Dec15

ICD-10-CM: Too many or not enough?

PCP vs Specialist use of ICD-9-CM codes

A recent study published in American Family Physician (and reported on Medscape, at this link: http://www.medscape.com/viewarticle/836049) says that primary care physicians (PCPs) use more ICD-9-CM codes than specialists, and then concludes that this shows how much more complex primary care is, and therefore that PCP pay should be increased. Specifically, the article says that PCPs use about 23 codes to account for 50% of the care they provide while specialists use only six, and some specialties use even fewer. 

The argument about pay is something I'm not qualified to comment on, but I was very interested in the data about use of codes. As the US approaches its deadline to switch from ICD-9-CM to ICD-10-CM, the complexity of codes used for billing is once again a hot topic. Should providers support the switch? These data point out why it's an issue. Of course providers want better access to patient data, and of course they want the ability to coordinate care with other provders. However, it seems clear to me that if you're only using 23 (or six, or only three if you're a psychiatrist) codes for half your services, those codes probably aren't telling a very useful clinical story. Moving to ICD-10 will increase the granularity of coding somewhat, but will still fall short of the kind of detailed coded record-keeping that will be needed to enable the next generation of population health measurement and electronic decision support. So, even the most tech-happy providers looking at ICD-10-CM may see increased work without obvious clinical value.

As a terminologist focuing on accelerating eHealth through the use of coded data, more data is always better, and so I'd rather see ICD-10-CM coding than ICD-9-CM. But, I do sympathize with the naysayers who don't find any compelling value... I'd be a whole lot happier if we could start coding and sharing records using full-blown clinical terminologies like SNOMED CT, LOINC, and RxNorm. 

What do you think? Is ICD-10-CM a good place for the US to go, a step in the right direction, or a giant waste of time and energy?

About the Author

John Carter