It’s common sense: Local challenges should be confronted and solved locally whenever possible. Protecting Americans’ health is no exception.
Yet few realize that the World Health Organization still exerts influence over American health care, even as the United States has taken steps to separate from it. Earlier this year, a presidential executive order initiated the process of withdrawing the U.S. from the WHO, citing concerns that the organization prioritizes politics over science and public accountability.
The future of all health care should be patient-centered, not controlled by slow-moving, politically driven bureaucracies.
There is no question that leaving the WHO was and still is an important step forward for American patients, but there is much more work to be done before the organization’s foreign influence is extracted from our health care landscape and families can fully access the treatments that are best for them.
The next critical step? Detach the U.S. medical insurance coding system from the WHO’s model to ensure that it gives patients access to all medical procedures, from lifesaving precision oncology options to restorative, cutting-edge reproductive health therapies.
Unfortunately for patients, U.S. diagnostic codes are modeled after the WHO’s bulky and inherently limited insurance coding protocol. These codes play a pivotal role in determining patients’ access to care, provider reimbursement, and clinical outcome reporting. In the 1990s, the CDC’s National Center for Health Statistics began to establish ICD-10-CM codes, which conform to the WHO’s framework governing how health care providers bill diagnoses. The Centers for Medicare & Medicaid Services likewise developed ICD-10-PCS codes — which mirror WHO coding protocol — for use in inpatient hospital settings.
Just one of the many problems with each of these coding systems is that they are slow to adapt to medical advancements. Restorative reproductive medicine, for example, is a comprehensive approach to solving underlying fertility complications at the core. RRM seeks to heal human reproduction systems metabolically, hormonally, and otherwise. Already, it has helped thousands of couples struggling with infertility to have children.
The CDC and CMS bureaucracies have historically failed to recognize and cover evidence-based reproductive treatments like RRM that address the root causes of infertility, leaving families seeking such treatments — such as natural family planning/fertility awareness-based methods — to cover the costs themselves or resort to in-vitro fertilization to achieve pregnancy.
At its core, inadequate diagnostic coding for RRM discourages many providers from relying on RRM to heal patients at all because they know that code limitations will prevent them from being reimbursed through insurance.
Unfortunately, the ICD-10 codes doctors are forced to use do not accurately represent the nuanced hormonal, structural, and immune-related causes of infertility such as polycystic ovary syndrome, endometriosis, and luteal phase defects that so often prevent pregnancy.
Even Current Procedural Terminology codes developed by the American Medical Association do not reflect modern fertility-preserving surgical interventions such as laparoscopic restoration of fallopian tubes, excision of endometriosis, or varicocele repair.
Instead, doctors who wish to deliver comprehensive treatments such as these are tied into relying on non-specific or “unlisted” codes, leading to denials of coverage and limited patient access to restorative procedures, which, if covered, would be far more cost-effective than artificial reproductive technologies like IVF.
Perhaps even worse for American patients and doctors alike is the fact that unclear coding undermines transparency and accurate reporting in these vital areas of medicine. Failing to differentiate between RRM’s and IVF’s distinct clinical approaches, ethical frameworks, and long-term health implications limits transparency in outcome reporting while obscuring the true effectiveness and cost-efficiency of restorative treatments.
Each of these coding challenges points to a dire need for an evidenced-based, patient-centered, common coding lexicon nationwide.
The good news is that we have ample evidence that these coding changes are possible and effective. My organization, which facilitates common-sense, cost-saving therapies for our members, already allows providers to bill for effective treatments so often inaccessible through traditional insurance companies.
The federal government would be wise to do the same. The future of all health care should be patient-centered, not controlled by slow-moving, politically driven bureaucracies that rely on outdated, foreign billing and coding restrictions.
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