ICD-10: The New Metric System?

At last, the 30+ year old ICD-9 code set has become outdated in the US. No longer considered usable for today’s treatment, reporting, and payment processes, it does not reflect advances in medical technology and knowledge, or provide accurate patient diagnoses.

On October 1, 2015, ICD-10-CM, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, became effective. Now including 68,000 codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease, ICD-10-CM has already had a profound impact on daily practice in terms of documentation challenges. In addition, the US also has the ICD-10 Procedure Coding System (ICD-10 PCS), a coding system that contains 76,000 supplementary codes not used by other countries.

So, what implications does ICD-10 have for healthcare analytics?

First, one must consider whether the full range of ICD-10 codes will be used, or just a subset based on convenience.  The clinical work necessary to accurately choose codes may be too overwhelming for busy practitioners, leading to time-saving short-cuts in the form of limited diagnosis code checklists.

Second, just like coding under ICD-9-CM, analysts need to be cautious about the clinical value and accuracy of ICD-10-CM codes. While ICD-9-CM has been using outdated codes that produce inaccurate and limited data, the hope here is that the new ICD-10-CM codes will make it easier to measure the results of treatment and the quality of care.

The structure of the ICD-10 code is as follows:

  • 1-3 (Category of disease)
  • 4 (Etiology of disease)
  • 5 (Body part affected)
  • 6 (Severity of illness)
  • 7 (Placeholder for extension of the code to increase specificity)

To make the conversion from ICD-9 to ICD-10, and sometimes vice versa easier, translation tables have been developed: https://www.cms.gov/medicare/coding/icd10/downloads/gems-crosswalksbasicfaq.pdf

Embrace the change, it’s time to jump on board with the rest of the world.