August 21, 2012

ICD What?

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ICD-10 is coming! ICD-10 is coming! (With apologies to Paul Revere and his fans…)

Unless you’ve been living under a rock, or just started working in healthcare last week, or just didn’t care one way or the other, you know about ICD-10 and all the change – both good and bad – it represents.

Likewise, if you work in healthcare, or the mortuary business, or in a county coroner’s office, then you also know about ICD-9.

And be assured, it takes someone special (that is, someone as “experienced” as I) to have any experience with ICD-8, which was used from 1968 to 1978 (almost exactly the period of time in which I worked in clinical laboratories).

All that first-person experience completely evaporates if you go way back to the beginning, yet it could be argued that we should know how it all began if we truly are to appreciate ICD-10. Remember, though, that in the beginning ICD only was used to classify deaths, not diseases, conditions or treatments. And so, I have it on good authority that the following was the entire ICD-0 (1870-1899) code set:

  • 01: Died of natural causes (meaning we have no idea what happened)
  • 02: Died in a fight (man, bear or alligator)
  • 03: Died while hunting/fishing/drinking
  • 04: Died while receiving the very best medical care (Dr. Stoner’s Elixir of Youth and leeches)
  • 05: Died of buffalo/horse trampling, initial or subsequent
  • 06: Died while riding in one of them newfangled horseless carriages, or behind an “iron horse”
  • 07: Died of boredom… it IS 1870, after all…
  • 08: Died ‘cause she promised to “love, honor and obey ‘til death do us part,” and he just got tired of it all
  • 09: Died in a freak accident (but not at a circus)
  • 10: Didn’t die, but we thought he might have, at least until he sobered up…
  • 11: Actually died, but we didn’t know it until we sobered up
  • 12: Would have died, had it been up to me…
  • 13: Don’t ever use this one … bad luck, don’t you know.

It particularly interests me that a system designed to compile death statistics has evolved into a mega-system like ICD-10. I mean, consider the following examples:

  • R46.1 = “bizarre personal appearance” (Hey Ruthie, here comes an R46.1, don’t look at him…)
  • W22.02XA = “walked into lamppost, initial encounter” (I dunno doc, it just kinda jumped out in front of me…)
  • W22.02XD = “walked into lamppost, subsequent encounter” (…again.)
  • V91.07XA = “burn due to water skis on fire” (Well, I TOLD you it was hot water!)
  • V9543XD = “spacecraft collision injuring occupant, subsequent encounter” (And you said lightning and spacecraft never strike twice…)

Well, you get the idea. The fact is, with 300 million or so people in the country, these are things that might happen, and the whole purpose of ICD-10 is to increase the accuracy of accumulated data. I would argue that it’s not that difficult to count the number of people, nationally, who become involved in a “subsequent” spacecraft collision, but who am I but a sideline observer?

Finally, there is one very real but as yet perhaps unheralded advantage to the ICD versions. Here’s a chart of the time frames for all of them (as used by mortuaries, but not necessarily hospitals):

  • ICD-1 1900-1909
  • ICD-2 1910-1920
  • ICD-3 1921-1929
  • ICD-4 1930-1938
  • ICD-5 1939-1948
  • ICD-6 1949-1957
  • ICD-7 1958-1967
  • ICD-8 1968-1978
  • ICD-9 1979-1998
  • ICD-10 1999-

Now this becomes like an astrological sign!

(Scene in a bar)

Man: “Well hi there. Come here often? I haven’t seen you before, and I come here often. I’m an Aquarius and an ICD-7. You?”

Woman: “I’m an ICD-9 and you’re drunk and disgusting.”

Man: “Noted.”

The mind boggles at the possibilities, don’t you think?

Until next time…

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.