July 21, 2014

Chronic Diseases and an ICD-10 Value-Add for Better Care

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Chronic diseases are having a massive effect on our healthcare system and our society. According to testimony provided to the U.S. Senate Finance Committee last week, chronic disease care accounts for 93 percent of all Medicare spending. That figure is really something we cannot ignore, and the ICD-10-CM code set can be a part of a multi-faceted solution.

 

Chronic diseases even have gained bipartisan attention in Washington, D.C. with the Better Care, Lower Cost Act of 2014, which was introduced back in January of this year by Democratic and Republican sponsors in the House and Senate. The bill offers an innovative path for the future of Medicare, and its introduction surely sends a message that ICD-10-CM should be implemented soon – for without the information and the specific clinical data that ICD-10-CM brings forth, we will not be able to achieve better care and lower costs in healthcare. Let’s take this even further with a closer look at chronic diseases and their role in ICD-10.

What are chronic diseases? The Centers for Disease Control and Prevention (CDC) offers the following information and facts:

Chronic diseases are noncommunicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely. Examples of chronic diseases include heart disease, cancer, stroke, diabetes, and arthritis.

  • Chronic diseases cause 7 in 10 deaths each year in the United States.
  • About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness.
  • More than 75 percent of healthcare costs are due to chronic conditions.
  • Approximately one-fourth of persons living with a chronic illness experience significant limitations in daily activities.
  • The percentage of U.S. children and adolescents with a chronic health condition has increased from 1.8 percent in the 1960s to more than 7 percent in 2004.

In addition, the CDC shares these shocking figures about the health (or lack thereof) of our citizenry:

  • Cancer, the nation’s second-leading cause of death, claims more than half a million lives each year.
  • Diabetes is the leading cause of kidney failure, nontraumatic lower extremity amputations, and new cases of blindness each year among U.S. adults ages 20–74.
  • Arthritis, the most common cause of disability, limits activity for 19 million U.S. adults.
  • Obesity has become a major health concern for people of all ages. One in every 3 adults and nearly 1 in every 5 young people ages 6–19 are obese.

The ICD-10 code set is the critical classification system partner for chronic disease data capture. When taking a closer look at chronic conditions such as Alzheimer’s disease, diabetes, neoplasms (cancer), and obesity, we can see how ICD-10 provides detail, specificity, and enhancements to clinical data – all features that are missing today. Keep in mind that some aspects of a disease are very complex, and thus the code set in many cases proves fully capable of capturing complexity through the necessary medical record documentation.

Alzheimer’s Disease:

Within ICD-10-CM the coding of Alzheimer’s disease now should be able to capture and identify the type and onset of the disease through the codes. This includes whether the disease has an early or late onset. The type of Alzheimer’s and various symptoms also will be captured through documentation of any delirium and dementia, with or without behavioral disturbances. The documentation of these components of the disease can help with improving patient care and research, identifying prevention, and finding cure(s).

Some facts from the Alzheimer’s Association’s 2014 Alzheimer’s Disease Facts and Figures (Alzheimer’s & Dementia, Volume 10, Issue 2) include:

  • An estimated 5.2 million Americans of all ages will have Alzheimer’s disease in 2014. This includes an estimated 5 million people ages 65 and older and approximately 200,000 individuals under age 65 who have younger-onset Alzheimer’s.
  • One in nine people ages 65 and older (11 percent) has Alzheimer’s disease.
  • By 2025, the number of people ages 65 and older with Alzheimer’s disease is estimated to reach 7.1 million.

These figures constitute an urgent cry for chronic disease management within our healthcare system. Maintaining the status quo with our current coding classification system is simply not the answer for the clinical data we need; however, ICD-10 offers the big data we need and can use.


 

Diabetes:  

The documentation and coding of diabetes in ICD-10-CM features new and improved guidelines and code options to enhance the capture of disease data. The type of diabetes, the body system affected, and the complications or manifestations affecting each body system are critical data elements needed to better understand this chronic condition. Because of the systemic nature of diabetes, capturing the body system affected will provide the clinical information to achieve better care.

The body systems affected and complications include the following:

  • Circulatory
  • Renal/Kidney
  • Neurologic
  • Ophthalmic
  • Hyperosmolarity
  • Other specific complications
    • Arthropathy
    • Dermatitis
    • Hyperglycemia
    • Hypoglycemia
    • Oral complications
    • Skin ulcer

In addition, some diabetes now are classified as “secondary” to drug and chemical agents, and identifying that within the data is now enhanced under ICD-10, marking an added plus. As you may have heard, diabetes is nearing epidemic volumes in the United States among young and old sufferers alike, so having a robust code set will help with tracking and trending this disease

According to the American Diabetes Association, in 2012 there were 29.1 million Americans, or 9.3 percent of the population, who had diabetes. The percentage of Americans ages 65 and older who suffer from diabetes also remains high at 25.9 percent of that population, or 11.8 million seniors (diagnosed and undiagnosed). This chronic disease will be better treated and addressed once ICD-10 is implemented.

Neoplasm:

Documentation and coding of neoplasms will be enhanced under ICD-10-CM as it pertains to capturing the specific site of the malignancy and laterality (right, left, and bilateral) for paired organs and the extremities. In addition, the capture of morphology occurs in more of the malignancy neoplasms with ICD-10-CM than with ICD-9. Data will become available for several very clinically complex neoplasm conditions as well. 

Updating the code set for clinical practices was one of the goals of ICD-10-CM. Within the Neoplasm chapter there are new categories, reclassifications, use of combination codes, information about histological type and grade, and revised terminology. This is especially true in the classifications for lymphoma and Hodgkin’s, which now contain new terms and descriptions. Another improvement example within the neoplasm classification can be found for melanoma of the skin. Within ICD-10-CM we are able to capture the stage and depth of the lesion, which ICD-9-CM cannot. There is also an expansion of the specific site of the melanoma within ICD-10-CM. Again, the ICD-10-coded data will allow for better healthcare data and better care.

Obesity:

Obesity carries many healthcare risks and also affects other body systems and conditions, commonly being associated with diabetes, respiratory compromise, and cardiac disease. Within ICD-10-CM the classification has been expanded to capture more information about obesity. Specifically, the new code set will capture the underlying cause, be it “drug-induced” or “due to excess calories.” In addition, the ICD-10 code set will also capture the body mass index, or BMI, which allows for the measurement of height and weight compared to the excess of total proportion of body fat.

Given the focus of public health efforts on obesity, surveillance of trends in obesity remains important, especially for childhood obesity. Better data from ICD-10 supports better healthcare and chronic disease management.

Summary:

Chronic diseases affect the young, middle-aged, and the old alike. We all likely know someone or know of someone with a chronic disease. They are far-reaching and delve deep into our public health structure. Evaluation, treatment, prevention, and cures all are tied into the clinical data. That, without any possible argument, is itself a clear reward for having ICD-10 in 2015.

In order to have the best public health surveillance data available across all aspects of our healthcare system – in national, state, tribal, and local public health sources – we need to adopt ICD-10 in 2015. We can not delay ICD-10 any further, if just for the sake of chronic disease sufferers and for public health surveillance alone. We each need to take some ownership to better our healthcare system with better data across the U.S., and that will come from having ICD-10 implemented.

Better care is the calling card for the ICD-10 code set. Everyone, in and out of the healthcare system, needs to advocate strongly to support ICD-10. Chronic diseases are real, the value of the ICD-10 code set is real, and thus 2015 marks an the opportunity to make a big difference.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne is a coding and HIM professional with 40 years of experience. She is the past president of the California Health Information Association. Gloryanne is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.