Sunday, November 10, 2013

Healthcare basics I

There are a lot of areas that I see us lacking consensus or basic factual understanding but nowhere is it worse than in the area of healthcare. This series is a number of short examinations of what healthcare is and how it is currently paid for in the US. Some of the lessons are specific to the US while others are universal.

Healthcare consists of two basic things, figuring out what (if anything is wrong with you) and doing procedures to treat (and possibly cure) what ails you. In the US, what is wrong with you is laid out in a code book written by the World Health Organization (WHO) who author the ICD codes. In the US, the National Center for Health Statistics (NCHS) has been licensed by WHO to create a variant with greater detail for clinical use that is identified by a trailing CM on those products.

Currently, the US is transitioning from using the ICD-9-CM code book to the latest update, the ICD-10-CM code book. The ICD-9-CM was frozen as of October 1, 2013 and will no longer be updated. ICD-10-CM is in limited update mode during this transition until October 1, 2015 when it will start regular yearly updates once again. At this point in time your medical provider in the US should either be fully transitioned, or at least transitioning to ICD-10-CM to describe any medical conditions you may have. If they aren't, they are going to start running into payment reductions and refusal of payment issues which may jeopardize their ability to keep their doors open.