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Holdup at the doctor's office? New billing codes could be why

Doctors and hospitals will soon have to be far more specific in detailing diagnoses and treatments when they submit bills to insurers for payment.

So patients shouldn’t be surprised it takes longer than usual to be billed for their portion once the new medical coding system, required by federal law, takes effect Oct. 1, experts say. It might even add to waits at doctor’s offices, some say.

“It’s like learning another language,” Karen Zupko, a consultant in Chicago who has been working with doctors and hospitals around the country, says of the changes.

Before a bill can go to an insurance company, medical practices and hospitals have to indicate the diagnosis and treatment using billing codes. The number of those codes will increase dramatically, from around 14,000 to about 68,000.

The change is meant to help the government collect more specific data on health trends and outbreaks. Its implementation has been delayed twice since 2012 over concerns medical offices weren’t prepared.

Under the new system, doctors will need to have more specific notes from their patient visits to help with the billing code selection, Zupko says. In many doctor’s offices, the codes are chosen even before the patient leaves.

“While you are waiting in your office for your appointment, in order to check you out, I have to close that record, and the only way is to have diagnosis codes,” Zupko says. “So it may take them longer to identify those codes. You may be at the doctor for a bit longer.”

While some hospitals and medical practices have been preparing for years for the new coding system, others have left that to nearly the last minute, according to Zupko, who says some have scheduled training for only the day before the changes go into effect.

Orthopedic surgeons face the biggest challenge. They have more codes than any other surgical specialty.

Illinois Bone and Joint Institute — which has about 100 doctors at 17 locations around Chicago — spent about $600,000 over the past year and a half to prepare for the Oct. 1 rollout, according to David Wold, the group specialty practice’s chief operations officer. That includes the cost of training and making the necessary technology updates, says Wold, who doesn’t anticipate patients will notice any slowdown in the billing process.

“I think we are ready to handle this potential challenge — but you should call me in the middle of October and ask how we are doing,” Wold says.

The Cook County Health and Hospitals System, which has more than 900 doctors who see about 300,000 patients a year, began preparing in 2011, says Donna Hart, county agency’s chief information officer.

“We had a full assessment with every department in the hospital,” Hart says, covering every aspect of the process, from patient registration to when a claim is sent to an insurer.

Still, Hart says seeing patients might take a little longer as the county health system’s staff adjusts to the new system.

Alicia Waletzko, a consultant who has been helping Northwestern Memorial Hospital prepare, says the hospital has taken steps to try to ensure doctors take the right notes and that bills go out properly.

Waletzko sys that, while big hospitals have the money to spend to prepare for the massive changes in the billing system, many smaller medical operations might find the shift more trying.

“These smaller practices, they just don’t have the resources,” Waletzko says.

In practices where doctors do their own coding and billing, they might need time to take more notes while seeing patients and then figuring out the right codes.

“If you are a patient, you are going to need to be patient,” Zupko says. “It’s likely to take them a little longer the first couple weeks of October pulling these codes.”