ICD-10: there's a code for that

Abstract

The International Classification of Diseases (ICD) is the system for describing and coding mortality and morbidity incidents, implemented by most WHO member states. As of Oct 1, 2015, the USA formally transitioned to the updated codes, although they have already been in use in 117 other WHO member states (such as China and Canada) since release in 1992. The directive by the US Federal Government for ICD-10 compliance has been a major and controversial administrative and financial undertaking for health-care professionals, hospitals and health centres, and insurance companies. Notably, the American Medical Association (AMA) has been resolutely opposed to the upgrade, since the reforms will probably add a substantial burden of cost to medical practices and physicians, are administratively disruptive, and offer no benefits to patient experience.The change is considered necessary because of the inadequate and outdated coding offered by ICD-9, and the need for global consistency. The update from ICD-9, in use in the USA since 1979, has increased diagnostic codes from 14 000 to 68 000 to describe the circumstances of injury, and includes almost all conceivable and unusual injuries such as: problems in relationships with in-laws; struck by an orca, initial encounter; and prolonged stay in weightless environment. The cost of the upgrade includes IT systems, which need to adapt to new medical records, an overhaul of data storage facilities, training for physicians and administrative staff, and loss of productivity. The AMA estimate that this cost will be around $86 000 for the smallest practice, to a range of $2–8 000 000 for a large practice. The Centers for Medicare & Medicaid Services has appointed a physician as ombudsman, and the AMA has set up an online facility to submit complaints directly to him.ICD-11 is due in 2018—other countries are already becoming prepared for this next wave. US consistency with the rest of the world is desirable, but the likely chaos and expense of the next few months will make many sceptical as to its necessity, especially beleaguered physicians already daunted by more complex reporting and reduced reimbursement. The International Classification of Diseases (ICD) is the system for describing and coding mortality and morbidity incidents, implemented by most WHO member states. As of Oct 1, 2015, the USA formally transitioned to the updated codes, although they have already been in use in 117 other WHO member states (such as China and Canada) since release in 1992. The directive by the US Federal Government for ICD-10 compliance has been a major and controversial administrative and financial undertaking for health-care professionals, hospitals and health centres, and insurance companies. Notably, the American Medical Association (AMA) has been resolutely opposed to the upgrade, since the reforms will probably add a substantial burden of cost to medical practices and physicians, are administratively disruptive, and offer no benefits to patient experience. The change is considered necessary because of the inadequate and outdated coding offered by ICD-9, and the need for global consistency. The update from ICD-9, in use in the USA since 1979, has increased diagnostic codes from 14 000 to 68 000 to describe the circumstances of injury, and includes almost all conceivable and unusual injuries such as: problems in relationships with in-laws; struck by an orca, initial encounter; and prolonged stay in weightless environment. The cost of the upgrade includes IT systems, which need to adapt to new medical records, an overhaul of data storage facilities, training for physicians and administrative staff, and loss of productivity. The AMA estimate that this cost will be around $86 000 for the smallest practice, to a range of $2–8 000 000 for a large practice. The Centers for Medicare & Medicaid Services has appointed a physician as ombudsman, and the AMA has set up an online facility to submit complaints directly to him. ICD-11 is due in 2018—other countries are already becoming prepared for this next wave. US consistency with the rest of the world is desirable, but the likely chaos and expense of the next few months will make many sceptical as to its necessity, especially beleaguered physicians already daunted by more complex reporting and reduced reimbursement.