Elevating to ICD-10: It may be a great fit for healthcare

December 1, 2007

The World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) will bring "the good, the bad, and the ugly" for nearly all who use this classification system. However, the biggest asset is that the latest version is much more detailed and organized than ICD-9.

ALTHOUGH MOST ANALYSTS would be hard-pressed to equate the World Health Organization's latest version of the International Classification of Diseases and Related Health Problems (ICD) with a 1966 Clint Eastwood movie, there will indeed be "the good, the bad, and the ugly" for nearly everyone who moves forward with this classification system. And, like the sly gunslinger in those spaghetti westerns, intelligence and speed will differentiate industry participants who successfully scale up from ICD-9 to ICD-10.

The ICD has become the international standard diagnostic classification for all general epidemiological and many health-management purposes. These include the analysis of the general health situation of population groups and monitoring of the incidence and prevalence of diseases and health problems in relation to other variables, such as the characteristics and circumstances of the individuals affected.

It is used to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and hospital records. In addition to enabling the storage and retrieval of diagnostic information for clinical and epidemiological purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by World Health Organization (WHO) member states.

As of yet, there has not been a mandate for government programs, though that time might come soon. In 2006, the House and Senate passed separate bills that would have mandated an ICD-10 conversion deadline. Attempts to reach a compromise were unsuccessful, so the issue remains unresolved, but the debates seem to indicate that lawmakers understand the need for ICD-10 conversion. In February, Senator Norm Coleman (R.-Minn.) introduced a new bill, the Critical Access to Health Information Technology Act of 2007, which is in the first step in the legislative process.

While the exact details have yet to materialize, the U.S. government knows that, as the biggest national healthcare payer, the change to ICD-10 presents a significant challenge. While healthcare does not need another IT panic, it's possible that the fear generated by other conversions, such as Y2K, actually contributed to its success.

THE GOOD

If no problem can be solved until it is reduced to its simplest form, ICD-10 is one of the best things ever to happen in healthcare. Its biggest asset is that it is much more detailed and more organized than ICD-9.

The structure of ICD-9 has been expanded to include two additional characters moving to ICD-10-CM. While the three-character parent code structure still exists, the sections have all been revised and thus given new parent code values. With the expansion to seven characters, much greater specificity is possible, such as the ability to identify right limb versus left limb simply by choosing a different seventh character value.

ICD-10-PCS, the procedure coding system, has a seven-character alphanumeric code structure. Each character contains up to 34 possible values. Each value represents a specific option for the general character definition (e.g., stomach is one of the values for body part). Procedures are divided into sections that identify the general type of procedure (e.g., medical and surgical, obstetrics, imaging). ICD-10-PCS codes can be deconstructed at several levels:

To put it in purely quantitative terms, ICD-9 offers approximately 20,000 diagnosis codes; ICD-10-CM features about 70,000. Likewise, ICD-9 features 3,800 procedural codes, whereas ICD-10-PCS has nearly 90,000. That increased level of specificity clarifies diagnostic coding on the front end and can result in more accurate categorization and risk and severity adjustments.