New medical codes that only Kafka could love

Insurance red tape spreads like disease

The world we doctors inhabit is looking more and more as if it were designed by Franz Kafka. The road to successful treatments and cures is cluttered with expanding red tape: courses to take, certifications to achieve, endless electronic record keeping that takes the place of patient contact, and now, a chokehold list of insurance billing codes that has been expanded from fewer than 15,000 disease/health issue entries to 68,000.

The International Classification of Diseases, 10th edition, is a cumbersome mess that is supposedly designed for flexibility and precision. But with more than 100 choices for diabetes alone, I must spend more time than ever in front of a computer screen, trying to decide what accurately describes my patient.

If I don’t get it exactly right, I might not be paid.

I am a small-time player in a solo practice, though I have the machinery of a great university behind me making sure I get the codes right. But what about the hundreds of thousands of others in my category who are out on their own in a community setting without university backing?

Here is what patients can anticipate as the system struggles to adjust: longer wait times and more ancillary staff, which means a higher cost of doing business. The only way your doctor will be able to make up that cost is to see a higher volume of patients in an even shorter amount of time.

The Centers for Medicare and Medicaid Services have adopted these new codes, with supposedly a year for providers like me to adjust before we will be penalized by insurance companies for inaccurate codes. Private insurers are following Medicare’s lead.

Of course, Obamacare is behind it, too: The expanded and aging patient pool creates the need for a more complex system of disease identification. Theoretically, this means insurance would pay more for an accurate description, though in the real world it means they will be using an inadequate description as an excuse for paying less.

Depending on your insurance, this could also mean that you end up getting hit with a charge you weren’t anticipating, or that I end up seeing you for free.

If I end up seeing too many patients for free, I will go out of business.

There is an upside. If you are suffering from helicopter parenting, sibling rivalry, problems with your in-laws or fear of thunder, insurance will now cover your needs. There is even a code for being “sucked into a jet engine” — I kid you not.

But for the vast majority of us, we are looking at the world of Kafka’s final novel, The Castle, where a growing wall of bureaucracy keeps us from ever reaching our goal, in this case an effective treatment or lasting cure.