The ICD-10 Emperor Has No Clothes

They howled ICD-10 was delayed. And they howled loud and fierce.

Apparently, the life of U.S. healthcare hangs in the throes of 68,000 diagnosis codes.

Meanwhile, the rest of the world has switched to ICD-10. But here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM.

Let’s reiterate: The rest of the world is not using ICD-10-Clinical Modification set, which has 68,000 codes.

The Canadian version of ICD-10 has about 16,000 codes, but the physicians do not use those codes for billing and reimbursement. They use a more limited code set of about 600 three-digit codes.

ICD-10-CM is going is going to add significant cost and complexity to physician practices without any benefit to the patient or physician. Perhaps facilities or payers need this level of detail, but doctors don’t.

Let me take this a step further. I helped create my own EMR and Practice Management Software, so that I could A) run my own practice and B) sell the software to other doctors so that they can run their own practice.

Let me tell you what I would never do.

CREATE A PRODUCT FOR DOCTORS WITH 68,000 user-facing codes of anything. (There’s actually way more software coding, though, to be fair.)

Let’s compare: Microsoft Word has about 1,200 functions. A commercial cockpit, hundreds.

And yes, these are two vastly different operations, but by comparison, WE ARE HELPING KEEP HUMAN BEINGS ALIVE.

I’d venture to say, it’s pretty damn important. And something that should never have 68,000 of ANYTHING related to getting paid for doing the important work.

However, for years, experts have said that we needed greater granularity and detail in our diagnosis coding. The transition from ICD-9-CM to ICD-10-CM increases the number of diagnosis codes from about 14,000 to 68,000. That is significant additional granularity.

But, really, the ICD-10 emperor has no clothes.

Some rational objections to ICD-10-CM are that it includes:

  • needless specificity.
  • absurd adherence to taxonomy.
  • unnecessary detail about injuries.
  • insufficient additional information about chronic illnesses.

Let’s compare.

In ICD-9, there are about a dozen codes for acute or chronic conjunctivitis.

There are about 50 in ICD-10.

Here are four: unspecified chronic conjunctivitis, right eye, unspecified chronic conjunctivitis, left eye, unspecified chronic conjunctivitis bilateral eyes, unspecified chronic conjunctivitis, unspecified eye.

Of the 68,000 codes over half are for injuries and accidents.

Is it a laceration with or without a foreign body, which side, initial or subsequent encounter?

Is the fracture at the upper or lower end of the ulna?

What type of fracture is it?

The mainstream media focused on the external cause codes “struck by a parrot.” But, these external cause codes are the least of our worries as we attempt to use ICD-10-CM in medical practices. And, I assure you, “struck by a parrot” is not in the WHO ICD-10 code set.

Betsy Nicoletti says it best when she compares it to Star Trek IV the Voyage Home (1986). In the movie, Dr. McCoy says, “the bureaucratic mind set is the only constant of the universe.”

You remember the scene, right?

Our heroes are in a shuttle — wait, okay, so Dr. McCoy wasn’t talking about ICD-10-CM, but his theoretical reaction is priceless.

“Dammit Jim, I’m a doctor not a coder.”

But, in medical practices today, ICD-10-CM will do little more than increase the bureaucratic side of physicians’ lives at the expense of their being doctors. And you know how I feel about red tape. I can deal with government involvement with billion dollar drugs and patent regulation — that’s called public policy and public good — but this, this is plain old farce.

One thought on “The ICD-10 Emperor Has No Clothes

  1. Pingback: http://t.co/HVcie9Y1FS The ICD-10 Emperor Has No C… « Hippocrates Shrugged

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