Updated on: September 23, 2013

Tell me again: Why do we need ICD-10?

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Original story posted on: July 3, 2012

More than ever, the burning question remains “Why ICD-10?” It feels like heartburn for most, but the increase in hesitation to adopt this new system appears to be directly related to the announcement of the impending October 2014 delay in the implementation date.

The reason for ICD-10 is more than those frequently stated: “Older data structure” or “We’re running out of space for new codes,” and let’s not forget that ICD-9 hasn’t kept pace with current medical practice. All of these reasons are very true and important, but let’s not overlook reasons like disease management programs, quality outcomes, and device recalls.

To better understand where I am going with this, just ask any primary care physician (PCP) how many asthma patients they have in their practice. They could easily answer that question by searching their ICD-9-CM code files. But then ask, “How many of those have persistent asthma that is moderate or severe?” PCPs have no way to answer that question without doing a retrospective record review or prospectively asking every asthma patient clinically oriented questions.

If the ICD-10-CM system were already in use in this country, a simple computer search for subcategories J45.4- and J45.5- would provide a quick answer. Unfortunately, to date, there is no cure for the disease of asthma, but with ICD-10, asthma patients would benefit from and probably welcome better managing a disease that limits their physical activity. Other chronic diseases could benefit from the same intervention if it were easier to identify the severity of the at-risk patients in the organization, practice, or hospital population.

What about ICD-10-PCS? One of the biggest benefits of the ICD-10-PCS system is the specificity and number of different concepts captured within a single seven-character code. It captures the detailed body part, including left or right, as well as other features of the surgery, such as the approach, the device that remains in place after the procedure, and other unique details, in the qualifier value.

Medical Device Recalls

Let’s look at the case of the multiple device recalls in the last few years that involve all-metal hip prostheses. Two major manufacturers, DePuy and Zimmer, have both had recalls on all-metal devices. In the ICD-9 procedure system, we can track that the patient has had a hip replacement and even the type of bearing surface used in the replacement. Today, your data search would include a two-code combination to explain the procedure. If subsequent revision were performed, the information regarding “all-metal portion” may be misleading. Unfortunately, ICD-9 codes do not detail original placement versus revision, and when they are considered together, data analysis can become rather difficult.

Let’s partner this up with another little-known fact. Kevin J. Bozic, MD, an orthopedic surgeon and vice chairman of orthopedics at the University of California San Francisco Medical Center, was quoted in the August 26, 2010, issue of Arthritis Today as saying, “We happen to be one of the only developed countries in the world that doesn’t track joint replacements through a patient registry.”

It might make you wonder how officials figured out the all-metal hip prostheses were a problem. Sadly, we had to be told by the British! Arthritis Today reports that the British Joint Registry showed that about one in eight, or 12 percent, of those who received these implants needed corrective procedures within five years. Other sources report that a typical joint prosthesis can last between ten and 15 years, depending on the patient’s activity level.

In current practice, tracking of joint prosthesis placement is hit or miss. Some facilities track it through an operating room registry, others through the central supply department, and others only through identification of the prosthesis in the paper or electronic medical record.

It’s hard to believe that we are the only developed country that has not implemented a system directly tied to data management, patient safety, and high quality outcomes. I’m not talking about joint registry, but rather ICD-10. If both ICD-10-CM and ICD-10-PCS were in place, the diagnosis codes for the complications related to prostheses would reveal the exact hip, as well as the specific complication. The procedure codes would tell us the exact hip, as well as the material used on the bearing surface of the prosthesis, and whether it was cemented in place or un-cemented. The simplicity of having one diagnosis code associated with one procedure code is ripe for data mining techniques that can detect issues far easier, and result in better outcomes.

Hopefully this article gives you better insight as to why ICD-10 is so important for us to adopt. In light of the case examples above, your outlook on ICD-10 should be promising, calm your heartburn, and give you hope for a better tomorrow, knowing that data, patient safety, and high quality outcomes are all tied together.

The old adage “You can’t monitor what you can’t measure” has never been truer.

About the Author

Maria T. Bounos, RN, MPM, CPC-H, is the Business Development Manager for Regulatory and Reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.

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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.
Maria Bounos, RN, MPH, CPC-H

Maria T. Bounos, RN, MPM, CPC-H, is the practice lead for coding and reimbursement software solutions for Wolters Kluwer.  Maria began her career at Wolters Kluwer as a product manager, responsible for product development, maintenance, enhancements and business development and now solely focuses on business development.  She has more than twenty years of experience in healthcare including nursing, coding, healthcare consulting, and software solutions.