By now, you’ve probably heard more than a few ICD-10 jokes—”a man walks into a lamppost…” for example. And although they’re pretty funny—and not entirely unfounded—there’s actually a reason why ICD-10 contains so many ultra specific diagnostic codes, at least according to Richard Averill, senior vice president of clinical and economic research at 3M Health Information Systems. Here’s some of what Averill has to say (paraphrased) in response to some very good questions posed by Tom Sullivan, editor of Government Health IT (also paraphrased):
Q: Macaws are (almost entirely) native to South America, so why does the US need codes for macaw injuries?
A: Remember the avian flu? Well, that was originally transmitted by a bird. If the US experiences another bird-source outbreak, we’ll have the necessary codes to accurately report it to the United States Centers for Disease Control and Prevention (CDC).
Averill also points out that most of the codes people are using as punchlines are actually already in ICD-9; there are just many more in this new set, which brings us to another question.
Q: The sheer volume of codes has a lot of people concerned. Considering that most practitioners will only ever use a small subset of the codes, why are there so many?
A: The coding system is similar to a dictionary in that even though there are 470,000 words in the unabridged version, we only use a fraction of a percent of those words in a typical conversation. But the fact that 470,000 words are available to us doesn’t make it any more difficult for us to carry on a conversation. The same goes for the coding system. In most situations, you’ll only use a small subset of the codes. But there may come a time when you wish to describe something out of the ordinary, and in that case, the unusual codes will be there for you to use.
According to Averill, the large number of codes came about not as a result of bureaucracy, but rather because the medical community asked for this level of specificity to better do their jobs. Additionally, Averill says: “John Hopkins Bloomberg School of Public Health noted that to further research in the area of non-fatal injuries, we must be able to more accurately describe the nature of the injury sustained and correlate the nature of the injury with the mechanism of the treatment and outcome.” In short, he says, “they’re arguing that we need the detail to really understand outputs.”
Q: Could we put the ICD-10 data to use? Perhaps to determine the likelihood of injury based on sport?
A: Yes. If we as a country require providers to report these injuries at that level of specificity, we’d have a national database we could use to track trends. We could also go one step further by tracking patients who suffer football-related concussions during childhood, for example, to see if they also experience learning difficulties or seizures later in life. However, right now providers are not required to record such detailed information.
Q: What’s the best example of how ICD-10’s specificity can actually help improve health management?
A: In ICD-9, there’s no way to code which trimester a pregnant woman is in, which is an incredibly important piece of information to have if you’re treating someone for preeclampsia or other complications. Also, using ICD-9, “in rheumatoid arthritis [cases], we don’t even know what joint is involved. And so if we’re really trying to understand care, and a patient has rheumatoid arthritis in the knees, hips, and so on, [his or her] ability to recover from, say, a stroke may be significantly impaired, especially compared to having rheumatoid arthritis only in [his or her] little finger.”
According to Averill, there are many cases in which ICD-10’s specificity is actually incredibly beneficial to the healthcare community as a whole. There aren’t “just a couple of examples.” And we couldn’t agree more. Who knows what brilliant insights will come from the data that specifies whether a patient sustained his or her injury in an opera house or an art gallery?
As HealthLeaders Media writer Cheryl Clark points out here, there are lots of reasons why ICD-10—and all of its specificity—will be a very good thing:
- It’s a much-needed update to outdated or non-existent 1970s medical terminology
- It improves public health tracking
- It discourages fraud
- It allows providers the opportunity to code reasons for patient non-compliance
- It details accidents and injuries in a way that will allow for trend identification
- It better describes—and allows tracking of—adverse events that take place within a healthcare environment (clinic, hospital, etc.) as well as those that result from medical device complications
- It allows providers to track the specifics of procedures based on level of difficulty
- It creates jobs
- It supports the transition to EHR/EMR
So what do you think? Do you see the benefits of ICD-10’s specificity or do you think 68,000 codes is a bit much? Tell us in the comments section.