In October of next year, the United States will become the last industrialized nation to switch from the more than 13,000 codes of ICD-9 to the 70,000 plus codes included in ICD-10. We’ve all read articles making the case for sticking with ICD-9 because of “bizarre codes,” or that this update of our coding system will add little to the care of our patients. By Pete Spitellie, M.D., medical education director, Precyse Learning Solutions
By Pete Spitellie, M.D., medical education director, Precyse Learning Solutions
In October of next year, the United States will become the last industrialized nation to switch from the more than 13,000 codes of ICD-9 to the 70,000 plus codes included in ICD-10. We’ve all read articles making the case for sticking with ICD-9 because of “bizarre codes,” or that this update of our coding system will add little to the care of our patients.
While it’s true the higher level of ICD-10 specificity will result in a significant increase in the total number of codes, the new clinical concepts in ICD-10 aren’t foreign to providers. There is also nothing new regarding the documentation requirements for ICD-10; it’s just that ICD-10 is able to pick up more detail from a well-documented note. And yes, some of the code descriptions seem odd and out of touch with mainstream practice, but codes for rare occurrences aren’t new to ICD-10. In reality, most of us will use a small number of codes that are relevant to our specialty in ICD-10, just as we do with ICD-9.
The recent Ebola outbreak has certainly received its share of press and, not surprisingly, some of it has even involved coding. Nine months ago, writing about Ebola in the context of coding would likely have qualified as one of those bizarre codes. And even though the diagnosis remains extremely rare in the U.S., it provides an opportunity to gain some valuable historical context and insight into ICD-9 and ICD-10.
It may be surprising that the first case of Ebola in 1976 precedes the adoption of ICD-9 in the U.S. by three years, and yet there is still no code for Ebola in ICD-9. Obviously, there have been advances and new diseases discovered since 1979, and those have been dealt with by adding new codes via yearly updates. Theoretically, a new code could also be added for Ebola at the time of the next update, but at present a coder has no way to actually show a patient has fallen ill from Ebola and would instead need to use the generic code for “other specified diseases due to viruses.”
I say theoretically because ICD-9 was never designed to accommodate the volume of new code additions and is running out of space. As chapters reach their limit, there is no choice but to relegate new codes to chapters that do have space, whether it makes sense for a specific disease or not. This makes searching for a code more challenging, not to mention increases the potential for confusion and mistakes.
Sadly, every other developed nation in the world can classify Ebola in code form but the U.S. cannot, at least not for patients who are alive. Since 1999, the U.S. has used ICD-10 to track mortality, so if a patient dies from Ebola it can be specifically coded.
And please don’t misunderstand me, I completely understand the case for ICD-10 improving the care of an individual patient is extremely difficult to make, if not impossible. But it’s equally hard to argue that anecdotal evidence is a replacement for good data when trying to understand the value of the extremely high price we pay for healthcare. The U.S. consistently ranks number one in healthcare expenditure, but is 34th in life expectancy. If we don’t have reliable, accurate data, how can we hope to resolve this disparity?
The industry has spent billions of dollars preparing for the implementation of ICD-10. If this coding system is never implemented, all the time, training, funds, and resources healthcare organizations have spent so far will be wasted at the cost of sticking with an outdated, increasingly inflexible system that cannot even classify Ebola, unless it’s for reporting mortality data. I personally, as a physician and general consumer of healthcare, will happily accept the effort needed to prepare for ICD-10 to ensure we are able to report accurate healthcare data. This is a serious issue, and the stakes are high. I think it’s important to be aware of the actual benefits of a more modern coding system and the potential is has to promote improvements in healthcare.
I will leave you with a quote from Sue Bowman, Senior Director, Coding, Policy and Compliance at the American Health Information Management Association (AHIMA) that I think sums up the importance of collecting this information. “I think we’ve gotten so lost in arguments that some people have lost sight of why we’re doing this [switching to ICD-10]. We’re doing this to get better data, not just for the U.S., but to share globally around things like global health threats. And healthcare today is global, just like everything is global.”
About the author
Pete Spitellie, M.D., is the Medical Education Director for Precyse Learning Solutions. He is a physician who has worn many hats in various clinical arenas, former anesthesiologist, and oculoplastic surgeon in both academic and private practice. Most recently worked in Health Care IT at Allscripts. Dr. Spitellie joined Precyse in June of 2013.