ICD-10: Healthcare’s Y2K?

Injured while crocheting? Hurt at the opera house? Dinged on the squash courts? From hidden perils to the most random brush with nature, when injuries strike in the future, there will be a code so specific to your injury it is almost comical.  Today, hospitals and doctors work with 18,000 codes, but that number is growing nearly eight-fold to 140,000 codes.

The ICD-10, a new federally-mandated version of the coding system, will add tens of thousands of codes to describe what bone was broken and where the injury happened (from bathroom to chicken coop). Recently the Wall Street Journal wrote an amusing article on the upcoming ICD-10 implementation and what it means to our industry.

Background:

As you may already know, the ICD is the international standard code set for diagnostic classification. The code set is used to classify diseases and other health problems recorded on medical bills, health records and death certificates.  The codes help enable the storage and retrieval of diagnostic information for clinical, analytical and quality purposes. They also provide World Health Organization (WHO) Member States’ with the basis for national mortality and morbidity statistics. ICD-10 stands for International Classification of Disease, Tenth Edition. It’s a coding system WHO created in 1989 to replace ICD-9. Nearly every country has adopted this standard, although some countries have created their own modifications.  The US already partially uses ICD-10, but only for mortality reporting done for the CDC (cause of death). For now, US diagnoses continue to be reported with ICD-9-CM.

The big switch in the US happens October 1, 2013. On that date the ICD-10 will replace the ICD-9 and the Center for Medicare Services (CMS) will adopt ICD-10 CM (clinical modification) in place of ICD-9 CM and ICD-10-PCS (procedural coding system). Implementation of the PCS system is scheduled to coincide with implementation of the new diagnostic coding system.

Impact on the Medical & Insurance Industries:

Could this be Y2K all over again, but this time for healthcare?  Seems like the same level of drama for the medical and insurance industries but, just like with Y2K, few real issues will come from this.

Some tweaks in the IT department, of course, will have to be made to accommodate the switch:

• Data exchanges and data storage must be able to handle the longer codes. Anyone on a relational database will have no issue with storage length of the code -- from five to seven characters.
• Anyone using XML standards for data exchange will have no issues either.  Those using fixed width flat file exchanges have to modify their code. 

• New codes must be loaded into reference tables. 

• Validation rules need to be updated for the new format.

At the people level, the biggest issue will be coding training for medical providers, payers and industry service providers. Documentation and coding will have a learning curve and that will likely impact productivity when it’s implemented across all aspects of US healthcare.  

The good news is the expanded code set is much more logical and detailed, which in the hands of good data analytics organizations, will allow for unlimited improvements in predictive modeling of outcomes.  The ability to assess risk by nailing detailed information about how and where an injury occurs will dramatically improve medical outcomes and cost projections.  The more detail, the better when it comes to generating optimal data analytics. And that's the aspect of this switch I’m most eager to see.