Poor ICD-10, it has such an image problem. It needs a good makeover, someone who would be willing to conduct a serious spin campaign against all these silly accusations against it.
I am tempted to take it on, but I am frankly tired of the whole thing and could not pursue it with any gusto. It would be spectacular if some physician somewhere would take up the ICD-10 image problem as a fun cause. Think of it: an ICD-10 spin doctor doctor. Definitely too cool to happen.
If anyone else out there is interested in the job, here is an ICD-10 spin doctor starter kit, consisting of three popular accusations against ICD-10, followed by three counteroffensive positions an ICD-10 spin doctor could use.
Spin: ICD-10 contains 140,000 codes (therefore too many for the industry to deal with) and ICD-9 only has 20,000 codes
Counterspin: Without their seventh character “modifiers,” there are 33,365 ICD-10 diagnosis codes. If you make left, right, bilateral, and unspecified a modifier in ICD-10-CM (as it is in CPT) the number drops to roughly 20,000.
As for ICD-10 procedure codes, they consist of 3,121 unique concepts combined as needed in table format. Counting each element in the procedure code tables as a separate code is like taking the multiplication tables from 1 to 1000 and saying, “OMG, there are a million possible combinations, how will we even cope?”
So, dear rational reader, which set of numbers is more accurate? Are there 140,000 codes in ICD-10 or are there 23,000?
Spin: ICD-10 is seven characters long (therefore needlessly complex and difficult)
Counterspin: CPT codes are nine characters long. CPT modifiers are two characters each, they are required for payment, and two modifiers are often needed. A series of complex rules that can differ for every payer dictates which modifier must be used and when.
ICD-10-CM seventh character extensions are the “modifiers” of the diagnosis code set. ICD-10-CM seventh character extensions are much easier to understand and use than CPT modifiers, since they are explicitly added to the system as an integral part of every code to which they apply. This creates a unique code for every base code that uses the modifier. Woohoo. (If you really want to do your homework, you could come up with a valid estimate of how many CPT codes there would be, if it were designed with the modifiers pre-applied in all appropriate combinations, like ICD-10-CM.) ICD-10-CM could have called the seventh character extensions modifiers, and not applied them where they belong as unique codes, so the total number of codes would be much smaller, but gosh, that would be spinning the truth, wouldn’t it?
Spin: ICD-10 contains nonsense codes for being bitten by parrots and burned by flaming skis
Counterspin: Nonsense happens when you multiply a piece of information consistently across an axis of classification. ICD-9 codes contain such nonsense as a diagnosis of tuberculosis that was confirmed by inoculating an animal (I’m so sorry, but the rabbit started coughing up blood this morning, so you do have TB after all). There is an ICD-9 procedure code for stripping varicose veins in the brain.
Nonsense also happens when you introduce new codes before their time, for experimental procedures. ICD-9 contains a procedure code for implantation of mechanical kidney. It also includes replacement of the mechanical kidney, in case the first one wears out. This code has been in the codebook for years. There is no mechanical kidney on the market, although a room-sized prototype “shows promise.”
Is it a problem that there are codes in all code sets that are rarely used, or not at all? Is it a problem that 83×42 in the multiplication table isn’t used as much as 7×3?
I offer this blog in the spirit of fun. After all, in the face of such goings on, laughing seems like the most appropriate response. Feel free to take it for a spin.