If you fall on a sidewalk and break your foot, or if you hurt your back after slipping in the bath, doctors and hospitals use different codes to inform insurers about the nature of the injuries In all, 18,000 illness and injury codes are used on medical and insurance charts.
A new federally mandated version of those codes — ICD-10 — will consist of about 140,000 codes to describe down to the finest detail how a patient has been injured or become ill, the Wall Street Journal reports.
Federal officials maintain the expanded codes allow more exact and up-to-date accounting of hospital inpatient procedures and diagnoses and could, therefore, streamline payment strategies, I have to wonder if ICD-10 will inject more confusion into the system and whether insurance companies will use the added confusion to delay or avoid making payments.
As experienced Virginia (VA) personal injury attorneys, my colleagues and I have reported at length on how insurance companies are not really in the busines of helping people. They are for-profit businesses and are not looking out for anyone else’s well-being other than their own.
We hear about cases of insurance companies seeking to avoid payment on a regular basis. Recently, we reported on a health insurance company for a 57-year-old Virginia Beach, VA, heart attack victim. This woman had been paying her health insurance company for protection from serious health problems and serious personal injuries for a considerable number of years. She recently suffered a disabling heart attack which required lengthy hospitalization.
As soon as her insurance company realized how big her medical bills were going to be they cancelled her insurance policy claiming that she knew that she had a heart condition before she took it out. The woman had to take out a lawsuit against the company for wrongly terminating her insurance policy.
While there’s no immediate suggestion that insurance companies will use ICD-10’s complexity to deny claims, given the companies’ track record, we cannot be confident this will not occur.
Another problem is that mistakes will be made while using the new complicated medical coding system. When a hospital data clerk hits a wrong number, your record will show you got hurt in a barn, not in a car accident. Then, the insurance company lawyer in the auto case will say you must have had an injury on a farm that you did not tell the nurse about. This type of error would be funny if it was not a very likely type of problem that will allow the insurers to try to avoid paying claims based on bad information their silly systems created.
DM
About the Editors: The Shapiro, Cooper, Lewis & Appleton personal injury law firm, which has offices in Virginia (VA) and North Carolina (NC), edits the injury law blogs Virginia Beach Injuryboard, Norfolk Injuryboard and Northeast North Carolina Injuryboard as pro bono services.
Rick Shapiro has practiced personal injury law for over 30 years in Virginia, North Carolina, and throughout the Southeastern United States. He is a Board-Certified Civil Trial Advocate by the National Board of Trial Advocacy (ABA Accredited) and has litigated injury cases throughout the eastern United States, including wrongful death, trucking, faulty products, railroad, and medical negligence claims. During his three-decade career, Shapiro has won client appeals before the VA Supreme Court, VA Court of Appeals, NC Supreme Court, SC Supreme Court, WV Supreme Court, TN Supreme Court, and three times before the United States Court of Appeals for the Fourth Circuit, underscoring Shapiro’s trial achievements. In addition, he and his law firm have won settlements/verdicts in excess of $100 million. His success in and out of the courtroom is a big reason why he was named 2019 “Lawyer of the Year” in railroad law in U.S. News & World Report's Best Lawyers publication (Norfolk, VA area), and he has been named a “Best Lawyer” and “Super Lawyer” by those peer-reviewed organizations for multiple years. Rick was also named a “Leader in the Law, Class of 2022” by Virginia Lawyers Weekly (total of 33 statewide honorees consisting of lawyers and judges across Virginia). And in September 2023, Rick was selected as a recipient of the National Board of Trial Advocacy (NBTA) 2023 President’s Award. Although many nominations were submitted from across the country, Rick was just one of eight attorneys chosen by the prestigious National Board which certifies civil trial attorneys across the U.S. Rick was also recently named to Virginia Lawyers Weekly 2024 Virginia’s Go To Lawyers Medical Malpractice. The attorneys awarded this honor are nominated by their colleagues and chosen by a panel from the publication.
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