3Qs: 140,000 ways to code what ails you

Dan Feinberg explains how the new medical-billing system will impact health care delivery. Photo by Christopher Huang.

Beginning on Oct. 1, 2013, a new federally mandated medical billing system would require doctors to use a bank of more than 140,000 alphanumeric codes to describe injuries and medical services in bills sent to insurers. We asked Dan Feinberg, the director of the health informatics program — a joint program in the Bouvé College of Health Sciences and the College of Computer and Information Science at Northeastern University — to explain how the new coding system will affect health- care delivery.

How will the new medical-billing system change the way physicians, health insurers and information specialists deal with patients and patient data?


The new system — which is formally called the International Classification of Diseases, 10th Revision (ICD-10) — changes how data is represented, but it doesn’t really change the data that is collected. ICD-10 will be able to represent that data in a way that computers can understand. There is research on finding a way for computers to understand free text that doctors put into their notes, but a formalized coding system is far better for computer interpretation.

Under the new system, your provider and your insurance company will know that you were bitten by a rat and not by a dog. If we discover that there is an outbreak of a disease being spread by rats, you might get a letter or a phone call. That will be new. It also works the other way. By having this detailed data in a structured format, we’ll be able to find patterns of problems that occur after rat bites and discover that, for example, outbreaks of a flu-like illness occurred in people who were bitten by rats.

What are health-care information specialists doing to prepare for the billing code changes?


Systems are being upgraded at a time when we are already making a push toward electronic records. Not everyone will make it in time, but people are still trying to maintain a sense of urgency. Europe has been running on a slightly different version of the U.S. version of ICD-10 for quite a while, so this feels more like finally catching up than blazing a new trail.

Under the new system, suffering an injury in a chicken coop, walking into a lamppost and being struck by a turtle will all be describable by code. How can this type of information help health-care providers deliver higher-quality care to patients? What else may this information be used for?

We will be much better at detecting outbreaks, and we will be much better at identifying how to keep people healthy. A broken arm, an animal bite and severe flu may not seem to go together until we find out that they are all chicken-related, so the computer can flag you for a phone call from a nurse with special training in chicken-handling education. In reality, chicken-related injuries are not overwhelming the health-care system, and we don’t train nurses specifically to address this problem. Having said that, the finer data in ICD-10 will allow us to identify patients with problems and pair them with nurses who can address them.

People may laugh at codes for poor personal hygiene, but these are very significant red flags for mental health issues that will benefit from early intervention. Whatever the information is, having it in a structured format vastly improves our ability to look for patterns in the data.