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Injured by a sea lion? Your doctor's office has a code for that

 
Published Oct. 2, 2015

It was busier than usual at Small World Pediatrics on Thursday — and not because cold and flu season had come back with a vengeance.

Behind the scenes, the doctors at the Wesley Chapel practice waded through tens of thousands of new medical "codes," the snippets of information they give insurance companies in order to get paid.

The old system had about 14,000 codes to represent different diagnoses. But physicians nationwide switched to an updated system Thursday with nearly 70,000 codes for illnesses and injuries.

The new code for an unspecified fever? R50.9.

An ingrown nail? L60.0.

A migraine? That depends. You have 40 options.

Dr. Nancy M. Silva spearheaded Small World's transition to the new system. As she studied the 18 different codes for asthma, she weighed its costs and benefits.

"We have an opportunity to diagnose a child in much more detail, and hopefully, get fewer denials from the insurance companies," she said. "The flip side is that it's much more time-consuming."

The new system is known as the 10th edition of the International Classification of Diseases, or ICD-10 for short. It was developed by the World Health Organization and is already in use in other countries.

Until Thursday, doctors in the United States had been using the ninth edition, developed in 1979. That version was missing Ebola and novel strains of the flu, and didn't distinguish between a broken right leg and left one.

The new system did draw some attention for its more unusual codes, including contact with a sea lion (W56.19XA), a patient's first spacecraft accident (V95.40XA) and getting sucked into a jet engine (V97.33XA)

Silva's personal favorite: L81.2, the code for freckles.

But acting administrator of the Centers for Medicare and Medicaid Services Andy Slavitt said the overhaul had the potential to "create many improvements in our public health system."

Troy Quast, an associate professor in the University of South Florida's College of Public Health, pointed to another benefit: more detailed health data to help researchers determine trends.

"From a research perspective, it's really good to have that level of detail," he said.

Thursday's transition wasn't too traumatic at Palms Primary Care, a St. Petersburg practice owned by the hospital chain HCA.

"It flowed wonderfully," Dr. Tim P. Carlson said. "We had the technical support we needed."

It wasn't bad for the state's largest insurer, either.

"There were no anomalies or excessive denials," said George Vancore, Florida Blue's ICD-10 guru.

Vancore said the new system would empower health plans to provide the right payment to physicians — and design health wellness programs for certain members.

"This is the biggest change to the health care industry ever because it touches everything we do," he said. "It is going to make life so much easier for all of us."

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Information from the Associated Press was used in this report. Contact Kathleen McGrory at kmcgrory@tampabay.com or (727) 893-8330. Follow @kmcgrory.