Monday, January 26, 2009

Final ICD-10-CM rule likely on hold for review

The Obama administration has held for review all rules that either have not been published or have not yet taken legal effect. The latter condition applies to the final ICD-10-CM rule, because it does not take effect till March 17.

It's a long shot, but perhaps the review will lead the Obama administration to realize what a mistake the ICD-10-CM switch is.

Tuesday, January 20, 2009

The 318 ICD-10-CM codes for diabetes mellitus

In a previous post, we pointed out that despite the fact that there are very few known subtypes of diabetes mellitus, ICD-10-CM has approximately 290 codes for diabetes mellitus, not counting gestational diabetes mellitus.

In the 2009 release of ICD-10-CM, we count a total of 318 codes for diabetes mellitus, including gestational diabetes mellitus. The reason for the large number of codes is that ICD-10-CM combines multiple disease classes into a single code.

For example, the ICD-10-CM code E11.621 Type 2 diabetes mellitus with foot ulcer, contains two disease classes: diabetes mellitus and foot ulcer. For sure, this code implicitly means that the former caused the latter (note that this causal relationship is inaccessible to the computer), but that augments our point. Nothing is its own cause and thus these two diseases are distinct.

We provide here on Google docs the 318 codes and their text strings, in a spreadsheet format that anyone can at least copy-and-paste into their own spreadsheet or database table. An easy way to demonstrate the needless complexity caused by combination codes.

Sunday, January 18, 2009

Myth: SNOMED CT has more disease codes than ICD-10-CM

Because SNOMED CT is a reference terminology, and ICD-10-CM a disease classification, one might think that SNOMED CT would have more disease codes because it reaches a higher level of diagnostic precision (what the ICD-10-CM proponents ambiguously refer to as "specificity") than ICD-10-CM.

One would be wrong, however. We already busted this myth in a previous post, but we give it its own post to highlight the absurdity that is ICD-10-CM.

Per the final rule (warning: pdf) to adopt ICD-10-CM, ICD-10-CM has approximately 68,000 codes. SNOMED CT (the July, 2008 version), by contrast, has 63,731 active disease codes.

ICD-10-CM therefore has approximately 7% MORE disease codes than SNOMED CT. Assuming of course, that ICD-10-CM contains only codes for diseases, which it doesn't. It has codes for lots of other things, like symptoms of disease. If there were any way to count automatically how many ICD-10-CM codes represented diseases as opposed to something else, it would be possible to do an actual apples-to-apples comparison.

But, since ICD-10-CM says it classifies diseases (and not other things) and gives no way to infer automatically (i.e., by computer) whether it classifies other things than disease, we feel justified in making this comparison. It highlights another absurdity of ICD-10-CM: it isn't (entirely) what it says it is.

Friday, January 16, 2009

It's final: ICD-10-CM by Oct 1, 2013

The Department of Health and Human Services issued today a final rule (warning: pdf) mandating the adoption of ICD-10-CM as a code set under the Health Insurance Portability and Accountability Act (HIPAA). It pushed back the deadline from Oct 1, 2011 (from its proposed rule last August) to Oct 1, 2013.

At approximately the same time, the National Center for Health Statistics released a new, 2009 version of ICD-10-CM that is available here. Instead of the 23MB, 2,392 page PDF file of the 2007 format, we now have an 8.8MB, 2,369 page PDF file. A trimming of 1% on the page count, and a shrinking of over 50% in file size.

The health care industry now has a little more than 4.5 years to find every usage of ICD-9-CM codes in all of its systems, and upgrade and test them to use ICD-10-CM. All the effort spent on that, will not be spent on adopting electronic medical records, devising and participating in pay for performance programs, improving patient safety, automating the reporting of notifiable diseases, chronic disease management, quality initiatives, adopting other information technology standards for true interoperability, and the list goes on.

ICD-10-CM fails every basic requirement demanded of modern technology, terminology, and ontology, and yet it--and previously ICD-9-CM which also fails to meet these requirements--are the only code sets the government has mandated the industry adopt en masse. We suppose it's not surprising coming from a government bureaucracy. But it still is senseless.