Parrot injuries and other tales from the annals of medical billing

Polly wants an ICD-10 code? (Rachel Denny Clow - AP) Right now, there’s a big fight going on in the health-care industry. It isn’t about contraceptives. It isn’t about Obamacare. It is about very technical, very bureaucratic billing codes — and it matters a lot.

The battle centers on something called “ICD-10.” That’s insurance-speak for the Tenth Edition of the International Classification of Diseases, a laundry list of thousands of billing codes that health insurance plans use to categorize various medical conditions. Get injured by a flaming water-ski? There’s an ICD-10 code for that. Have an unfortunate encounter with a parrot? ICD-10 has not one but nine codes to categorize parrot-related injuries (“W61.01” refers to being “bitten by a parrot” while W61.02 denotes being “struck by a parrot.”)

Right now, the medical billing world uses the ninth edition of the ICD, or ICD-9, which has about 18,000 codes. When it flips to ICD-10, that number will swell to 140,000 billing codes. The federal government was initially set to require the health-care industry to switch to ICD-10 by Oct. 1, 2013. But after intense lobbying, especially from the American Medical Association, Health and Human Services announced this week that it would delay implementation.

ICD-10 has come under a lot of criticism, especially from industry, as what’s wrong with American health care: It’s overly bureaucratic and too aggressively regulated. “Every hour spent treating a patient in America creates at least 30 minutes of paperwork, and often a whole hour,” the Economist bemoans of the ICD-10 system in a recent article. It is most certainly true that American doctors spend a lot more time on paperwork and billing than their counterparts abroad, who work in government-financed health-care systems.

But ICD-10 isn’t without advocates: There’s a reason, after all, that the Obama administration thinks it’s important to implement. And that mostly has to do with the plus side of granularity: being able to understand, at an incredibly detailed level, what care Americans are seeking.

“For the most part, those ICD-10 codes exist because a constituency of health-care professionals wants to access that data,” Carl Natale writes for Government Health IT Watch. More data on how Americans use health care could presumably create a more nuanced, and informative, portrait of who uses what care, and the country can best use a set of limited health-care resources.

Do we need a medical billing system with nine codes for encounters with parrots? I’m not nearly expert enough on avian injuries to know. There is, however, an interesting debate here about what the future of health-care technology looks like in America, and what tradeoffs need to be made between granularity and bureaucracy.