The Key Benefits and Drawbacks of ICD-10 Coding System - Assignment Example

The Key Benefits and Drawbacks of Icd-10 Coding System The Key Benefits and Drawbacks of ICD-10 Coding System Introduction ICD-10 denotes the International Classification of Disease tenth revision. The World Health Organization (WHO) created this system of coding in order to facilitate proper medical records of diseases, symptoms, different types of injuries, as well as emerging diseases from research. Prior to the development of ICD-10, many countries had been using ICD-9. The concept of ICD-10 first emerged in 1990 and the full development took place in 1994 releasing a coding system that could replace ICD-9. The development of ICD-10 resulted from the fact that ICD-9 was proving insufficient, because its structure did not give room for the coding of new diseases. This explains why experts of the (WHO) developed a coding system with a better structure and capacity to accommodate the coding of additional diseases and symptoms. With the increasing technology and the innovation of new procedures in medicine, the globe needed a coding system that could allow for detailed coding. An efficient coding system cannot receive any form of underestimation because it is of critical significance in quality evaluation of patient care. This paper will present background information of ICD-10 and highlight the benefits and drawbacks associated with the coding system. In addition, the paper will present an example of a disease coded using this system. Background Information about ICD-10 As mentioned above, ICD-10 is a coding system is a coding system developed by the World Health Organization in 1992. However, the entire coding system was launched in its full version in 1994. In 2002, translation of the ICD-10 coding system into 42 languages formed the initial benchmark in its adoption by different countries (‘Query challenges coming with ICD-10-PCS’ 2014). Worth noting is the fact that out of the 42 languages, six of them included the official WHO languages. Implementation of ICD-10 has been taking place over time in different countries. Current statistics reveal that 138 countries have adopted ICD-10 for mortality records. However, only 99 countries are using the system for mobility records. Current users of the ICD-10 coding system include the United Kingdom, France, Australia, Nordic countries, Belgium, Germany, and Canada (Rahmathulla et al, 2014). According to these statistics, it emerges that most of the industrialized countries have adopted the ICD-10 coding system replacing ICD-9. The main reason why ICD-10 was a critical development is the fact that ICD-9 did not present any room for expansion (Abdusamadovich, 2013). Therefore, the continued use of ICD-9 would contribute to inconsistencies in data. ICD-10 is a more specific coding system with a larger capacity to accommodate the coding of new diseases and procedures. Worth noting is the fact that the United States is one of the industrialized counters that has remained reluctant to adopt ICD-10 over the years (Rinkle, 2013). In 1999, the United States adopted the system for only its mortality records. However, different states had to comply with an ultimatum that required the United States to adopt the ICD-10 system fully by October 1, 2014. The implementation of ICD-10 in different countries affects different processes such as data analysis, reporting, billing, disease surveillance, coding and documentation, theatre operations, direct care operations, referrals, and purchased care operations. This means that the implementation of ICD-10 has brought forth changes in numerous activities in the health care sector. The ICD-10 coding system receives recognition for its capacity to reflect the current advancements in medical practice (‘Practices Appear to be Split on Advantages to ICD-10 Delay’, 2012). Moreover, the system presents expanded data capture capacities a factor that was no longer possible with ICD-9. The format and basic guidelines of ICD-10 are similar to those of ICD-9 (Rode, 2013). However, there is a stark difference in the capacity of ICD-9 and ICD-10. Whereas ICD-10 presents a capacity of about 68,000 codes, ICD-9 presented only about 14,000. There are structural differences between the tenth and ninth version of the international classification of diseases (Adler, 2013). Structure of ICD-10 Retrieved on January 20, 2015 from http://www.tricare.mil/tma/hipaa/icd-10.aspx As highlighted above, ICD-10 has a different structure from that of ICD-9. The illustration above depicts the general structure of ICD-10 coding system. It comprises of three to seven characters in length with a capacity of over 68,000 codes (PR, 2013). As indicated in the image, the first three digits denote the category of the diseases, the second set of three digits denotes the aetiology, anatomic site, as well as the severity (Ronning, 2011). The seventh