The (increasingly) specific International Classification of Diseases (ICD) code set represents various injuries, medical conditions, and hospital procedures.
It’s been over 35 years since ICD-9 and now transition to ICD-10 is representative of an expansion from about 14,000 to over 141,000 codes!
This is hoped to improve healthcare efficiency, quality, and safety.
For example, physicians now have more specific codes with which to report their patient’s conditions, as this ICD-10 chart of 48 individual classifications applicable to spinal disc disorders illustrates:
Another example is the condition of sciatica (pain or numbness going down the back of the leg, usually caused by a disc condition), where with ICD-10 the following applies:
- M54.30 Sciatica unspecified side,
- M54.31 Sciatica right,
- M54.32 Sciatica left,
- M54.40 Sciatica with lumbago unspecified,
- M54.41 Sciatica with lumbago right,
- M54.42 Sciatica with lumbago left,
- For bilateral sciatica we will use both codes.
Prior to ICD-10 only a single code existed for sciatica.
If you have never looked at either a ICD-9 or ICD-10, you an only imagine how this 10-fold expansion increases specificity.
Nationally, there is some concern that this ‘transition’ to a more specific code set may prove to be a headache to at least a portion of the U.S. workforce (over 12%) which is employed by the U.S. healthcare system.
Nevertheless, hoped for benefits with this expansion include:
- Capture of more valuable data for evaluating and improving quality of patient care by making it easier to understand complications, track outcomes, and refine treatment protocols,
- Clarification between a provider’s performance and the patient’s condition, to include medical complications and medical safety issues,
- Improved effectiveness in recognizing public health diseases (such as Ebola) and situations (such as terrorism),
- Improved research capabilities due to capture of finer detail and a more logical representation of the patient’s condition,
- Early recognition of early signs of epidemics,
- Improved ability to recognize when less invasive procedures result in improved outcomes (when laparoscopic surgery is better than open surgery, for example).
- Much-needed improvements in accurate classification of the nature of injuries, their with cause, treatment, and outcome,
- An ability to more adequately describe not only the nature of the injuries, but also their severity and the probability of residual impairment. This could aid injury prevention programs,
- It is hoped that these more specific codes will allow for less need for additional reports, and finally,
- With the ability to code “gray areas”, ICD-10 will make it more difficult for dishonest hospitals and providers to hide behind ambiguities in code descriptions or rules, thus reducing fraudulent activity and saving resources.