Don’t Panic: Assuaging Concerns as ICD-10 Approaches Our Shores

August 11, 2010 at 3:56 pm 2 comments

The times they are-a becoming quite different. In a few years (by October 1, 2013 to be exact), the US will adopt ICD-10 as the official (and sole) system for coding diagnoses. This will mean that the volume of codes available for diagnosing patients will explode from 14,000 to over 155,000 different codes. This astronomical expansion of the numbers of codes is a way of addressing the need for greater refinement of codes and data capture. But let’s take a step back and examine the origins of ICD and what the future of this coding system will hold for all of us.

International Statistical Classification of Diseases and Related Health Problems (usually referred to as ICD) is a set of codes used to properly identify and classify issues facing patients – including diseases, injuries, infections, diagnoses, symptoms and other afflictions. Published by the World Health Organization (WHO), ICD is used by health professionals for billing/reimbursement, data capture and other informational purposes. The roots of ICD can be dated back to 1893, where a meeting of international physicians decided to adopt the “List of Causes of Death.” As time went on, and the focus expanded beyond morbidities, the system was adopted by various countries as the official way of tracking Diseases and Health problems.

The most recent iteration, and the cause for some stateside concern, is ICD-10. ICD-10 was begun in 1983, but it wasn’t finished until 1990 and came into use by WHO nations in 1994. Well, almost all of them. Many countries have adopted ICD-10 as the official coding system for diseases and health problems – particularly United Kingdom, Germany, Canada, Australia, France, Sweden, Korea and Thailand. But the United States has not adopted it yet. If you were to review the coding attached to medical forms today, the coding system you’d be viewing is ICD-9. However, there are plans for utilizing ICD-10 in the US – setting the date for implementation as October 1, 2013 (as previously mentioned).

So this is good news, right? The States will finally catch up to the rest of the world and will be on the same coding page. And, as the codes are much more specific and allow for deeper research, this will only improve medical advancements. And yet – there is a sense of unease creeping into many Health Information Manager’s offices; a nervousness about the sea change that is about to hit in Health Records and the mammoth change in behavior and reporting that ICD-10 necessitates. Since there are so many more codes in ICD-10 than ICD-9, will it be harder for coders to identify the codes that best correlate to the diagnoses the physicians gave? Will all of the computer programs that use ICD-9 be updated in time for ICD-10’s implementation? Are we about to grind our healthcare system to a complete standstill or is all of this just much ado about nothing?

According to Rhonda Butler, senior clinical research analyst for 3M Health Information Systems, the changes preparing to hit US health facilities in 2013 is more a source of promise than it is a cause for panic. In a piece she wrote for the AHIMA newsletter, Ms. Butler is quick to point out that most of the concerns are based on outdated and obsolete beliefs. In an age where computers have outstripped humans’ ability to memorize thousands of individual codes, and we have many programs capable of searching massive lists to find what we are looking for, the ability to adopt and adapt to ICD-10 is well within our reach.

For the most part, there is a 1:1 correlation between ICD-9 codes and ICD-10 codes. Obviously, it’s not that way throughout the two versions. But for those time where there are more ICD-10 codes to ICD-9 codes, it’s not because they are all more convoluted or vague. The increase in ICD codes is to better specify what the health professional meant. Many codes in ICD-9 (that is to say, many of the codes being used right now in US hospitals) are very much all-encompassing/one size fits all. For example, a common, ICD-9 preoperative diagnosis for a laparoscopic cholecystectomy would be “156.8 – Malignant Neoplasm of Other Specified Sites of gallbladder and extrahepatic bile ducts.” Now that diagnosis will be winnowed down to the much easier to understand ICD-10 “C24.8 – Malignant neoplasm of overlapping sites of biliary tract.” Perhaps, previously, that wasn’t what the physician was talking about – but that isn’t a case for ICD-9 or a strike against ICD-10. If C24.8 wasn’t what the physician had meant, then clearly Code 156.8 was too broad or vague to allow for such open interpretation.

Butler makes an excellent point when she summarizes the whole issue as being the “Y2K” of healthcare. Certainly, there were corrective steps that needed to be taken to address the old software bug that misread dates with “00” as “1900” instead of “2000.” Some code was rewritten, changes were made by programmers and the readiness was all that was needed. But January 1 wasn’t the apocryphal scenario that many people were screaming about; there was no barren wasteland of roaming marauders in a land forgotten by time and God. Instead, it was just another New Year’s Day with scores of people shuffling through the streets as they suffered through hangovers and lingering regrets. Or, as Butler puts it,

Yes, ICD-10 is coming. And yes, there is a lot of work to do. But it is not the end of the world as we know it. Getting work done well takes planning, attention to detail, persistence, cooperation. Sometimes finding reasons not to work is more appealing than doing work.


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A Useful Meaning for Meaningful Use? Words from Around the Web

2 Comments Add your own

  • 1. Words from Around the Web « Reports From The O.R.  |  August 13, 2010 at 3:41 pm

    […] piece by Rhonda Butler was the genesis for an earlier post on this site. But, just in case you missed it, be sure to check out Ms. Butler’s completely rational and […]

  • 2. Abby Andrews  |  August 17, 2010 at 6:13 pm

    I just wanted to post and say that I completely agree with the “Don’t Panic” message above. As a medical coder myself, I think that the key is to plan ahead and not wait until the last minute. Your organization should prepare an overall plan that addresses the steps toward a successful conversion, including determining a budget, software/IT needs, and staff training. With set milestone dates, you’ll know that you’re on track. I am going to start my training soon so that I can take my time and fully learn the new coding system. Here’s the program I am considering: ICD-10


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