Academy Member Assisting ICD Code Revisions
Three numbers. A period. Then another number or two. They’re the codes you use every day for classification and billing. Perhaps you find those codes to be frustratingly limited. Academy member Nicolas Walsh, MD, is helping to change those limitations.
Currently, Dr. Walsh is providing input on coding revisions to the World Health Organization (WHO). WHO will use this feedback to revise the International Statistical Classification of Diseases and Related Health Problems (ICD). Countries use the ICD to compile statistics, provide reimbursement, and monitor spending. But current versions like ICD-9 and ICD-10 aren’t always ideal for physiatrists. With PM&R at the table for this set of revisions, Dr. Walsh says ICD-11 will be more usable, both for physiatric practices and for the development of electronic health records.
You can be part of the revisions
WHO is applying Web 2.0 principles for the first time to revise the ICD. The ICD revision process is open to all who register on their site, back their suggestions with evidence from medical literature, and participate in online debate over proposed changes.
Visit the Web application to register and provide suggestions. Once comments have been reviewed, a draft of ICD-11 will be placed on the Web as a wiki for review and joint authorship.
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“I see this as something that’s going to be rather significant in how we’re able to describe both disease and function over the rest of the century,” said Dr. Walsh.
Coding revisions have a long history. Their future is rooted in transparency and worldwide feedback.
ICD history from mortality to Medicare
Classification of causes of death traces its roots to the 17th century. But it wasn’t until 1948 that an international code of diseases was in place, including diseases that weren’t necessarily fatal but could cause disability.
Since passage of the 1988 Medicare Catastrophic Coverage Act, US physicians have been required by law to submit diagnosis codes for Medicare reimbursement. To complete this task, most US physicians currently use ICD-9, a system developed in the 1970s. (WHO published ICD-10 between 1992-1994. It is used by American pathologists and some international physicians.)
“I run the trauma consult service for rehab medicine at a Level 1 trauma center,” Walsh said. “I can code how many times someone gets run over by different vehicles, but for the simple things we use in rehabilitation, ICD-9 is exceedingly limited.”
According to Walsh, the problem lies with revision committees. PM&R had no representative at previous revisions, created primarily by European internal medicine physicians. ICD-11 will be radically different.
A transparent revision process
WHO began revisions for ICD-11 in April 2007. The Japanese Orthopedic Society and the Bone and Joint Decade (BJD) approached WHO with concerns that the ICD was not relevant for musculoskeletal conditions. WHO then created a Musculoskeletal Technical Advisory group to participate in the ICD revision process.
“This is the first time that musculoskeletal has even been recognized as an entity by WHO,” Dr. Walsh said.
Dr. Walsh is the PM&R representative to the group, which also includes four orthopedic surgeons and two rheumatologists. The advisory group has a rehabilitation subcommittee that Walsh chairs. Dr. Walsh offers significant experience. A graduate of the US Air Force Academy, he served two tours of duty in Vietnam as part of the US Navy SEALs team before obtaining his MD at the University of Colorado in 1979. Dr. Walsh was also chairman of the American Board of PM&R and is currently a member of the BJD International Steering Committee.
As part of the revision group, Walsh receives a set of codes to consider. He provides input on revisions related to rehabilitation diagnoses and musculoskeletal functional diagnoses. He and his group are also considering public comments on the codes for the first time before passing their recommendations to WHO’s revision committee.
“That’s a pretty big deal because nobody ever got to take a look at what they would work from for a majority of their career,” Walsh said. “It’s an open invitation from WHO for this input. That, as you can imagine, is a massive step toward being transparent.”
The revised set of codes will include new codes, remove repetition, and provide a more diverse system for describing a disease. ICD-11 will be more like a database, transforming the hierarchical structure of previous versions. ICD-11 will also be correlated with the International Classification of Functioning, Disability, and Health (ICF) that measures health and disability. Walsh says these changes will allow physiatrists to more easily describe their patients’ conditions.
An eye-opening international experience
The first draft of ICD-11 is expected in 2010, with publication around 2014 and implementation after 2015. Walsh said his experiences working for this international purpose have been eye-opening so far.
“Everybody works within the confines of the resources of the country they’re in,” he said. “What I would consider an average hospital room, some countries would consider the highest-end isolation in an intensive care unit for patients with the most contagious diseases.”
Walsh has learned that diseases Americans consider common are non-existent in many other countries, and diseases presented during the 1950s are just now appearing in other countries. Yet the world is rapidly changing. Codes will continue to be revamped to meet the needs of ever-changing populations and practices.
For more information and history related to ICD, visit the WHO Web site at www.who.int.
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