Daniel Essin has trouble seeing how useful ICD-10 codes would be to his practice.
After trolling through all the granularity, he concludes, "From a clinical perspective, it doesn't look like ICD-10 codes are going to be of any more use than the ICD-9s, maybe less." He then suggests that health insurers will be able to reduce reimbursements since they're not allowed to deny coverage because of pre-existing conditions.
Of course I agree with Essin. Insurers are in the statistics business. All the specific data generated by ICD-10 coding is going to help healthcare payers make more money. But I see that as an argument for ICD-10 implementation. Because providers need to develop data analysis skills too.
[See also: Data Mining: The best argument for ICD-10 implementation]
But what really bothers me is that Essin seems to be struck by whimsy. He lists several diagnoses involving patients being struck by objects listed in previous news accounts of why healthcare professionals believe ICD-10 is too specific. He then dismisses the granularity, "There are, however, no codes for being struck by a falling tree or by one's spouse."
Too bad Essin is just a contributor to Physicians Practice and not a reader. On April 11, Bob Keaveney quotes Bill Rudman, AHIMA's vice president for education and the editor of its research journal, about how ICD-10 codes capture domestic violence:
"Domestic violence researchers, for example, have been stymied by the lack of information available to them in medical records. Of the tens of millions of medical records generated in the United States each year, said Rudman, no more than 1,200 or so contain domestic violence codes, even though a quarter of women are believed to be victims of domestic violence at least once in their lives. The reason: the current code set doesn't allow for suspected incidents of domestic violence, only confirmable ones, and few such incidents can be confirmed at the initial point of care."
"But ICD-10 contains codes for suspected cases of domestic violence. 'So now we'll be able to see when the nurse or the physician first suspects domestic violence, all the way to the point where it is actually confirmed,' Rudman said, which will allow researchers to gain clearer insight into domestic abuse patterns with record reviews."
The presentation "Implications of ICD-10 in Identifying Family Violence" by Bill Rudman, PhD, Felicia Cohen, PhD; Valarie Watzlaf, PhD; and Susan Hart-Hester, PhD, examines how ICD-10 is better at identifying victims than ICD-9 codes.
Here are the ICD-10 codes for domestic violence diagnoses:
- T74.01xA - T74.02xS: Neglect or abandonment, confirmed
- T74.11xA - T74.12xS: Physical abuse, confirmed
- T74.21xA - T74.22xS: Sexual abuse, confirmed
- T74.31xA - T74.32xS: Psychological abuse, confirmed
- T74.4xxA - T74.4xxS: Shaken infant syndrome
- T74.91xA - T74.92xS: Unspecified maltreatment, confirmed
Those are fine. But what's really important are the ICD-10 codes that can be used when domestic violence is suspected:
- T76.01xA - T76.02xS: Neglect or abandonment, suspected
- T76.11xA - T76.12xS: Physical abuse, suspected
- T76.21xA - T76.22xS: Sexual abuse, suspected
- T76.31xA - T76.32xS: Psychological abuse, suspected
- T76.91xA - T76.92xS: Unspecified maltreatment, suspected
This is important. How many married women have gotten black eyes from walking into a door? This will help researchers gain insight into domestic violence when the victims lie about the true cause of injuries. I'm willing to bet that a lot "Walked into lampost" diagnoses (W22.02xA) are paired with the ICD-10 code T76.11xA.
Maybe Essin doesn't suspect a lot of domestic violence in his practice. Which would explain why he doesn't feel a need to research the proper ICD coding. I will give him the benefit of the doubt. But he does say he sees a lot of latent tuberculosis infection (LTBI). And he knows the ICD-9 code is 795.5. Which puzzles me why he doesn't think he will be able to use ICD-10 code R76.1 (Abnormal reaction to tuberculin test).
Note, I'm not a doctor so it is possible I don't understand how latent tuberculosis is diagnosed. Someone like Essin should be able to explain why the ICD-10 code is inadequate. I'm sure a lot of ICD-10 codes fall short.
It's one thing to base anti-ICD-10 arguments on comical citations of incredibly specific diagnoses. I find it hard to tell if ICD-10 opponents are engaged in debate or auditions at the local comedy club. It's another thing to follow up trite examples with ignorance.
Carl Natale blogs regularly at ICD10Watch.com.