4 Things Doctors May Actually Like About ICD-10

Elizabeth Woodcock, MBA


April 03, 2013


Primary care physicians are up in arms about the International Classification of Diseases, Tenth Revision (ICD-10), and no doubt the new diagnosis system is complex and highly specific. But although the transition will create some upheaval and loss of time, in the long run ICD-10 may bring financial and clinical benefits for primary care doctors.

The biggest complaint is that ICD-10 contains lots more codes: 68,069 in the 10th edition compared with the 14,035 currently in use. Despite the widespread consternation, this change was inevitable. The current diagnosis coding system -- the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) -- is outdated. And the 10th edition, which is only now being adopted, was introduced in 1992, so it's no spring chicken either.

Much of the developed world has been using a modified version of the 10th edition for more than a decade. Many hospital administrators in the United States have opposed it, because hospitals must convert to a new diagnosis coding system and will have to transition all inpatient procedure coding to the new ICD-10 procedure coding system. That process will undoubtedly consume a significant amount of resources.

The Centers for Medicare & Medicaid Services (CMS) estimates that hospital coders will require about 50 hours of transition training. That compares with 16 hours for physician coders. Even so, there's no question that 16 hours will be a burden for many primary care physicians, especially when you add in software upgrades and other transition costs.

Still, you may appreciate these benefits:

1. More Specific Coding

You'll be better able to integrate the reason why the diagnosis was given (bitten by a spider, for example) or characteristics of the patient getting the diagnosis, as well as the laterality of the body (ie, on the left arm). In contrast, ICD-9 did not require these elements, and the physician or coder was left to modify the code to be more detailed or use "unspecified," "not elsewhere classified," or "other" as coding choices. These choices often led to denials by insurance payers.

These nuances in specificity are defined in the current coding system, but users of ICD-9-CM must look to the rarely used "E" codes for the reason (E006.4, for example, is the current code for "activities involving bike riding"), and then add a modifier to the Current Procedural Terminology code, such as "LT" to indicate laterality (for example, 73130-LT is radiography of the left hand).

Perhaps the most comprehensive change in the transition to ICD-10 relates to the musculoskeletal system; it will affect everything from a simple evaluation of the patient who is experiencing pain to use of more complex services, such as joint injections and fracture care.