By Dina Fine Maron
It was only about 10 minutes into the game when I fell on the soccer pitch this summer and tore a ligament in my knee. My subsequent trip to the hospital garnered me a specific diagnostic code that went to my insurance company. My insurer was then able to see why I sought care and billed accordingly. Despite significant upgrades in medical knowledge and care, the same thing would have happened a decade ago. Those codes have remained largely unchanged for more than 30 years. But soon a big change to that collection of numbers and letters may be making a splash—and should bode well for consumers.
Come October 1 a code update will go into effect that will take the current 19,000 diagnostic and procedural codes and catapult that number to 142,000. The transition promises to offer greater granularity to why we seek care. It gets wonky, but with the change researchers that deal in health data might gain more insight into what types of care get good results. That know-how could then trickle down into better care for you. Soon, instead of a code that simply indicates “torn anterior cruciate ligament” there will be separate codes that directly correspond to whether I tore the ACL in my right knee versus my left. Was it my first visit for care for this injury? The new coding system will cover that, too. Under the new system one code will indicate I tore my left ACL and this was my first visit for care. That larger compendium of choices will provide greater specificity for my doctor’s future reference and also for insurers trying to suss out whether my care was necessary. Yet one of the most significant aspects of this change continues to go largely ignored by medical workers bracing for rejected insurance claims and frustrations next month: More detailed medical billing codes could eventually improve your health care. Those new codes could provide a clearer picture of why individuals seek care and which health problems are growing or contracting in communities —helping inform what health issues should be researched and improved. At least, that’s the hope.
