Get PolitiFact in your inbox.
Doctors’ offices, already burdened by federal billing bureaucracy, will soon find themselves pecked to death by new rules, Texas congressman Ted Poe says.
New diagnosis codes required for reimbursement are so specific, he told Fox Business Network host John Stossel, there are a set of them just for injuries caused by turkeys.
"Whether you run into a turkey or the turkey runs into you, you're pecked by a turkey or you're bitten by a turkey, there's a difference between being pecked and being bitten," he said in an interview April 25, 2013. "So they have nine codes for turkeys."
Poe, a fifth-term Republican who’s a member of the Tea Party Caucus, argues doctors shouldn’t have to face the expense of complying with new rules or penalties for screwing up.
"Do they need to go through this much detail to get information to the federal government? I don’t think they do," he said.
We had to know: Do new Medicare billing guidelines include "nine codes for turkeys"?
First, a little background about this code thing. It’s not just a U.S. system — it’s international.
(And in case you were wondering, it has nothing to do with Obamacare.)
The "new" set of diagnosis codes that Poe talked about is known as ICD-10. "ICD" stands for "International Classification of Diseases." It’s published by the World Health Organization, then adapted for use in the United States.
The United States now uses ICD-9, which is more than three decades old.
Doctors’ offices use the codes to fill out Medicare and Medicaid claims, among other things. Their billing and practice management software is based on them. Their employees are trained to use them.
The American Medical Association says that depending on the size of the medical practice, it’ll cost $83,290 to more than $2.7 million to switch.
Doctors are dealing with so many other expensive regulatory changes, the association has begged since 2011 to delay or give up on the switch altogether.
Other countries have charged ahead.
They started to adopt the "new" set of codes nearly 20 years ago, and most developed countries now use it, according to the Centers for Medicare and Medicaid Services.
CMS will require American doctors, indeed, any organization covered by the 1996 health care law known as HIPAA, to switch by Oct. 1, 2014.
Claims for two different injuries might seem like duplicate filings if you couldn’t specify right vs. left hand, for example.
As Poe suggested, the new system does have far more diagnosis codes than the version developed in the 1970s — 68,000 instead of 13,000.
(Poe, in his Stossel interview, said the new system has 140,000 codes, but that’s only if you group both diagnosis and procedure codes — not a direct comparison with 13,000.)
How much detail are we talking?
The codes allow doctors to specify not just injuries from turkeys, but from parrots, macaws, ducks and geese.
There’s a different code for being "struck" vs. "pecked" or suffering from "other contact"— with specification for the first time, an unlucky repeat or even worse, "sequela." (That would be some "negative afteraffect" resulting from your turkey encounter. Headaches! Panic attacks!)
Poe’s office pointed us to this:
W61.4 Contact with turkey
W61.42 Struck by turkey
W61.42XA initial encounter
W61.42XD subsequent encounter
W61.43 Pecked by turkey
W61.43XA initial encounter
W61.43XD subsequent encounter
W61.49 Other contact with turkey
W61.49XA initial encounter
W61.49XD subsequent encounter
If you’ve seen TV ads about the need to prepare for a bright new career in medical billing and coding — this is part of the reason why.
Poe said doctors face a new regulatory burden, requiring them to use a system that includes nine different codes for turkey injuries. His office pointed us to the new codes, which will be required for Medicare claims by October 2014. Indeed, if your Thanksgiving tradition takes a tragic turn that year, your doctor will be able to describe it in seven-digit detail. (We hope it’s just W61.42XA and not W61.43XS.) We rate his claim True.
CQ Newsmaker Transcripts, "Rep. Poe Interviewed on Fox Business Network," April 25, 2013, subscription only
Interview with Shaylyn Hynes, press secretary for Rep. Ted Poe, April 26, 2013
Congressman Ted Poe, "Bureaucratic Codespeak," accessed April 10, 2013
ICD10DATA.com, "Contact with birds (domestic) (wild)," accessed April 29, 2013
Centers for Medicare & Medicaid Services, "About ICD-10," April 16, 2013
Centers for Medicare & Medicaid Services, "FAQs: ICD-10 Transition Basics," July 2012
Centers for Medicare & Medicaid Services, "HIPAA - General Information," April 2, 2013
Centers for Medicare & Medicaid Services, "ICD-10 Implementation Guide for Small and Medium Practices," accessed April 26, 2013
Centers for Medicare & Medicaid Services, "Statute and Regulations," April 16, 2013
Centers for Medicare & Medicaid Services, "HHS MODIFIES HIPAA CODE SETS (ICD-10) AND ELECTRONIC TRANSACTIONS STANDARDS OVERVIEW," Jan. 15, 2009
World Health Organization, "International Classification of Diseases (ICD)," accessed April 26, 2013
American Health Information Management Association, "ICD-10 Debunked & Confirmed," November 2012
American Medical Association, "ICD-10 Code Set to Replace ICD-9," accessed April 29, 2013
American Medical Association, "AMA Responds to HHS Announcement of One Year ICD-10 Delay," Aug. 27, 2012
American Medical Association, letter to chair of Senate health committee, Jan. 17, 2012
American Medical Association, letter to Centers for Medicare and Medicaid Services, May 10, 2012
Library of Congress' Thomas, "Health Insurance Portability and Accountability Act of 1996," Aug. 21, 1996
Read About Our Process
In a world of wild talk and fake news, help us stand up for the facts.