ICD 10: Adoption and patient care

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.

ICD-10 CM: Clinical Modification for diagnosis coding
ICD-10 PCS: Procedure Coding System for inpatient procedure coding

All HIPAA-covered entities must use ICD-10
ICD-10 vs. ICD-9:
14000 codes
69000 codes
Limited severity parameters
Extensive severity parameters
Limited combination codes
Extensive combination codes
No laterality
Laterality defined(Right or Left)

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.

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

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