Opinion: Are ICD codes really necessary?

After much angst and several delays, the healthcare industry recently completed the ICD-10 transition. In fact, despite last-minute pleas to delay the update again, we now have roughly one full quarter of working with ICD-10 behind us.

The good news is U.S. healthcare did not experience any major disruptions once the October 1, 2015 deadline passed. Sure, there were some glitches, but that happens any time something new is introduced.

Now for what some might consider the bad news. The U.S. was so woefully behind in moving to ICD-10 that ICD-11 is already on the horizon. In fact, the World Health Organization (WHO) is already looking for beta participants, with the final revision currently due in 2018. 

Not to worry. If history has shown us anything it will still be several years before U.S. healthcare providers and payers are expected to move to the new standard. After all, the WHO completed its work on ICD-10 in 1992, and the U.S. clinical modification (ICD-10-CM) was available beginning in 1999.

The bigger question, though, is whether we even need ICD for claims anymore. To answer that question we must first look at its history.

How we got here

The original intent of ICD coding was to monitor diseases throughout the world. Introducing a standardized classification for those diseases made it easier to build statistical models, especially in the precomputer days when all patient data was contained in paper records. The first classification was published in 1893; in 1946 the WHO took over administration of ICD codes.

Note that nowhere in that history does it mention using ICD codes to pay insurance claims. That came later, as several countries realized that having a ready-made system of classification for healthcare procedures would provide a good structure for all of the data being gathered from healthcare providers.

Rather than having to read through individual charts or notes, submitting claims based on ICD codes would greatly expedite claims review. This meant payers could reduce their administrative burden and providers could get paid faster.

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