ICD-10 and What the Ebola Virus Means for Healthcare Reimbursement

Public health officials are learning more every day about the procedures required to care for Ebola patients. But one thing that the Ebola crisis has revealed is that the health care system lacks the classification codes to track the disease and ultimately, to reimburse for care of patients who have the disease.

what the ebola virus means for healthcare reimbursementICD-9 has no specific code for Ebola. Under the classification system, the hemorrhagic fever would currently fall under 078.89 – the code for “other specified diseases due to viruses.” That means Ebola shares a code with many other viruses that have not yet been assigned a specific code. The next iteration of the classification system, ICD-10, gives Ebola the code A98.4. But the U.S. Congress in the spring delayed implementation of the new classification system. The fact that the United States still uses ICD-9 will make it more more difficult to share information about the disease and its movement with other countries, HIT Consultant reported. All of the world’s industrialized nations use ICD-10 and use the codes in the newer system to report health information to the World Health Organization.

Besides disease tracking, health officials are starting to learn what the Ebola virus means for healthcare reimbursement. The classification codes are also important for reimbursing the cost of care. When health claims are submitted to payers, the claim must include a code to indicate a particular disease or procedure. If any more Ebola cases arise in the United States, ICD-9 allows no way for a health care provider to submit a claim specifically for Ebola. Thomas Eric Duncan, the Liberian man who was treated at Texas Health Presbyterian Hospital in Dallas, had health care costs estimated at $1,000 an hour, Bloomberg News reported. That cost takes into account not only the care provided to Duncan, but also the expense of isolation procedures for an Ebola patient. The Texas hospital is not expected to recover any of the costs associated with the care of Duncan, who was uninsured.

The Texas hospital has offered to pay the health care costs of Nina Pham, one of the nurses who treated Duncan and was later diagnosed with Ebola, while she was in the hospital’s care. Pham was recently declared Ebola free after being treated at the the National Institutes of Health; that bill will likely be picked up by the federal government.

ICD-10 offers a way to submit health care claims for Ebola and also file for reimbursement for treating patients with the disease. But its implementation did not come in time for Ebola’s arrival in the United States. Much is still being learned about the procedures hospitals need to use to care for Ebola patients and it’s unclear whether new codes will be needed. But what is now clear is that the health system has a classification code for Ebola but for now, it has no way to use it. To learn more, contact us.

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