More than ever the burning question remains, “Why ICD-10?” It feels like “heartburn” for most but the increase in hesitancy 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 the frequently-stated reasons: “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 forget about the 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 was 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 was 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 the number of different concepts captured within a single, seven-character code. It captures the detailed body part, including left and right, as well as other features of the surgery, such as the approach, the device that remains after the procedures and other unique details in the qualifier value.
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 (2) code combination to explain the procedure. If subsequent revision was performed, the information regarding “all-metal portion” may be misleading. Unfortunately, ICD-9 codes do not detail original placement versus revision and when 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 they figured out that 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 1 in 8, or 12 percent, of those who received these implants needed corrective procedures within 5 years. Other sources report that a typical joint prosthesis can last between 10 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 this 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 that is directly tied to data management, patient safety and high quality outcomes. I’m not talking 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 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, subside 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 that says ‘You can’t monitor what you can’t measure’ has never been truer.