SSA will overhaul medical coding systems

The Social Security Administration has spent the past 10 years cutting its rate of errors nearly in half for the medical diagnosis coding used for millions of disability benefit recipients. But now the agency has to start over.

Rather than continuing to improve its existing coding system, SSA is preparing to overhaul it to comply with new International Classification of Diseases, 10th Revision (ICD-10) medical codes, according to a new report from SSA Inspector General Patrick O’Carroll.

The ICD-10 codes are numbers of as many as 10 digits that describe a disease or medical condition diagnosis. The current SSA systems use a four-digit medical diagnosis code.

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“We are in the planning stage for the conversion to ICD-10 standards to comply with Department of Health and Human Services’ mandates,” wrote James Winn, executive counselor to SSA's commissioner, in a response attached to the report.

The medical coding upgrade applies to all doctors, hospitals and federal agencies. Under HHS regulations, the coding upgrade is to be completed by October 2013, although some doctors are petitioning for more time.

The SSA conversion plans follow a positive report from O’Carroll indicating that the agency has reduced the errors in its existing use of medical codes for disability benefit recipients.

“While the diagnosis codes for approximately 5.5 percent of disabled beneficiaries or recipients were missing, invalid, or unestablished, the number of records with these errors had declined significantly over the past 10 years,” O’Carroll wrote in the Dec. 8 report. “The total number of records with these errors declined by about 45 percent.”

O’Carroll made two recommendations to further reduce errors, one of which is to enhance communication between SSA’s Disability Control File and Supplemental Security Record. However, Winn disagreed with that advice, saying it might detract from the upcoming conversion of the coding.

“We are transitioning to ICD-10 standards, and ICD-10 will eventually supplant our current diagnosis code standards,” Winn wrote. "As we proceed with ICD-10, we will work to make sure that the Supplemental Security Record and Master Beneficiary Record interface properly with the Disability Control File."

“However, if we focus on making those enhancements, we may have to redirect resources assigned to ICD-10 efforts,” Winn added. "It may not be desirable for us to redirect those resources, especially considering that our current accuracy rate is very high."