Friday, March 28, 2014

Does the ICD 10 have the Metric Curse?

Headlines on all the health care outlets yesterday (3/27/2014): 

Bill also delays ICD-10, two-midnight rule and RAC audits

According to the article: “The House of Representatives on Thursday approved a temporary fix to the sustainable growth rate (SGR) for one year in a bill that also delays ICD-10 implementation until at least October 2015 and postpones hospital compliance with the controversial "two-midnight rule" and recovery audits of medically unnecessary claims until March 2015.

While several items were approved, the excitement was due to yet another delay for the ICD-10. In 1996, the new HIPAA law mandated the acceptance of the ICD 10, and much like the poor metric system, it has been delayed and delayed in its implementation.

Why has it been delayed? Cost and complexity:

There are significant differences between ICD-9, what is used now and ICD-10, what is currently used in 25 countries, which this table demonstrates:
3-5 characters in length
3-7 characters in length
Approximately 13,000 codes
Approximately 68,000 available codes
First digit may be alpha (E or V) or numeric;
digits 2-5 are numeric
Digit 1 is alpha; digits 2 and 3 are numeric;
digits 4-7 are alpha or numeric
Limited space for adding new codes
Flexible for adding new codes
Lacks detail
Very specific
Lacks laterality

Has laterality (i.e., codes identifying right vs.

What has the medical community so upset about adopting the ICD-10: moving from around 13,000 codes to 68,000 codes. Why such an increase? Because in the ICD-10 the code tells a story. Instead of a code that says “Fracture”, the new code says “Fracture, left foot, first incident, middle toe, while a passenger in a car in a car crash”. In fact, the codes are so complex, they are unintentionally funny. Here are a few real codes:
T63.442S Toxic effect of venom of bees, intentional self-harm, sequela

W56.22xA Struck by orca, initial encounter

Z73.4 Inadequate social skills, not elsewhere classified

V91.07xD Burn due to water-skis on fire, subsequent encounter

And then there is the cost. I have already had some webinars on the glory that is ICD-10, and it is recommended to the physicians that they obtain a line of credit to keep their businesses open during the transition, as the new codes will cause delay in payments. In fact, on the CMS Website, a handout for physicians states, “Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of superbills, trainings, and related expenses.” Great, a new unfunded federal mandate, but at least this time they are stating it will be costly to transition.

Needless to say, the medical community is doing cartwheels over a possible delay. (The first question on a CMS ICD-10 webinar I attended at the beginning of March “Is there going to be a delay?” The answer was "no"). Let’s all hope that the Curse of the Metric System continues to plague the ICD-10 or the next time you go to the doctor your code could be “Headache before sex, subsequent occurrence, would rather read “10 Shades of Gray”, or at the least take a long hot bath, sheesh…”

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