Why the number of ICD-10 codes is not a big deal

Believe it or not, you do not need to know or care about how many ICD-10 codes there are.  I know this goes against the grain. It is almost the only thing that gets said about ICD-10. Apologies in advance to all of you who already understand that the total number of codes in the system: (1) doesn’t dramatically affect your job, (2) isn’t inherently any more disruptive or costly than any other software upgrade, and (3) is mentioned by consultants and commentators because it is an easy score.

Regrettably though, it appears I have to waste all of our time trying to get the word out that the number of ICD-10 codes is fundamentally irrelevant. The AMA House of Delegates voted "to work vigorously to stop implementation" because the increased number of codes in ICD-10 is the “last straw” for physician practices. Then the CEO of the AMA, not to be outdone by the volunteers, sent  a letter to various members of Congress urging them to “put a stop to” the ICD-10 implementation, citing the number of codes as the problem, and look for a “suitable replacement” for ICD-9.  If at some point you are persuaded that the ICD-10 numbers are not a deal-breaker after all, you owe it to yourself to let your representatives in Congress and your professional organizations know what you think.

First, a question or two:  Did you know how many codes there were in ICD-9 before everyone started comparing? There are roughly 17,000 ICD-9 codes. Do you know and care about each one of them? Of those 17,000, how many get coded every day by your coders?

Here are three reasons why the increased size of ICD-10 will not be an overwhelming burden on your practice. I have explored these reasons in a bit more detail in a previous blog, an open letter to physicians called, “To Physicians: Some non-Hype about ICD-10.”

  1. The increased numbers of codes is concentrated in select areas of the classification. For example, the injury and poisoning chapter of the classification accounts for nearly half of the total number of codes at around 39,000 codes. Unless you are an ER physician, your exposure to the increase in codes here is not a serious consideration in the day-to-day operation of your practice. In any case, I will devote a blog in this series to injury codes and a blog to poisoning codes.
  2. The number of codes is easily accounted for when a new axis of classification is added consistently to a broad area of the system (for example, eye diagnoses now have separate codes that specify the affected eye — whether left, right, bilateral or unspecified — which means four times as many eye codes right off the bat).
  3. The total number of codes in the classification system does not change the basic coding and documentation tasks currently required in your practice. Your job as physician is to document each patient encounter to meet your own needs and to satisfy the language requirements for complete coding, just as you do now. The coder’s job is to select the code or codes that will best summarize the total picture of the patient’s health within the constraints of the classification system.

When they code, coders are basically compiling a little medical Cliff’s Notes entry for each encounter using prefab sentences — the descriptions attached to the ICD-9 or CPT codes. That task is no different using ICD-10. The idea that coders will be hopelessly baffled by the increase in the number of choices is nonsense. We all navigate hordes of choices all day every day. If I want to pick up a 12-pack of beer, I can find the brand I want whether it’s in a convenience store or a mega-store. When I get to the beer and chips aisle at the mega-store, I don’t look at the number of choices and fall to my knees wailing in despair. I look for the two big Xs on the Dos Equis label, grab the brown box that says “amber,” and I am good to go.

I believe fear of the unknown is the greatest obstacle to a physician practice making an efficient transition to ICD-10. Blowing the differences between ICD-9 and ICD-10 out of proportion by emphasizing things that don’t matter for coding and documentation is one way to induce fear. ICD-10 is not as exotic as it seems when you just settle down and actually look at what’s in the code titles. So let’s do that, shall we? Next blog I will focus on common diagnoses among the general population, and what if anything is different for ICD-10.

Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems. She is responsible for the development and maintenance of the ICD-10 Procedure Coding System since 2003 under contract to CMS, and for the development and maintenance of the ICD-10 General Equivalence Mappings (GEMs) and Reimbursement Mappings under contract to CMS and the CDC.  She leads the 3M test project to convert the MS-DRGs to ICD-10 for CMS, and is on the team to convert 3M APR-DRGs to ICD-10. Rhonda also writes for the 3M Health Information Systems blog.

Comments (2)

Kim Carter: One thought to expand on this: most physicians select their own codes from a drop-down list in current EHRs, especially for office visits. Any advice to these physician coders?
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