Pain in limb 729.5 doesn't cut it in ICD-10

By Bernie Monegain
12:50 AM

Virtually all technologies and processes in a hospital will be affected by the conversion of the nation's disease code sets from ICD-9 to ICD-10, Cynthia Grant, director of Courtyard Group, told a roomful of anxious CIOs. "If you think this will be a software update, think again," she said.

Oct. 1, 2013, is the drop-dead deadline. All care providers and payers will have to adopt the ICD-10 coding.

"It's a pretty dramatic thing that's going to happen on that date," Grant said.

The International Classification of Disease code system is used for billing and clinical classifications. The number of codes will jump from about 17,000 today to 150,000 with ICD-10. The difference between ICD-9 and ICD-10 is "like apples and beefsteak," Grant said. "I can't even compare it to another fruit.

Proponents of ICD-10, such as AHIMA and the American Hospital Association, say the new codes will bring the healthcare system into the 21st Century. It will also replace an ICD-9 code set that is broken, they say, because:

  • It lacks sufficient specificity and detail
  • It is running out of space, and the limited structural design cannot accommodate advances in medicine and medical technology and the growing need for quality data,
  • It is obsolete and no longer reflects current knowledge of disease processes, contemporary medical terminology, or the modern practice of medicine,
  • It hampers the ability to compare costs and outcomes of different medical technologies, and
  • It cannot support the transition to an interoperable health data exchange in the United States.

Moreover, as Grant reminded her audience, most every other country in the world made the switch long ago – the UK in 1995, France in 1996, Australia in 1998 and Canada in 2004

"Other countries are saying, 'Why are they doing that now?'" Grant said.

In the United States, it's long overdue. The conversion is has been postponed, most payers and providers will say until it can be postponed no longer.

Though most other countries are looking to ICD-11 already, there's no skipping straight to ICD-11 for the United States.

"You have to go to 10 anyway," said Grant, because 11 is an upgrade.

Grant has led several projects for Courtyard Group, a Canadian consulting firm. Today, she is leading US based initiatives in the area of Health Information Management - ICD-10 implementation. Her background is in health information management and coding. She said she would never forget the code for pneumonia - 486.0.

But, ICD-10 changes everything. A pain in the limb, 729.5, is no longer just a pain in the limb. In ICD-10, there are more than 30 code choices.

"You need to know where the pain the limb is," Grant said, "and also whether it's on the left or the right.

There's a code for that.

If you're simply coding pain in the limb, unspecified, "you could be leaving money on the table."

Grant offered a few reasons for converting to ICD-10 codes:

  • It allows for better patient care;
  • It allows for better quality outcomes;
  • The data set will be richer and lead to more informed decisions.

On the downside, Grant said, Canadian data show that the productivity in Canada after conversion from ICD-9 to ICD-10 never rebounded to pre-ICD-10 levels. More granularity takes more time.

Just how much more time, of course, depends on the size and complexity of the hospital.

Grant offered some final words: Just as it's critical to educate the coding staff, it's just as important – perhaps even more so – to make sure that physicians are trained, too.

"They don't need to become coders," Grant said, but the information needs to be available to the HIM coder.
"You can't code what isn't charted."