In the 1860s in London, Florence Nightingale, who is credited with establishing modern nursing, may have been the first to propose systematic collection of medical data. As sentiment coalesced around the need for uniform documentation of diseases, ICD-1 was implemented by 1900 to classify causes of death in the United States.
Here we are a century later, grappling with the latest version containing more than 64,000 codes. Despite popular belief, our government did not create the International Classification of Diseases (ICD) to frustrate practitioners and interfere with doctor-patient relationships, although it might do both exceedingly well.
Rather, since 1948 ICD has been updated and disseminated by a distinctly non-U.S.-based organization, the World Health Organization, and more than 100 countries use it. Maybe there are areas outside your neighborhood where it is important to distinguish between being “struck” vs. “crushed” vs. “bitten” by an alligator (Crushed: W58.03XA) vs. by a crocodile (Crushed: W58.13XA). Maybe such variety of reptilian trauma was identified by accidents reported to Bascom Palmer from the nearby Florida Everglades?
In time, payers may use the increased specificity of ICD-10 codes as leverage to dictate medical necessity and deny claims deemed unnecessary in the name of cost-savings.
Despite the ridiculous granularity of some pathologies in ICD-10, there are remarkable deficiencies in others. A single code, H35.31, describes “Nonexudative AMD,” a disease that ophthalmologists have known for decades can range from asymptomatic drusen to debilitating, severe geographic atrophy. Similarly, a single code, H43.82, describes vitreous-macular interface findings ranging from simple vitreomacular adhesion to severe vitreomacular traction.
There is hope that more specific coding will translate into improved patient outcomes. ICD-10 reduces the need for codes such as “unspecified” or “not elsewhere classified.” More specific data may bring about a deeper understanding of diseases and inform clinical practice—more promises of Big Data that collaborative endeavors such as the American Academy of Ophthalmology IRIS Registry may fulfill.
Not yet comfortable with ICD-10? Don’t worry. You have at least two years to figure it out before the WHO presents the ICD-11 code set, currently slated for 2018.