How Current Coding Can Negatively Impact Long COVID Treatment

It is easy to assume that medical coding only affects the business side of medicine. It certainly does affect billing and payments, but medical coding can also impact diagnosis and treatment. We have known this for a long time. But now, with more people being diagnosed with long COVID, we are again reminded how current coding practices can negatively impact treatment.

Necessity prompted the powers that be to develop a new ICD-10 code for long COVID in October 2021. That code is U09.9 Post COVID Condition. It's a start. Unfortunately, it is not specific enough. A single code is only applicable after a firm diagnosis. But we are now learning that long COVID can be difficult to diagnose in patients whose original case was asymptomatic.

It Can Take Too Long

In an article discussing how long COVID is diagnosed, The Hill's William Haseltine likened the problem to getting a diagnosis for something like chronic fatigue syndrome or endometriosis. Both conditions are usually diagnosed through a process of elimination. Apparently, it can take as long as 10 years to diagnose endometriosis – but after how many visits and procedures?

What does this have to do with medical coding? A lot. If a patient visits a clinician for a particular problem and is unable to get a solid diagnosis, the code for that visit is reflective of the ambiguous outcome. The code is fine for billing purposes. But for future diagnosis and treatment, it is largely meaningless.

A patient can bounce around from one doctor to the next. An endless array of tests can be ordered as well. Each one is represented by a billing code that doesn't help each successive clinician figure out what is going on. So rather than zeroing in on known quantities and going from there, the patient is left to try one thing after another to see how it goes. It could take forever to get a diagnosis.

Missing Out on Treatments

There is still a lot we don't know about COVID. As much as we do know about the acute disease, we barely know anything about long COVID. This is expected. What is not expected is a medical coding system that makes figuring things out and recommending appropriate treatments harder than it needs to be.

We now have a single medical code for long COVID. It is an ICD-10 code that is necessarily ambiguous. Perhaps there is nothing we can do about that in the short term. But the more we learn about long COVID, the greater the need for more codes that offer increased specificity.

On a much larger scale, the difficulty in diagnosing long COVID is perhaps a wake-up call to the way we do healthcare in this country. For example, the process of elimination is a normal part of medical diagnoses. That is the way science sometimes works. But we are locked into a convoluted billing and payment system that can take a short process and stretch it into nearly a decade of searching until a decision is finally made.

Medicine Should Be Medicine

Medical coding and billing appear to be necessary evils in American medicine. But neither one should prevent medicine from being medicine. Clinicians having to struggle so much with medical codes proves that there is something wrong with the system. The issues with diagnosing and coding long COVID are merely symptomatic of a much larger problem.

Current coding standards are negatively impacting long COVID diagnosis and treatment. That much is clear. How to fix it, not so much. Perhaps it's time to dismantle the entire coding system and start over. Good luck with that.

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