3 ms·

When I was working on a project that involved ICD codes, one thing that kept cropping up in my mind was even how consistently the codes would be used. I other

When I was working on a project that involved ICD codes, one thing that kept cropping up in my mind was even how consistently the codes would be used. I other fields of endeavor, when I see such voluminous, nuanced classification codes, the real result is that it becomes confusing as to 1) what code any given subject should be classified as, 2) the people doing the classification cannot know all the codes available and therefore will classify to something close that they know... even if a closer code exists, 3) there can be general disagreement on what any given code means and where dividing lines sit between similar codes, and 4) in medical offices, where several codes may be available and could reasonably apply, I've seen choices made based on the financial differences between the codes where they existed (not to mention that all the previous problems in coding a condition for the practitioner is also a problem for those deciding how codes may/may not be covered or paid for). Given all that, it seems to me any coding system like this, which apparently fails to account for the limits of human judgement and usage patterns, will ultimately fail. Naturally, I assume that the goal in constructing such a system is the collection of nuanced data, but expect the result to be a muddle of that data as the system is misused. And based on the medical offices I have worked with over the years, there is nothing about the medical profession that will mitigate those issues.

nradov 8y ago
You can always find occasional errors and discrepancies but the vast majority of coding is done correctly. Medical coders go through an extensive training and certification process.
- sbuttgereit 8y ago
  I understand that there are training/certification processes for medical coders and I expect that to certainly help. But is there a basis to the claim that errors are occasional and that coding is done correctly? Or is that just an anecdotal assertion? My observations are just anecdotal, but do come from a fair amount of on the ground experiences. I expect their to be limits on the effectiveness of that sort of thing. My original comment dealt with the complexity issue, but there's how well that training/certification ages over time... such that common codes are handled well due to daily reinforcement, but less common codes will tend to fare worse. Unless there are required maintenance trainings and re-certification requirements (I'm not aware of that either way), I expect on average for there to be issues in practice. While there has been medical procedure coding of some sort for a very long time, this rather more complex coding that we're generally discussing with this story is still in rather early days. Nonetheless, I would be interested to see an actual study on how the complexity of coding systems like ICD fare at actually capturing the information they try to; I just tried searching the ACM Digital Library, but didn't find anything... though that could just be weakness of my search terms.
  - nradov 8y ago
    It's not just an anecdotal assertion. I know that public and private payers conduct audits and reviews on a subset of claims to verify accurate coding. Private insurers don't release their audit results but if you search around you can probably find something from CMS for Medicare claims. Certified medical coders are required to complete several hours of additional training every year in order to maintain their status. ICD-9 had been in use for many years. ICD-10 is only slightly more complex. Most provider organizations typically only use a small subset of the available codes so it's not too hard to keep track of the common ones.

nradov 8y ago

You can always find occasional errors and discrepancies but the vast majority of coding is done correctly. Medical coders go through an extensive training and certification process.

sbuttgereit 8y ago
I understand that there are training/certification processes for medical coders and I expect that to certainly help. But is there a basis to the claim that errors are occasional and that coding is done correctly? Or is that just an anecdotal assertion? My observations are just anecdotal, but do come from a fair amount of on the ground experiences. I expect their to be limits on the effectiveness of that sort of thing. My original comment dealt with the complexity issue, but there's how well that training/certification ages over time... such that common codes are handled well due to daily reinforcement, but less common codes will tend to fare worse. Unless there are required maintenance trainings and re-certification requirements (I'm not aware of that either way), I expect on average for there to be issues in practice. While there has been medical procedure coding of some sort for a very long time, this rather more complex coding that we're generally discussing with this story is still in rather early days. Nonetheless, I would be interested to see an actual study on how the complexity of coding systems like ICD fare at actually capturing the information they try to; I just tried searching the ACM Digital Library, but didn't find anything... though that could just be weakness of my search terms.
- nradov 8y ago
  It's not just an anecdotal assertion. I know that public and private payers conduct audits and reviews on a subset of claims to verify accurate coding. Private insurers don't release their audit results but if you search around you can probably find something from CMS for Medicare claims. Certified medical coders are required to complete several hours of additional training every year in order to maintain their status. ICD-9 had been in use for many years. ICD-10 is only slightly more complex. Most provider organizations typically only use a small subset of the available codes so it's not too hard to keep track of the common ones.