Dr Raghav Gattani, CNS Medical Correspondent
International Classification of Diseases (ICD) is a method of integrating disease diagnosis and medical and surgical procedures into codes; codes of patient’s state of health. These codes primarily allow electronic documentation of patient conditions which help physicians revisit, transfer or share unambiguous data within the health care system. Extensive debates on the need to update the ICD from its 9th edition to the 10th, have led to adoption of ICD-10 CM/PCS from October 1st, 2015 throughout United States. Surprisingly though, the update has come after 35 years and has expectedly brought with it diversity and specificity that will ultimately refine and revolutionise the medical system in the United States of America.
International Classification of Diseases (ICD) is a method of integrating disease diagnosis and medical and surgical procedures into codes; codes of patient’s state of health. These codes primarily allow electronic documentation of patient conditions which help physicians revisit, transfer or share unambiguous data within the health care system. Extensive debates on the need to update the ICD from its 9th edition to the 10th, have led to adoption of ICD-10 CM/PCS from October 1st, 2015 throughout United States. Surprisingly though, the update has come after 35 years and has expectedly brought with it diversity and specificity that will ultimately refine and revolutionise the medical system in the United States of America.
Components:
ICD-10 CM: Clinical Modification for
diagnosis coding
ICD-10 PCS: Procedure Coding System for
inpatient procedure coding
Coverage:
All HIPAA-covered entities must use ICD-10
ICD-10
vs. ICD-9:
ICD-9
|
ICD-10
|
14000 codes
|
69000 codes
|
Limited severity parameters
|
Extensive severity parameters
|
Limited combination codes
|
Extensive combination codes
|
No laterality
|
Laterality defined(Right or Left)
|
Specificity:
The increase in the number of codes from a mere
14000 to a massive 69000 will allow finer granularity in the diagnosis and
treatment and improve overall evaluation on patient follow up. Consider a
physician who is asked to treat a patient previously tagged as Congestive
Heart Failure according to ICD-9 versus the same patient tagged as Chronic
Diastolic Congestive Heart Failure according to ICD-10. The daunting
question that needs to be answered is whether the physician would treat the patient
differently given the increased specificity. The answer is a simple YES.
Severity
Evaluation:
Mark Bieniarz, M.D., Cardiologist says,
“ICD-10 allows us to speak the same language as the people that are going to be
telling our story - for outcomes, for data assessment and for billing. It is
incredibly important to have the severity of disease we are managing accurately
portrayed.”
The additional granularity based on
Anatomical Location, Laterality and Severity provided in the codes is the
hallmark of ICD-10. For example, code 572.0444 of ICD-10 describes a non-displaced
fracture of the base of neck of right femur, subsequent
encounter for closed fracture with delayed healing replacing an incomplete
ICD-9 code which describes a similar injury as a closed femur fracture.
This helps in improving medical communication, focus on severity, and manage
disease and its complications efficiently.
Another example is of the new
classification of asthma which specifies the severity (mild/moderate), persistence
and exacerbation, exposure to environmental tobacco smoke
(acute/chronic) instead of chronic obstructive asthma as per ICD-9, thereby
helping design and align an unmitigated treatment plan and follow up.
Trauma:
Another significant inclusion is that of
elaborate codes on injuries and accidents that considerably lacked detailing in
ICD-9. For example, while describing a motor vehicle accident, the details
about the collision vehicle, intoxication correlation, and traffic details
provided in ICD-10 has a more holistic approach that can be used to mould
public health parameters by forming and promoting accident prevention policies.
Financial
Benefit:
It has been seen that the unexpected
soaring medical bills often leave patients dissatisfied even after being
treated adequately. ICD-10 cuts right through this by better describing the
gravity of patient’s condition which in turn predicts the length of continuing
treatment, procedures required, and allow a more realistic estimate of medical
expenses. This helps greatly reduce unnecessary procedures, fraud, abuse, and
reimbursement failures.
Public
Health:
The broad based adoption of ICD-10 across
the globe will aid medical communication in a common language and help organise
research efforts on patient population. Analysis of disease patterns with an intricate
set of codes would help recognise and prevent biases in studies and treatment
modalities and help develop advanced and accurate algorithms for management of
both acute and chronic diseases.
This colossal increase in the number of
codes along with the inputs required from health care authorities to facilitate
this process has received both positive and negative reactions. The fact of the
matter remains that the change was inevitable. ICD-9 could not keep up with the
medical advancements of the past two decades. ICD-10 will allow health care
providers to be more specific and prudent, health care payers to be more aware,
and will lead to making patient care more agreeable.
(About the author: Dr Raghav Gattani, MBBS, Junior Consultant at Avadh Hospital and Heart Center is also the honorary Medical Correspondent for CNS - Citizen News Service)
17 November 2015
17 November 2015
Bibliography:
1.HCPRO, I. 10
Ways ICD-10 Will Improve Quality of Care.
2015. Disponível em: < http://healthleadersmedia.com/page-5/QUA-273822/10-Ways-ICD10-Will-Improve-Quality-of-Care
>. Acesso em: November9, 2015.
2.ICD-10-CM/PCS Myths and Facts Fact Sheet -
icd-10mythsandfacts.pdf. 2015. Disponível em: < https://www.cms.gov/medicare/coding/icd10/downloads/icd-10mythsandfacts.pdf >. Acesso em: November
9th.
3.Impacts of ICD-10 on Patient Satisfaction - Phoenix Health
Systems. 2015. Disponível em: < http://www.phoenixhealth.com/icd-10/impacts-icd-10-patient-satisfaction/ >.
4.Marketing Orientation -
Navicure-ICD-10-Preparation-Survey-Q3-2015_Final.pdf. 2015.
Disponível em: < http://info.navicure.com/rs/669-OIJ-380/images/Navicure-ICD-10-Preparation-Survey-Q3-2015_Final.pdf >. Acesso em: November
9th.
5.Road to 10: The Small Physician Practice's Route to ICD-10 ICD-10
Implementation Success Stories - Road to 10: The Small Physician Practice's
Route to ICD-10. 2015. Disponível em: < http://www.roadto10.org/success-stories/ >. Acesso em: November 9th.