character is an extension. In more specific terms, the first digit is alpha; the second and third digits are numeric, while digits four to seven can be either numeric or alpha. This structure allows for a high level of flexibility in adding new codes as well as specificity (Baltic, 2014). A close analysis of the ICD-9 structure reveals that it comprised of only three to five characters and with an approximate of 13,000 codes. This introduces numerous limitations while adding new codes (Sanders et al, 2012). In addition, ICD-10 has laterally, a factor that is not evident in ICD-9. Worth noting is the fact that ICD-10 coding system allows for the use of modern medical terminologies. The out-dated terminologies used in ICD-10 do not appear in the new system. Whereas ICD-9 lacked details and used generic terms for body parts, ICD-10 coding system presents a high level of specificity and details and body parts have a thorough description. In addition, the system focuses on describing methodologies and procedures in depth (‘New ICD-10 Survey Shows Physicians Unconvinced of ICD-10 Benefits’, 2013). The diagram below summarises the details and specificity reflected in the ICD-10 coding system. Retrieved on January 20, 2015 from http://www.tricare.mil/tma/hipaa/icd-10.aspx Example of Coding Diseases using the ICD-10 System: Heart Disease In the ICD-10 coding system, categories 120-125 represent the coding for ischaemic heart disease. This includes myocardial infection, chronic ischemic heart disease, and angina pectoris (Becks, 2014). More specifically, this section will present the coding of atherosclerotic coronary artery disease. Evidently, ICD-10 reveals an existing relationship in patients with angina pectoris and coronary atherosclerosis (Bosanko-Cera, 2011). This explains why both conditions are represented by combining codes. There are subcategories under each combination code that distinguish different heart conditions (Stanfill et al, 2014). There are subcategories under each combination code that distinguish different types of atherosclerotic coronary artery disease (Becks, 2014). I25.11: Native coronary artery, I25.70: Unspecified coronary artery bypass graft I25.71: Autologous vein bypass graft, I25.72: Autologous artery bypass graft I25.73: Nonautologous biological bypass graft, I25.75: Native coronary artery of transplanted heart, I25.76: Bypass graft of transplanted heart, and I25.79: Other coronary artery bypass graft (Becks, 2014). The combination code subcategories presented above have been broken into different levels of granularity in the ICD-10 coding system as illustrated below. I25.710: Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris, I25.711: Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm, I25.718: Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris, and I25.719: Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris (Becks, 2014). As highlighted in this coding, there is a high level of specificity of atherosclerotic coronary artery disease coding, which did not exist in ICD-9. Notably, the complete coding should include character X as the seventh character in the code. This character is a placeholder taking the seventh position and signifying room for future expansion. The seventh character X is of critical importance in determining the validity of a code in the ICD-10 system. Therefore, it should appear in the six character codes above for validity (Bradleyn, 2011). Benefits of the ICD-10 Coding System There are numerous benefits associated with the adoption of the ICD-10 coding system. Notably, the ICD-10 system is a product developed by the WHO (Schwend, 2007). The adoption of the system by different countries in moth mortality and mobility records creates a firm basis for comparison on a global front (Jette et al, n.d). This system is of critical importance since it allows a proper and in depth analysis of disease patterns. The ICD-9 coding system did not allow room for the coding of emerging diseases (Chapman, 2013). However, ICD-10 presents medical practitioners with the opportunity to capture data for emerging diseases and procedures resulting from innovation. The specificity and flexibility of ICD-10 present several advantages in surveillance by organizations such as Centre for Disease Control and Prevention (CDCP) (‘Still Confused about ICD-10s Benefits? Read This’, 2012). In addition, ICD-10 is highly advantageous when conducting research, clinical trials, and epidemiological studies. This is because there is constant research in the health sector with the purpose of gaining more evidence in support of diagnostic procedures or intervention strategies (Lucas, 2013). Whereas ICD-9 did not leave room for the inclusion of new knowledge into the system, the flexibility of ICD-10 encourages extensive research that can lead to the expansion of the coding system. Experts have highlighted that the implementation of ICD-10 