SAN FRANCISCO -- In 1855, European statisticians gathered in the stately chambers of France’s Corps Législatif. There on the banks of the Champs-Elysées, they made the world’s first formal attempt to list every single way a person could die.

More than 150 years later, in a beige and windowless hotel ballroom thousands of miles away, hundreds of American medical coders are diligently chipping away at the exact same task. They’ve set out to master the nuances of the sprawling ICD-10, formally known as the Tenth Edition of the International Classification of Diseases.

“It gives me a heart attack just thinking about it,” Louisa Reolubin said with a sigh. The grandmother, at a three-day training for medical billers, uses green and pink highlighters to mark important new instructions on how to use the code set.

Reolubin is one of the country’s 186,000 medical coders who work in the back offices of hospitals. It’s her job to translate doctors’ scribbles into diagnosis codes. Those are sent to insurance companies, which use them to determine how much to pay hospitals for care.

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