Background TheInternational List of Causes of Death(ICD) began in 1893 and was developed bythe International Statistical Institute. The ownership and development of theICD codes was transferred to the World Health Organization when theorganization was founded in 1948.
Since then the WHO has developed many versionsof the list. The most recent revisions in use by 27 countries in the World HealthOrganization are the ICD-10 codes. ICD codes are used to record diseases andhealth care trends internationally. It helps to make health information easy tostore, retrieve and analyze.
It allows healthcare professionals, hospitals,regions and countries to share and compare their healthcare data with oneanother. Besides just recording healthcare data, it also allows forreimbursements.1ICD-10was developed in 1992 and since then many countries have adopted it however theUnited States was delayed in its adoption. The United was one of the lastcountries in this list of 27 actually adopt the use of ICD-10. We as a countrydid not adopt the coding system till October 1st, 2015. It took over20 years for us to adopt this new version of the code. This delay was a resultof many factors such as politics, the cost and technical support necessary andalso the “opposition from the American Medical Association(AMA) and othergroups.” 2In2013, ICD-9 only had approximately 13,000 codes while ICD-10 had almost 68,000at the time and could continue to expand.
ICD-9 in this year had little chancesof being expanded, because it was only made up of 3-5 numeric codes besides theV, E, and M codes. With ICD-10, each code has 3-7 characters which gives codedevelopers the opportunity to create more codes when there is the need to doso. ICD-9 did not have this flexibility and thus ICD-10 had to be created toaccount for what ICD-9 was lacking. Thereare many benefits of using ICD-10 as opposed to ICD-9. With the increasednumber of codes it makes coding more specific. For instance, when it comes to “intracerebralhemorrhage” 3ICD-9 codes only has one code where ICD-10 has over 9codes that describe the condition in greater depth. They focus on the various nuancesthat are associated with a diagnosis. They keep in mind that each diagnosiswill be different for different people and so it will keep some of thedifferences that can happen in mind.
3 On October 1, 2015, the healthcare system wasin a frenzy as ICD-9 was dismissed tomake way for ICD-10. Doctors, Nurses, Insurance companies were tying up looseends of their Icd-10 training and implementation of the new coding system. Peoplewere terrified that ICD-10 at the time of its launch would affect their workflow. People were afraid that their claims would get denied or worst that theirsystems would shut down.
However after the implementation, many healthcareworkers have reporting that the transition was not as intense as was oncepredicted. According to HIMMS, many physicians actually reported the transitiona none event because of how well everyone prepared for the transition. Someorganizations prepared for many monthseven years so they were well equipped to manage the changes that came with ICD-10.4Although many had a smooth transition, every change will come some downsides.The transition in the first month of its enacted was associated with a declinein productivity in many companies, one company reported having a 30% decline inproductivity. But after the first month things became a lot smoother. 4 Application Whoexactly uses these codes? ICD codes arecurrently used by physicians, hospitals, pharmacies, insurance companies, DurableMedical Equipment Suppliers, researchers and other entities They are used torecord “diagnoses, symptoms and procedures.”5 These codes are used by, physicians, DurableMedical Equipment Suppliers to submit their claims to payers.
With the new and more specific codes, payersare now requiring coders to be as specific as possible with their codes, theywant as many codes that apply to be utilized. If the codes are not as specificas possible then the insurance company could potentially send the claim back tobe made more specific. With ICD-9 there was the option to use an “unlisted”code but now with so many codes this is no longer an option. 3 Usuallythe codes are recorded by medical coders, and they usually do so by looking atthe notes from doctors.
So now coders have to base everything off of what thephysicians says in their notes and cannot just assume a code. So physiciansneed to ensure that they get as detailed as possible in their notes to makesure that the claims are not denied for being too vague. Codes are also used by medical devicemanufacturers so their customers can code the devices they have purchased. Inaddition, this new change effects labs because they also have to make theirdocumentation more specific. At the beginning of the transition, it actuallywas extremely difficult for medical coders because they had to keep track ofboth ICD-9 and ICD-10 and they had to use them at the same time. 3Theuse of ICD-10 codes could be used to connect social determinants of health tohealth especially for the people hit the hardest.
