Does the Affordable Care Act Really Require Doctors to Report When Citizens Walk Into Lampposts or Get Bitten by Turtles?

In a May 10 speech for the Iowa Republicans, Senator Rand Paul (R) of Kentucky received a bunch of laughs while talking about a set of new diagnostic code requirements for hospital administrators. Below are Paul's comments on the matter.

"I know you've heard some bad things about Obamacare - and I haven't been a big fan of Obamacare - but you know your government just wants to take care of you. They don't think your smart enough to make these decisions, ok? So, I'm a physician and when you come in to see me I put down a little diagnostic code. There was 18 thousand of these, but under Obamacare they're going to keep you healthier because now there's going to be 140 thousand of these 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've ever seen an injury from a macaw?' There's two new injury codes under Obamacare for injuries sustained from a turtle. Now, you might say 'well, turtles can be dangerous.' But why do you have to have two codes? Well, your doctor needs to inform the government whether you've been struck by a turtle or bitten by a turtle. There is a new code for - I see some alcohol out there - walking into a lamppost. There's also a code for walking into a lamppost, subsequent encounter. There is a code for injuries sustained from burning water skis. You're government is just trying to take care of you."

The bit may be funny, but is it true? Paul's speech is peppered with jokes about the federal reserve being robbed and an explanation of a Jimmy Kimmel skit. It is not hard to see how a listener would be incredulous. Sadly, it appears that there is some truth to the ridiculous codes.

The codes are part of the International Classification of Diseases, Tenth Revision or ICD-10. Hospitals already use ICD-9, but will be required to upgrade to the 10th revision in October of 2014.

The "required" part is where the affordable care act comes in. ICD codes have been around since at least the Health Insurance Portability and Accountability Act of 1996 (HIPPA). The move to the 10th edition, however, is part of an expansion of HIPPA commanded by the affordable care act, which would likely not be required of physicians without the new law.

By no means did Paul dig every funny code out of ICD-10 either. There are requirements for physicians to report if someone was injured in an opera house, there are 10 codes for injuries around a mobile home, and even a code for those who are injured while knitting.

The Wall Street Journal has compiled many of the more humorous codes in a pretty thorough document titled "A Code for What Ails You."

For those interested in searching through ICD-10 for themselves, the Centers for Disease Control have posted lots of information about the upcoming changes on their website.