In last week’s blog about ICD-10 Terry mentioned the astonishing number of codes nephrologists will find on the 2728 form, which has 4 pages of nephrology-diagnosis alphabet soup. I find the mixture of letters and numbers and codes of various lengths interesting, so here are some ICD-10 “well that at least makes a little sense” factoids.
Do you remember the Kingdom classification system from high school biology? Just to jiggle your brain a little, people began to document the plant and animal world from the earliest time of historical records, but the first real taxonomic study was De Plantis in 1583, which described 1500 plant species. In 1725 Carl Linnaeus published Systema Naturae creating a standard binomial naming system for the plant and animal kingdoms. The Linnaean system creates order out of chaos. This system of Domain, Kingdom, Phylum, Class, Order, Family, Genus, and Species makes it possible for scientists to document the diversity of living organisms, which enables current efforts at conservation and protection. Today the “Catalogue of Life” database tracks 1.4 million species living on earth.
W17.1XXA Fall into storm drain or manhole, initial encounter
The International Classification of Diseases (ICD) was likewise developed as a standard classification of diseases to enable global monitoring of the incidence and prevalence of diseases. ICD-9 was published in 1977 with what must have seemed like a generous 13,000 codes. Advances in medical diagnosis and changes in care delivery have increased the coding documentation needed; ICD-9 can no longer adequately describe the disease details we can now diagnose. While ICD-9 “chapters” are full and new codes can’t be added, ICD-10 has huge code capacity. ICD-9 also lacks the specificity needed to fully describe encounter findings while ICD-10 can code for details such as physical laterality and initial versus follow up encounters.
Here is an example from the American Medical Association (AMA) of the detail the 3-7 character alpha-numeric ICD-10 code provides:
S52 Fracture of forearm
S52.5 Fracture of lower end of radius
S52.52 Torus fracture of lower end of radius
S52.521 Torus fracture of lower end of right radius
S52.521A Torus fracture of lower end of right radius, initial encounter for closed fracture
V95.40XA Unspecified spacecraft accident injuring occupant, initial encounter
All ICD-10 codes start with a letter that represents a “chapter”. Here are some nephrology examples:
Here are some specific nephrology code examples from the Pulse Systems, Inc. “Top 20” list for nephrology ICD-9 to ICD-10 codes:
N18.2 CKD, stage 2
N18.3 CKD, stage 3
N18.4 CKD, stage 4
N18.9 CKD, unspecified
Single ICD-10 codes reflect detailed diagnosis specificity, like N04.3 for Nephrotic syndrome with mesangial proliferative glomerulonephritis. In addition to great specificity, ICD-10 codes for chronic diseases like asthma can also denote disease severity. This granular data enhances population health understanding and tracking. Such information about disease severity and distribution enables efficient resource deployment by the healthcare community.
V86.52XA Driver of snowmobile injured in nontraffic accident, initial encounter
If ICD-10 is a logical classification system that replaces an out of date, inadequate ICD-9 coding system, why is the U.S. the last industrialized country to adopt it? Let’s face it, it is hard to change. One common grumble from providers is that we all know the old ICD-9 codes by heart and now we have to memorize new codes. It’s like living in the same city for 20 years where you know all the stores, restaurants, and shortcuts and then you move to a new city and it takes at least 6 months to be able to drive from home to the grocery store without your GPS. Your efficient daily activity is disrupted until you know the new landscape.
Aside from inconvenience, the U.S. has an additional ICD-10 problem that the rest of the world hasn’t dealt with: reimbursement. In the U.S., ICD-10 coding creates the reimbursement claim. Providers not only need to make sure that ICD-10 codes specifically reflect the care provided, but they have to hope that payers are capable of processing new ICD-10 claims. The government hasn’t had a stellar record of launching new technology, which makes the “flip the switch” to ICD-10 on October 1, 2015, a high stakes day. CMS has published extensive ICD-10 online support like “Road to 10” which offers provider instructions for testing ICD-10 claims, eligibility verification, quality reporting, and other transactions submissions. Healthcare Finance News recently reported that 875 Medicare Administrative Contractors along with other payers participated in ICD-10 claims file testing with an 88% success rate and only 2% of failed claims related to ICD-10 coding errors.
Why are we making all of this effort for ICD-10 implementation when ICD-11 is just around the corner? The “Road to 10” points to the current history, with ICD-10 as part of the explanation. ICD-10 was endorsed by the World Health Organization (WHO) in 1990 and released in 1995. The U.S. Department of Health and Human Services (HHS) proposed adoption of ICD-10 in 2008 and it will finally be implemented October 1, 2015. This represents a 20-year delay from ICD-10 release to U.S. implementation. Given this historical fact pattern, CMS speculates that WHO will release ICD-11 in 2017, but the U.S. will not make the transition until 2039. Not only will ICD-9 be woefully inadequate by 2039, but CMS notes, “….a transition directly to ICD-11 [from ICD-9] would be an even larger and more dramatic undertaking for the US healthcare industry.”
Perhaps we will get to ICD-11 sooner than 2039. If so, what can we look forward to? Good news, ICD-11 is all about electronic health applications and information systems. The ICD-11 revision is underway and WHO welcomes expert and stakeholder participation in the process. Visit the WHO ICD website to register for a participant account and become an ICD-11 revision contributor.
T-minus 107 days and counting. Are you ready?
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.