Today’s Managing Health Care Costs Number is 10
The implementation of ICD-10, a diagnosis coding system completed by the World Health Assembly in 1990 (!) and released by the World Health Organization (WHO) for use in 1994, was finally adopted by the US on October 1 after years of delay. It has been the butt of dozens of jokes. ICD 10 includes a lot of ridiculous sounding diagnoses – like burns associated with water skis on fire and being struck by a macaw. For clinicians in practice, it’s no longer OK to say “skin infection,” but one now must say “skin infection on the left forearm, initial visit.” This does seem like a lot of bureaucracy. Why bother?
Medical claims are a crucial resource for health services research. They aren’t as robust as the data in electronic medical records (or paper charts), but they are highly structured and thus perfect for “big data” research. Medical claims using internationally accepted codes also allow comparison of disease and treatment across countries.
Electronic medical records and billing systems generally allow providers to type a text diagnosis and will suggest likely ICD 10 diagnoses – so this system really won’t upend practices as much as some have suggested.
The US has come last in adopting ICD10. That’s likely because ICD10 has reimbursement implications in the US that outstrip those in other countries. We use diagnosis coding to:
· Determine whether a condition is medically necessary. Now back pain diagnoses include length of time of symptoms – which might lead to denials of CT scans ordered prematurely.
· Determine risk of a population – which leads to risk adjustment and increased global budgets or capitation payments for providers taking care of a sicker population. Diabetes isn’t good enough anymore – there are dozens more levels of complications listed compared to ICD9.
The United States is one of the few countries which use diagnosis coding to determine payment amounts – so there are high stakes here which are absent in other countries. Therefore, we will probably code more carefully (which is good), but the constituencies to delay changes to the coding system were much more effective at delaying implementation. Sometimes, caring too much makes it hard to adopt improved administrative processes.
