An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

The latest iteration of international disease codes, ICD-10, was completed in 1992 and has been used by the rest of the world for decades. Why did it take the United States until 2015 to fully deploy it? The problem was that the United States’ medical billing system, and how to game it, evolved based on ICD-9. Changing to the new system, which identifies medical conditions more specifically using new numerical codes, was good for international epidemiology—but terrible for the business of American medicine. Physicians’ groups mocked the new system, noting that it contained codes like W56.22, “struck by Orca”; or V91.07, “burn due to water-skis on fire”; or W55.21, “bitten by cow.” (Remember, in most of the world this is primarily a scientific system for tracking disease, injuries, and deaths; codes were unconnected to practice and finance.) Because adopting the new system in the United States would require new billing software and require every coder to go back to class, the medical industry convinced Medicare to delay adopting ICD-10 year after year. Doctors’ groups warned that switching to the new system would lead to a “catastrophic” number of “unpaid Medicare claims.” When it finally came into use—uneventfully—in late 2015, it created some headaches for doctors and a burst of new business for coding consultants.