At a Republican Party event in Iowa earlier this month, Senator Rand Paul of Kentucky did a bit about the scale of Obamacare's diagnostic coding. It killed. The only problem was that Paul's critique of the new codes are a critique of codes that aren't new and aren't Obamacare. A lot of them aren't even American.
Paul delivered the bit as a small part of a long speech, but — given the solid punchlines — the routine has at last been picked up by the conservative media. An article at Glenn Beck's The Blaze walks through the jokes, dubbing the speech "hilarious — yet revealing."
Here's the relevant stretch.
I'm a physician, and when you come in to see me, I put down a little diagnostic code and there was 18,000 of these. But under Obamacare, they're going to keep you healthier, because now there's going to be 140,000 codes. Included among these codes will be 312 new codes for injuries from animals. 72 new codes for injuries just from birds. Nine new codes for injuries from the macaw. The macaw? I've asked physicians all over the country: Have you ever seen an injury from the macaw?
Paul goes on to note other weird or excessive codes besides these violent macaws, unseen by the country's medical experts. Turtles get two codes. Walking into a lamppost gets one. Walking into a lamppost for a second time gets its own. Big government, amirite.
But there's probably a good reason Paul didn't find any doctors who'd experienced macaw injuries. (He apparently didn't talk to this guy in Arkansas.) Senator Paul only asked doctors in America. Perhaps he should have spoken to doctors in a country with more macaws — a country that uses the same diagnostic codes we do, since the new Obamacare codes he refers to predate Obama, are not in any way specific to the Affordable Care Act, and largely derive from international guidelines.
The codes cited by Paul all appear in a document known as the International Classification of Diseases, Tenth Revision. Donna Pickett of the Centers for Disease Control explains how the codes work in a brief article at the CDC website.
The ICD-10 is copyrighted by the World Health Organization (WHO), which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. ICD-10-CM was developed following a thorough evaluation by a Technical Advisory Panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility.
We spoke with Pickett this afternoon, and she explained just how "thorough" that evaluation was. "The Affordable Care Act came well after the development of the ICD," Pickett told The Atlantic Wire in a phone interview. The CDC worked with a number of groups on developing the modification to the WHO's core set of diagnostic codes — work, she pointed out, that "started in 1997 and continues to the present." They weren't doing so on behalf of the Affordable Care Act, of course. The new, expanded code set is the intended replacement for ICD-9, as mandated by 1996's Health Insurance Portability and Accountability Act.
The document's WHO pedigree is likely why it includes things like turtle and macaw attacks. Pickett:
The WHO version is an international classification, so there are things that are broadly grouped. … So yes there may be things in there that are not specific to the US and some things that are specific to the US. The idea being that you have a code for any particular classification.
The National Committee on Vital and Health Statistics website explains how the lengthy ICD-10 was developed, pegging the starting point for its adoption in 1994. (At the time, Barack Obama was an attorney in Chicago, having not yet signed the ACA into law.) The 1997 date cited by Pickett was the date at which the initial draft modifications became available for public comment, meaning that there already existed a robust set of updates.
Senator Paul's office did not respond to an email. Below, the list of diagnostic codes included in the ICD-10. Feel free to make up your own jokes, but do try and be specific on the details.