ICD-10—Out with the Old

Disclaimer: Everyone is just getting back from the holiday or still in “holiday mode” and I am feeling a bit holiday myself. So dear reader if you are not in the mood for “lite” reading, don’t bother with this blog. Get off your computer and go do something fun for three minutes instead—it’s on me!

When we talk about the benefits of ICD-10, we usually talk about additional detail that has been added to the system. I have discussed it in many previous blogs, including my most recent one . But there is another benefit to moving into a new classification system and out of the old. Just as when you move to a new house, you get the chance to get rid of old stuff you don’t use anymore.

Think of the last time you moved to a new place. What happened? After ten years in your house all the closets were so full your kids were complaining there was no place to hide. When you put things in the basement storeroom you didn’t even turn on the light anymore, just opened the door, tossed it in and shut the door again—quick. And needless to say, your cars lived outdoors on the driveway, where they stared longingly at the garage.

So now that you are moving, you will take the time to sort through your closets, your storeroom, your garage, your drawers and cabinets. (For a fabulous treatment of cubbyholes and classification, see Ron Mills’ recent blog series on the subject.) If you don’t, you have to find somewhere to put it in the new house. Throwing the old stuff out is work, but you know you’ll be glad you did it when you get to the new place.

Moving to a new classification system provided even more motivation for the people who developed ICD-10-CM. They couldn’t clean house while ICD-9-CM was in use. Once something is in the classification it is virtually impossible to take it back out. So moving to a new version was their only real chance to get rid of old terminology lurking in the index and embedded in the codebook.

While I was doing some ICD-10 conversion work recently, I came across terms in the ICD-9 index that are not in the ICD-10-CM index. My first thought was, “Holy cow, how did that ever get in there!?” My second thought was, “This system is old.” My third thought was, “Good for them, they took the time to do some housecleaning before moving to the new digs.” Here are a few relics I found hiding in the ICD-9 basement. None of them survived the move to ICD-10.

Ondine’s curse – According to Wikipedia, the term refers to the myth of Ondine, a water nymph whose human lover was unfaithful. Though he swore that his “every waking breath would be a testimony of love,” she caught him in the act and as angry water nymphs with a flair for poetic justice will do, she cursed him so if he fell asleep, he would forget to breathe. Since promiscuity can be exhausting, you know how this story ends.

21st century physicians are less indulgent in their use of myth when they describe their patients. They call this condition congenital central hypoventilation syndrome (CCHS). It is a very serious congenital respiratory disorder, fatal if untreated.

In ICD-9, Ondine’s curse is indexed to the worse than useless code 348.89 Other conditions of brain. Both ICD-9 and ICD-10 have a specific code for CCHS. I suspect that when the new code was added to the system, the Ondine’s curse reference was left in the basement, in the dark. Probably a good idea.

Humpback, Hunchback—I don’t usually get exercised about political correctness, but these terms needed to go. In ICD-9, both terms are indexed to two different codes, depending on whether hunchback or humpback is congenital or acquired. Good riddance. We are not surprised when children blurt out the cruel things we are all thinking, but we don’t expect it as an officially sanctioned feature of the health care system. (I looked for “Quasimodo’s curse,” but it wasn’t in ICD-9.)

Video display tube syndrome—This term was indexed to a non-specific ICD-9 neck diagnosis code. One can just imagine when this entry was added—in the heady days of the new computer workplace, and long before ergonomics training became a standard part of new employee orientation. I would love to know how much the addition of this term to the index cost Worker’s Comp.

These few tidbits of old stuff from the ICD-9 basement are the house-moving equivalent of the combination video player and popcorn maker from the brother who orders gifts from in-flight magazines—the kind of thing you don’t want your new neighbors to see you carry in the front door.

Rhonda Butler is a Senior Clinical Research Analyst with 3M Health Information Systems.

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