Begin­ning on Oct. 1, 2013, a new fed­er­ally man­dated med­ical billing system would require doc­tors to use a bank of more than 140,000 alphanu­meric codes to describe injuries and med­ical ser­vices in bills sent to insurers. We asked Dan Fein­berg, the director of the health infor­matics pro­gram — a joint pro­gram in the Bouvé Col­lege of Health Sci­ences and the Col­lege of Com­puter and Infor­ma­tion Sci­ence at North­eastern Uni­ver­sity — to explain how the new coding system will affect health– care delivery.

How will the new medical-​​billing system change the way physi­cians, health insurers and infor­ma­tion spe­cial­ists deal with patients and patient data?

The new system — which is for­mally called the Inter­na­tional Clas­si­fi­ca­tion of Dis­eases, 10th Revi­sion (ICD-​​10) — changes how data is rep­re­sented, but it doesn’t really change the data that is col­lected. ICD-​​10 will be able to rep­re­sent that data in a way that com­puters can under­stand. There is research on finding a way for com­puters to under­stand free text that doc­tors put into their notes, but a for­mal­ized coding system is far better for com­puter interpretation.

Under the new system, your provider and your insur­ance com­pany will know that you were bitten by a rat and not by a dog. If we dis­cover that there is an out­break of a dis­ease being spread by rats, you might get a letter or a phone call.  That will be new. It also works the other way. By having this detailed data in a struc­tured format, we’ll be able to find pat­terns of prob­lems that occur after rat bites and dis­cover that, for example, out­breaks of a flu-​​like ill­ness occurred in people who were bitten by rats.



What are health-​​care infor­ma­tion spe­cial­ists doing to pre­pare for the billing code changes?

Sys­tems are being upgraded at a time when we are already making a push toward elec­tronic records. Not everyone will make it in time, but people are still trying to main­tain a sense of urgency.  Europe has been run­ning on a slightly dif­ferent ver­sion of the U.S. ver­sion of ICD-​​10 for quite a while, so this feels more like finally catching up than blazing a new trail.


Under the new system, suf­fering an injury in a chicken coop, walking into a lamp­post and being struck by a turtle will all be describ­able by code. How can this type of infor­ma­tion help health-​​care providers deliver higher-​​quality care to patients? What else may this infor­ma­tion be used for?

We will be much better at detecting out­breaks, and we will be much better at iden­ti­fying how to keep people healthy.  A broken arm, an animal bite and severe flu may not seem to go together until we find out that they are all chicken-​​related, so the com­puter can flag you for a phone call from a nurse with spe­cial training in chicken-​​handling edu­ca­tion. In reality, chicken-​​related injuries are not over­whelming the health-​​care system, and we don’t train nurses specif­i­cally to address this problem. Having said that, the finer data in ICD-​​10 will allow us to iden­tify patients with prob­lems and pair them with nurses who can address them.

People may laugh at codes for poor per­sonal hygiene, but these are very sig­nif­i­cant red flags for mental health issues that will ben­efit from early intervention. Whatever the infor­ma­tion is, having it in a struc­tured format vastly improves our ability to look for pat­terns in the data.