In the new version of thecodes, there are codes that capture social determinants of health and socialeconomic status as it relates to health. Some of the Z codes are dedicated tocoding things like homelessness, poverty, low income, lack of insurance andother things. Including these things helps doctors and care providers todeliver better care. Now that there is an opportunity to code for it, it willhelp doctors focus on the underlying cause of certain health issues which couldbe related to social determinants of health. This will have potential to makecare more comprehensive because then they could focus on treating the patientholistically by bringing in social workers who can help homeless people findhomes and help them with other social services. 6 7 9Significance Thereare benefits to the new coding system to population health management. The newspecificity that ICD-10 has will make reimbursements more accurate and reducethe number of rejected claims.
In addition, this would also help the payers topay more accurately for procedures and waste less money. Which addresses thecost portion of the triple aim to reduce cost. This would make the adoption of payfor performance easier because the specificity will make claims more accurate. 67 9Thereare benefits for patients, because these codes are more specific because itincreases the amount of data we have. Having this specific data of code couldbetter help us find ways to improve the quality of care we delivery topatients.
These codes could help ustrack outcomes of the care patients receive and also better understandcomplexity that certain diseases can have. Having this data could also help usfigure which treatments work best for patients with certain illnesses. 6 79Thereis also hope to increase Health Information Exchange with these new codes.
With ICD-9 codes therewere limited codes which made itdifficult to communicate specifics of thediagnosis or the disease. With ICD-10codes providers could communicate nuances with codes instead of using words.Using codes will make it easier to exchange more information about diseasesespecially between two different EHR systems. Every EHR system will have ICD-10as a requirement so it is not something that needs special coding to be done. 79Memberstates who belong to the World Health Organization are all using ICD-10 codesin the healthcare system. Currently, if all of these countries are using ICD-10they could all share disease and diagnoses internationally in real time.
Thesecountries could work together to share knowledge they might have about theillness and quickly work on solving it. It is especially important right nowbecause bioterrorism is on the rise andsharing knowledge back and forth about this will be extremely important.Sharing this data with the WHO or any of the member states could increase ourefficiency with finding treatments and cures for bioterrorist attacks or evenprevent other countries from experiencing the same bioterrorism. In addition itcould help spread information about outbreaks happening locally and nationally.
For instance, currently in Michigan there is a hepatitis A outbreak and codingcould help better analyze this data and see what locations it is happening.This code could also help countries compare best practices globally aboutspecific illnesses. 7 9ICD-10gives physicians and healthcare workers the opportunity to code morespecifically about diagnoses. However, this is not necessarily what ishappening. Some physicians have claimed to just use the code that they foundeasiest to find and also gets them money.
Physicians are not focused on beingas accurate as possible they are just focused on their reimbursement. In orderto solve this problem, it would be important for physicians and coders to geteducated about the importance of coding as accurate as possible. If doctors arenot coding as accurately as they can, then they are impacting the work of manypeople like payers, auditors, and the hospital overall. This is also affectingthe quality of care because if we are not coding accurately, then we won’t haveaccurate data to analyze and possibly use to improve care in the future. 7Toalso improve this we could also use incentives to motive doctors to actuallytry harder to find the appropriate codes. 7 9Eventhough some people are not coding accurately, the accuracy rate of inpatientcoding has been on the raise since the implementation of ICD-10.
There areICD-10 contests that happen and it is used to assess how well people are doingat coding. In 2016 the average inpatient coding accuracy was 55 and then in2017 it was 61%. More research like this needs to be a done in real settings tosee if ICD-10 is improving the quality of care being given to patients. 89 In conclusion, ICD-10 is moreaccurate and specific for the usage of coding for diseases than ICD-9. It hasthe potential of helping with the Triple Aim and population health managementin general. It could help us improve healthcare, deliver better care and alsolower costs. It is important for the United States to conduct more research onhow it has improved patient outcomes.