthma
- 493.00: Extrinsic asthma, unspecified
- 493.01: Extrinsic asthma with status asthmaticus
- 493.02: Extrinsic asthma with (acute) exacerbation
- 493.1: Intrinsic asthma
- 493.10: Intrinsic asthma, unspecified
- 493.11: Intrinsic asthma with status asthmaticus
- 493.12: Intrinsic asthma with (acute) exacerbation
- 493.2: Chronic obstructive asthma
- 493.20: Chronic obstructive asthma, unspecified
- 493.21: Chronic obstructive asthma with status asthmaticus
- 493.22: Chronic obstructive asthma with (acute) exacerbation
On the other hand, asthma is considered as just asthma in ICD-10 and categorized by its degree of severity using the terms mild, moderate and severe. It is further categorized as either intermittent or persistent. No separate codes are there for chronic obstructive asthma.
- J45: Asthma
- J45.2: Mild intermittent asthma
- J45.20: Mild intermittent asthma, uncomplicated
- J45.21: Mild intermittent asthma, with (acute) exacerbation
- J45.22: Mild intermittent asthma, with status asthmaticus
- J45.3: Mild persistent asthma
- J45.30: Mild persistent asthma, uncomplicated
- J45.31: Mild persistent asthma, with (acute) exacerbation
- J45.32: Mild persistent asthma, with status asthmaticus
- J45.4: Moderate persistent asthma
- J45.40: Moderate persistent asthma, uncomplicated
- J45.41: Moderate persistent asthma, with (acute) exacerbation
- J45.42: Moderate persistent asthma, with status asthmaticus
- J45.5: Severe persistent asthma
- J45.50: Severe persistent asthma, uncomplicated
- J45.51: Severe persistent asthma, with (acute) exacerbation
- J45.52: Severe persistent asthma, with status asthmaticus
In short, it requires excellent knowledge in medical terminology, anatomy, physiology, pharmacology, and pathophysiology to assign the appropriate ICD-10 codes for a condition. As the number of patients flocking to the physician’s offices and hospitals are increasing with ACA implementation, healthcare providers will be required to code millions of new charts every year. In order to avoid medical claim denials and receive maximum reimbursement, the service of coding specialists well-versed in the new coding system is inevitable.
It is expected that there will be a significant decrease in coder productivity after ICD-10 implementation. Many healthcare experts cite the example of Canada’s transition to ICD-10 with 50% productivity loss to support this. According to the American Association of Clinical Coders and Auditors, anticipated loss of coder productivity remains a major concern and it stems from the changes including increase in volume of the codes, increase in the specificity, increase in the number of physician queries, addition of alphabetical characters, a complete overhaul of the procedure reporting system and new coding guidelines. Many organizations have already begun to improve their documentation and train their coders to overcome these challenges. This again implies the need for well-trained medical coders.
Medicare Efficiency and Medicaid Expansion
The overhaul of Medicare with less payment for medicines, free wellness exam, free counseling and more ensures that elder people would receive care in a more effective manner. With the restructuring of reimbursement as bundles instead of a fee per service, the efficiency of Medicare increased further. Overall, this may lead to the surge of elderly people to physicians’ offices or hospitals, and a corresponding demand for accurate coding for higher reimbursement and thereby the service of coding specialists. With Medicaid expansion in certain states, more people are getting coverage. A survey by the UCLA Center for Health Policy Research says that the Medicaid expansion may lead to a dramatic rise in emergency room and hospitalizations for people who were uninsured previously, though that increase is temporary.
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