ICD

The International Statistical Classification of Diseases (ICD) is a set of codes from the Unified Medical Language System (UMLS). ICD is used to classify diseases, symptoms, and other health problems.

Introduction

The International Statistical Classification of Diseases (ICD) is published by the World Health Organization (WHO). ICD-9 has been used in the United States since 1977 for reporting statistics and billing to Medicare, Medicaid, and insurance companies.(1) The code set was developed before computers were widely used to process medical data aside from billing, indexing, and statistics. The World Health Organization has since published a revised set of codes called ICD-10 in 1992. The new scheme allows for 155,000 unique codes as opposed to the 17,000 of ICD-9-CM.

History and Background

The first coding system was developed in 1893 in France by a physician, Jacques Bertillon. The system was called International List of Causes of Death (ILCD) or the Bertillon Classification of Causes of Death at that time. Its primary purpose was to compile mortality statistics [1]. The WHO became custodian of ICD in 1948 and adopted the ILCD, which was expanded to include morbidity coding. Hence, with the Sixth Revision in 1948, the ILCD evolved as means to code diseases for more than just cause of death. From then onwards, it was called the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD) [1].

Benefits

ICD-10 allows for greater granularity and specificity of reporting data. In addition, the system solves many of the problems of ICD-9, most notably the problem of expandability. Previously, newly classified diseases and procedures were simply added to the end of the current list of codes. In 1998, the National Center for Health Statistics released a modification of ICD-10 for the reporting of morbidity data and thus began the process of converting U.S. government departments to the new code set.(2) In 2008, CMS announced that all diagnosis data for claims processing would have to use ICD-10 beginning in October 2011.

Implementation

The proposed implementation is being met with resistance by U.S. providers and insurers due to the cost of implementation and increased administrative complexity. One estimate puts the cost at $285,000 for a 10-physician practice over the 3-year implementation period between 2008 and 2011.(3) Although HHS's goal is to reduce improper or inaccurate charges, the transition is expected to result in two-to-threefold increases in rejected claims in the short-term. Some believe the timeframe for the changeover is unworkable, although the legislation by Congress in 2006 proposed the change be completed by 2009.(4)

In a letter sent to HHS Secretary Sylvia Mathews Burwell, former WEDI Chair Jim Daley wrote, "Unless all industry segments make a dedicated effort to continue to move forward with their implementation efforts, there will be significant disruption on Oct. 1, 2015" (Healthcare IT News, 4/6) This new system is a vast departure from what physicians and coders are used to and will require the most amount of training for hospitals to become compliant with accurate PCS reporting. Providers and staff must learn the new terminology and definitions that come with the 31 root operations, words that have often been used to describe one thing will now be used for another. (Zeissert and Bowman, 2010) For example, the root operation “resection” is defined as “cutting off or out, without replacement, all of a body part”. In the current medical vernacular, the term “resection” is often used to describe cutting either an entire body part or a portion. This will obviously become important when coding in ICD-10-PCS.

Implementation Delay

Much has been discussed about the financial impact on hospital and physicians to get ready for the implementation of ICD-10-CM/PCS as well as the potential savings that might be realized down the road. The AMA has vigorously fought against the October 1, 2013 implementation deadline and wrote a letter to the Acting Secretary of Health and Human Services, Kathleen Sebelius, asking that the deadline be rolled back and/or the transition to ICD-10 be foregone altogether. (Madera 2012) In a move that surprised many HIM professionals, HHS proposed a final rule to extend the implementation date to October 1, 2014. (CMS 2012) While this may delay some costs for some physicians, most larger facilities and health insurance companies have already invested millions of dollars in infrastructure and training to prepare for the original date. This year delay could actually cause a loss for those that now have to retrain or invest in additional spending to support software contracts for services related to ICD-10 that they will not use for another year.

References

1. Top Health Inf Manage. 2001 Feb;21(3):54-88. Zeissert A, Bowman S. Pocket Guide of ICD-10-CM and ICD-10-PCS. Chicago, American Health Information Management Association, 2010.
2. Madera J. [internet] Letter to HHS, February 2, 2012. [cited May 31, 2012]. [1]
3. CMS Office of Public Affairs. [internet] HHS proposes one year delay of ICD-10 compliance date. [cited May 31, 2012] CMS.gov, 2012. [2]