This summer, I fell on the soccer field about 10 minutes into the game and tore a ligament in my knee. The next time I went to the hospital, they gave me a code that told my insurance company what was wrong. My insurance company could then see why I went to the doctor and bill me for it. Even though medical knowledge and care have improved in many ways, the same thing would have happened a decade ago. Most of these codes haven't changed much in more than 30 years. But soon, that string of numbers and letters might change in a big way, which should be good for consumers.

Come October 1 a code update will go into effect that will take the current 19,000 diagnostic and procedure codes and catapult that number to 142,000. The transition promises to offer greater granularity to why we seek care. It gets wonky, but with the change in researchers that deal in health, data might gain more insight into what types of care get good results. That know-how could then trickle down into better care for you. Soon, instead of a code that simply indicates “torn anterior cruciate ligament,” there will be separate codes that directly correspond to whether I tore the ACL in my right knee versus my left. Was it my first visit for care for this injury? The new coding system will cover that, too. Under the new system, one code will indicate I tore my left ACL and this was my first visit for care. That larger compendium of choices will provide greater specificity for my doctor’s future reference and also for insurers trying to suss out whether my care was necessary. Yet one of the most significant aspects of this change continues to go largely ignored by medical workers bracing for rejected insurance claims and frustrations next month: More detailed medical billing codes could eventually improve your health care. Those new codes could provide a clearer picture of why individuals seek care and which health problems are growing or contracting in communities —helping inform what health issues should be researched and improved. At least, that’s the hope.

At the same time, some doctors expect insurance companies and doctors to have a lot of trouble getting used to the new system, which is called the International Classification of Diseases (ICD-10). It is very hard to understand. In the current system, there are 15,000 diagnostic codes. Now, there will be 70,000. The current total of 4,000 codes for inpatient hospital procedures will jump to 72,000. A lot of the codes won't be used very often (like V97.33CD, which indicates you were sucked into a jet engine, and this is your subsequent visit to a doctor). William Rogers, the ICD-10 Ombudsman for the Centers for Medicare and Medicaid Services (CMS) and an emergency doctor at Georgetown University Hospital, says that the average internist probably won't need more than 40 to 50 ICD codes to make a diagnosis. But the people in charge of the change in hospitals and doctors' offices know that there will be a big learning curve. Lynne Thomas Gordon, CEO of the American Health Information Management Association, says that coders in other countries have become very confident in their coding in about six weeks to six months.

In order to avoid these problems, CMS said that during the first year of this new policy, they won't turn down valid insurance claims as long as they are in the right ballpark. That means the doctor will still get paid if you coded for heart failure but didn't click on the most specific code for "heart failure" (or the insured patient will still be reimbursed). Pat Brooks, a senior technical advisor for CMS, says, "The policy says you didn't get the exact right one, but you got the right category."

Lisa Iezzoni, who runs the Mongan Institute for Health Policy at Massachusetts General Hospital, says that next month's rollout problems are likely to be as bad as the worries about the year 2000. She says, "I think it will be like the worries about the year 2000, since we are talking about new alphabetic systems." For ICD-10, computers had to be changed so that billing codes could start with any letter instead of mostly numbers. This is a big change, she says. But in the end, "the millennium came and went without a peep," and I think the same thing will happen here.

The codes are actually a U.S.-specific change to the ICD, which is a set of categories used around the world to record the causes of death. The current U.S. codes group different diseases or procedures and are mostly based on what doctors knew in 1975. This is another reason why it's time for a change. Gordon says that every other industrialized country, like Iceland and Australia, has already made the change. "There was no code to track Ebola. I think it was embarrassing for our country, but now we'll catch up with everyone else," she says. The director of coding and classification at the American Hospital Association, a group that helps teach hospitals how to use the codes, said that over the years, "hundreds" of small changes happened on an ad hoc basis when doctors asked for them. For example, new codes were added to tell the different types of skin cancer apart. But when it came to diagnoses, the codes only had a certain number of options before they ran into another category of disease. This meant that there was a limit on what could be added that was not real.

For researchers, the new system will be the difference between "knowing there are apples in the supermarket and if there are Granny Smith apples or McIntosh apples," says Gordon. Some examples from medicine: the new codes will say what trimester a patient is in when she goes to the doctor. There is also more information about which bones or tendons are affected when it comes to orthopedics.

There is more hope that information can be gleaned from these codes than from electronic health records. Most of the time, these patient records are different in different health care settings, so it's not always easy to combine them and get health information from them. On the other hand, these medical billing codes will be the same everywhere in the country. Brooks says, "It's true that you can look at a paper record or an electronic one, but it takes a lot of time." "If you have codes that are reported on a national level, you are talking about a simple program that looks at trends with thousands of patients." Even though the codes aren't as precise as they used to be, they still help research on the quality, cost, availability, and results of health services. They also help figure out care trends. Will better codes lead to better health in the long run? Researchers are counting on this. The changes are, after all, just what the doctor ordered.

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