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Steven Syre

Code book changes put hospitals in bureaucratic bind

Your doctor is about to get a serious headache.

The medical establishment in Boston and beyond is howling over new government rules that dramatically alter one of the most important documents in health care, the code book hospitals must use to describe an injury, the essential element in all medical record-keeping and billing.

Exactly how detailed are all these new medical descriptions?

Code W61.01XA: bitten by a parrot, initial encounter.

Code V95.43: spacecraft collision injuring occupant.

Code V97.33XD: sucked into a jet engine, subsequent encounter.

With these and many more extravagantly detailed descriptions of possible injuries, the bulging book of codes will grow from 14,000 entries to about 68,000 possibilities.


“How will the doctors get through their day when they have to document at this level?” asks John Halamka, chief information officer at Beth Israel Deaconess Medical Center. “How will we get through audits?”

There appears to be no turning back. The federal Centers for Medicaid and Medicare Services is sticking to an Oct. 1 deadline to roll out the updated and vastly expanded system known as ICD 10.

Get ready for a paperwork meltdown at the medical office.

There are hundreds of other crazy codes in the new system, many that would make you shake your head. Search yourself if you don’t believe me, at icd10data.com.

The parrot bite is hardly novel. The new system has all sorts of codes for injuries at the beaks of birds, whether pecked by a turkey, snapped by a duck, or struck by a macaw (which, as far as I know, is a kind of parrot). And if you’re unlucky enough to be in a spacecraft collision, your hospital better not pass it off as a run-of-the-mill outer orbit crash. For this they must select among specific subcodes to get paid for treating spacecraft injuries.


Remember the poor guy who got sucked into a jet engine? What could a ‘subsequent encounter’ possibly be?

The new medical code book also demands highly specific details about where the injury took place. It’s not good enough that it happened at a cultural event. There are separate codes for injuries at museums, art galleries, music halls, theaters, and opera houses.

Of course, the really ridiculous codes won’t mean much as a practical matter. But the expanded system would turn a standard one-page “super bill” summarizing, say, services at the Orthopedic Department at Beth Israel Deaconess Medical Center into a 278-page tome. The number of codes to describe a basic injury like a sprained wrist would balloon from four to 72.

Companies that specialize in medical information technology, such as athenahealth Inc., of Watertown, are working overtime to adapt systems to the new codes and make it easier for medical providers to make the correct choices quickly.

“No one wants to do this but we have to,” says Jasmine Gee, director of product marketing at athenahealth. “It’s our job to make it not seem not like a daunting endeavor.”

The federal government is behind the push to adopt the new ICD 10 standards in the United States, but the codes were actually endorsed by the World Health Organization more than two decades ago. Other countries have been using them for years.

Most US health care providers will need to use the big new code book for medical record keeping. But some — largely hospitals — will have to use the ICD 10 codes on their bills if they want to get paid. Medical information executives in America can’t complain too much about updating the current system, established more than 40 years ago. But health care providers and insurers say the time and expense is a strain because they are also spending big to adapt to the Affordable Care Act, electronic medical records, and other initiatives at the same time.


Blue Cross Blue Shield of Massachusetts estimates it’s spending $45 million to incorporate the 10 code. Halamka says Beth Israel is spending $5 million — from a total IT operating budget of $30 million.

They’re spending the money because there’s no choice. And, no, there isn’t a code for complaining about government rules.

Steven Syre is a Globe columnist. He can be reached at syre@globe.com.