Monday, April 13, 2009

ICD-10-CM cannot save the personal health record

In a Boston Globe article, several so-called experts obtusely suggest that the switch to ICD-10-CM will improve the quality of data in personal health records.

First, we must briefly say what is a personal health record (PHR). Then, we will recap the Globe story. Finally, we will illustrate that the use of ICD-10-CM in place of ICD-9-CM could not have helped the gentleman in the story.

Wikipedia defines a personal health record as ...a health record that is initiated and maintained by an individual. This definition does not account for the recent trend of companies like Google and Microsoft setting up personal health records, whereby health care providers and payers also contribute data to alleviate the amount of data entry required by the person.

The Boston Globe article recounts the story of Dave deBronkart, who set up a PHR with Google. Google helped transfer claims data into his PHR from a Beth Israel Deaconess Medical Center.

Mr. deBronkart was subsequently alarmed to see a diagnosis in his PHR of spread of his cancer to his brain or spine. You see, Mr. deBronkart has a history of kidney cancer. But it had previously spread to his skull, not his brain or spine. But there is no ICD-9-CM code for spread of cancer to the skull, so the experts quoted in the article understandably postulate that medical records coders used instead codes for spread to brain and/or spine.

But two experts, Drs. John Halamka and Roni Zeiger, then go on to claim that ...the records will improve as more precise coding language is adopted in the coming years. The article does not mention the particular coding system they had in mind, but since the data in question was claims data, it is hard to imagine otherwise.

So, could the switch to ICD-10-CM have prevented the unnecessary fright experienced by Mr. deBronkart?


ICD-10-CM has the C64 family of codes for malignant neoplasm of kidney (his primary cancer that subsequently spread to his skull), including C64.0 (right kidney), C64.1 (left kidney), and C64.9 (unspecified kidney).

It also has C79.31 - Secondary malignant neoplasm of brain and C79.51 - Secondary malignant neoplasm of bone.

But ICD-10-CM has no code for secondary malignant neoplasm of the skull.

You cannot use C41.0 - Malignant neoplasm of bones of skull and face, because that code must be used only for cancers of bone that arise in the skull and face, not for any cancer that spreads to the skull or face from somewhere else.

And that's it. There are no other even-close-to-relevant codes.

So much for any benefit to ICD-10-CM to help Mr. deBronkart.