will make it easier for the measurement of quality of healthcare as well as the determination of safety levels (Collin, 2014). This is an important aspect in an era whereby there is a salient need for the healthcare sector to deliver quality services to patients. The previous systems were not compatible with quality evaluation methodologies. However, ICD-10 presents a high level of compatibility with the procedures and methodologies used in assessing the quality of health care (‘ICD-10 Summit Lays Out Transition Challenges, Opportunities’, 2011). The coding system is highly significant in promoting efficiency in payment systems as well as the processing of claims for reimbursement. ICD-9 had its limitations in ensuring efficiency in reimbursement. Many health practitioners as well as patients needed to present additional documents for the considerations of their claims (Utter et al, 2013). However, the details in the ICD-10 coding system do not require additional documentation prior to the reimbursement process. Therefore, it has the potential to increase the efficiency in the payment systems. The fact that the system has impacts on the clinical administrative as well as financial sectors, it ensures a measure of increased efficiency in each of these sectors (Colpas, 2013). ICD-9 had its limitations in each of these sectors. However, the advanced ICD-10 coding system will restore order in each of these sectors and ensure the smooth running of activities. The previous system presented loopholes that often led to fraud and abuse. However, the capacity of ICD-10 allows for early detection of fraud cases (Enos, 2011). The system also allows for the tracking of public concerns as well as risk assessment ventures, which are of critical importance in the improvement of health care quality. Worth noting is the fact that the ICD-10 system presents the potential for proper resource management in the healthcare system unlike the previous ICD-9 system. Medical practitioners have an easier time in understanding patient medical history because of the expanded coding system. Moreover, they can be able to describe diseases precisely. The system presents details that reflect the medical care that each patient requires a factor that results in positive impacts on the side of patients (Eramo, 2013). Drawbacks of the ICD-10 System One of the evident drawbacks of the ICD-10 coding system is physician incompatibility. Doctors and other medical practitioners will require rigorous training and numerous changes in an effort to adapt to the new coding system. Although the previous system needed the practitioners to become familiar with 14,000 codes, doctors need to take note of many specific codes in the new system. The specificity of ICD-10 translates to more attention from doctors so that they do not make errors. Any error in the coding system would present numerous consequences in the billing department (Fiks & Grundmeier, 2014). Many countries are afraid of the implementation challenges such as training that will result from adopting the system. Just like other systems, adoption of a new system results to slowed productivity. The initial phase of implementing ICD-10 will register slowed productivity in different healthcare facilities. This was the case in both Canada and Australia, which have adopted the system. This slowed productivity may present adverse effects in the health care system (‘Hospital Perspectives on ICD-10 Readiness’, 2011). In addition, implementation of the ICD-10 coding system may translate to a slower flow of income. This is because the system will present the impacts to different sectors in the healthcare system. Things will only return to normal after successful implementation of the system in each sector. There are concerns about reimbursement uncertainties in the initial phase of implementing ICD-10. This is because the new coding structure will need time to conform to the existing payment systems. Although a positive long-term outcome may result as highlighted above, the initial phase in the reimbursement sector will have certain challenges (ICD-10 coding Q&A, 2014). Conclusion Evidently, the ICD-10 coding system is an improvement of the ICD-9 but with new capacities. The revision of ICD-9 sought to introduce specificity and flexibility in the new system that will emerge. Whereas ICD-9 had limitations to about 14,000 codes, ICD-10 presents capacities of over 68,000 codes. Implementation of the new system is likely to have positive effects on the quality of healthcare. Moreover, the new system allows experts to include data on emerging diseases as well as medical procedures. Without doubt, ICD-10 has the capacity to allow for effective international comparison. Despite these advantages, there is a salient need for advanced training of all the staff prior to the successful implementation of the system. 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