ICD is a System and Systems are Upgraded

By: Rhonda Butler

Microsoft launched Windows 1.0 in 1985. Then Microsoft launched Windows 2.0 in 1987, Windows 3.0 in 1990, Windows NT in 1993, Windows 95 and Windows 98 in ’95 and ‘98, XP in 2001, Windows Vista in 2006 and Windows 7 in 2009. Microsoft is working on the next version.

The International Classification of Diseases (ICD) system is like an operating system for healthcare administration in the United States. In that sense ICD-9-CM is deeply embedded software: it works in the background, and it enables transactions critical to the functioning of the industry. ICD-9-CM is the primary system used to conduct the flow of money between healthcare providers and payers. ICD-9-CM is the primary statistical vehicle for studies monitoring the health of the population, the cost of healthcare, and the quality of healthcare. It would be difficult to exaggerate how much it is used. Like Windows, ICD-9 is everywhere.

And the ICD-9-CM system is 33 years old. It was released in 1979, six years before Windows 1.0 (in the era of MS-DOS, C:\ and dark screens with fuzzy cathode ray white type). Every year for the past 33 years, ICD-9-CM has been patched but not upgraded, meaning that new codes and their definitions were added, deleted or revised. Just bug fixes and tweaks in existing functionality. Never in its 33-year history has ICD-9-CM been upgraded in the sense of new design and new functionality. The new design, the new functionality is ICD-10. ICD-10 is the next upgrade.

The bare fact that a system so deeply embedded in the functioning of the healthcare industry has not been upgraded for 33 years should be more or less appalling to anyone who hears it. Upgrades normally work something like this: you get an upgrade and you install it. You may grumble, you may delay a bit, but in the end you suck it up and do the upgrade. If you really hate the system, then what you do is switch to another system. What you don’t do is claim that an upgrade is unnecessary forever.

Ripping on Windows is a popular pastime. It is easy for anyone to find something that looks silly or frivolous in Windows and make fun of it. But as much as we grumble about Windows, it is what we have. If there were a practical way to switch to something better sooner we would have done so.

The same is true of ICD-10. It is child’s play to take some individual ICD code out of its context as a statistical classification (in which the rare and obscure are cheek and jowl with the common and well known, or else how could you record everything to an equal level?) and score points by making it sound ludicrous.

ICD is what we have. It is a system of statistical classification used by the nations of world to capture data about the health of their citizens. ICD-10 is the latest in a series of upgrades to the parent ICD system, created by the member nations of the World Health Organization. The World Health Organization releases a new version of the ICD classification on a very modest and predictable schedule, roughly every ten years. ICD-10 has been available since Windows 3.0. How many people do you know who are still using Windows 3.0?