This year is the official deadline for the switch to the new International Statistical Classification of Disease and Related Health Problems version 10, known simply as ICD-10. One of the more controversial, or beneficial depending on how you look at it, features of ICD-10 is the expansion of code classifications. Some in the health care industry think that ICD-10 takes it just a little too far. The federal agencies that developed the classification standards went into great detail with version 10 as a way to enhance coding, but may end up bogging it down instead.
The Shift from ICD-9 to ICD-10
ICD-10 is a major change from ICD-9, the code classification system that has been in practice since 1975. One of the key goals in the creation of the new version was to assign coding standards that are more specific. Part of the reasoning behind this transition is the implementation of EHR systems. With medical records becoming digital and coordinated, advanced coding provides for better data evaluations and care quality.
There are those that question whether they took the breakdown of bill codes a little too far, however. ICD-9 featured around 18,000 codes to describe the medical services offered. ICD-10 expands that database to about 140,000 different coding choices. The expansion of codes provides a more accurate account of the diagnosis and treatment.
There is little doubt that the coding standards for ICD-9 were probably too general to support the current technology. The precision of ICD-10 takes it much further. For example, a code for the placement of a stent is now specific to the artery. A broken femur gets coded differently than a fractured ulna. There is nothing wrong with creating a system that clarifies the problem, but how far is too far? Some of the ICD-10 codes are way out there.
The Humorous Side of ICD-10
A patient comes in to a clinic after tripping and falling while picking up eggs in their chicken coop. No problem, ICD-10 has that covered. Fall down the stairs seeing La Boheme? There is a code for opera house injuries too. Consider some of the extremes associated with ICD-10.
R46.1 – bizarre personal appearance (whatever that means)
R46.0 – low level of personal hygiene (that is at least a little clearer)
W22.02XA – walked into a lamppost – initial encounter
W22.02XD – walked into a lamppost – subsequent encounter (just in case you do it again)
V91.07XA – burn due to water-skies on fire – initial encounter
V9107XD – burn due to water-skies on fire – subsequent encounter (that is some really bad luck)
ICD-10 has all types of animal encounters covered, as well. There are nine separate codes for duck accidents, nine for turtle injuries and nine more in case your macaw gets out of hand. In total, there are 72 separate codes for bird related injuries alone.
ICD-10 – A Good News/Bad News Scenario
The changeover to ICD-10 is a necessary step in many ways. ICD-10 data is easier for EHR/EMR software to retrieve and map. The codes offer more international appeal, as well. Patients in some countries may be more prone to macaw injuries. Medicare and the Centers for Disease Control and Prevention claims years of international input went into the creation of these codes. Being able to pinpoint specific risks will be a benefit to public health research all over the world.
Learning thousands of new codes is a challenge, but many of the codes will get little to no use. The point is they are there if you do need them. The ICD-9 codes were so vague they were almost useless.
The healthcare industry is shifting to coordinated care and meaningful use standards. Finding proper ways of labeling treatments is a big part of that shift. ICD-10 is designed to be as comprehensive as possible. It is difficult to look at the codes and not say that they accomplished that goal. Doctors may never need the code for being struck by a turtle, but if it does come up, ICD-10 has that covered.