It is time to question the boondoggle that is and will be the implementation of the World Health Organization-generated International Classification of Diseases, Eleventh Revision (ICD-11). Once it is likely adopted by the World Health Assembly next May and put into effect in 2022 after the Centers for Disease Control and Prevention (CDC) modify it, it will inevitably wreak havoc on the practice of medicine. But, don’t worry, despite further encumbering patient care, costing a bundle and contributing to physician job dissatisfaction, it will serve its real purpose of being a billing tool that ties medical diagnostic codes for reimbursement - all the while creating and expanding an entire industry of medical coding specialists. This ICD system further enables the Big Data obsession to continue without any assessment of the ultimate price paid.
To understand the burden it creates for physicians to add data entry to their patient care responsibilities, thereby generating another layer of distraction from the patient, consider that in 2015 the CDC along with the Centers for Medicare and Medicaid Services (CMS) initiated a clinically modified version called ICD-10-CM - containing 68,000 diagnostic codes and 87,000 codes for procedures, all to be selected by the physician for the purposes of billing and reimbursement. The previous ICD-9 included roughly 14,000 and 4,000 for procedures.
After a deep dive into the 68,000 codes, I wrote in 2016 about my top ten favorites that underscore the inane nature of the process - no embellishment necessary. Yes, the following are all different codes but are worth repeating. They reflect only a minor sampling, so imagine all of the others not included:
1. If statisticians who make up these codes treated patients, then they would realize paper cuts don’t usually require a follow-up.
W26.2XXA Contact with Edge of Stiff Paper, initial encounter
W26.2XXD Contact with Edge of Stiff Paper, subsequent encounter
2. Please don’t strike or get struck by sports equipment as the mental anguish your provider will face in selecting a code might be too much to bear, and now I am even uncertain if the gym is really safe:
Y08.8 Assault by Strike by Sports Equipment
W18.01 Striking Against Sports Equipment with Subsequent Fall
W21 Striking Against or Struck By Sports Equipment
W218 Striking against or struck by other sports equipment
86349 Striking against or struck by unspecified sports equipment
3. Self-explanatory:
04499 F02 Dementia in other diseases classified elsewhere
04500 F028 Dementia in other diseases classified elsewhere
4. Huh?!
04529 F101 0 Alcohol abuse
04530 F1010 1 Alcohol abuse, uncomplicated
04531 F1012 0 Alcohol abuse with intoxication
04532 F10120 1 Alcohol abuse with intoxication, uncomplicated
04534 F10129 1 Alcohol abuse with intoxication, unspecified
5. Well, this clarifies everything:
22704 N488 0 Other specified disorders of penis
22708 N4889 1 Other specified disorders of penis
22709 N489 1 Disorder of penis, unspecified
6. No part of the body spared when bites are the topic:
34128 S30867 Insect bite (nonvenomous) of anus
34129 S30867A Insect bite (nonvenomous) of anus, initial encounter
34130 S30867D Insect bite (nonvenomous) of anus, subsequent encounter
34131 S30867S Insect bite (nonvenomous) of anus, sequela
7. I could go on endlessly with every permutation. But, your attention span and my fatigue won’t allow it:
V10 Pedal cycle rider injured in collision with pedestrian or animal
V100 Pedal cycle driver injured in collision with pedestrian or animal in non-traffic accident
V101 Pedal cycle passenger injured in collision with pedestrian or animal in non-traffic accident
V103 Person boarding or alighting a pedal cycle injured in collision with pedestrian or animal
V104 Pedal cycle driver injured in collision with pedestrian or animal in traffic accident
V105 Pedal cycle passenger injured in collision with pedestrian or animal in traffic accident
8. Here I have to channel my inner zoologist, because in real life patients often do not even know what bit them:
86974 W5621 Bitten by orca
87157 W6111 Bitten by macaw
86886 W5522 Struck by cow
87187 W6133 Pecked by chicken
90025 Y9271 Barn as the place of occurrence of the external cause
W56 Contact with nonvenomous marine animal
W62 Contact with nonvenomous amphibians
9. How is as important as where:
W75 Intentional self-harm by explosive material
W76 Intentional self-harm by smoke, fire and flames
W77 Intentional self-harm by steam, hot vapors and hot objects
89965 Y92253 Opera house as the place of occurrence of the external cause
10. If water sports are your thing…
V9107 Burn due to water-skis on fire
V9422 Rider of non powered watercraft struck by powered watercraft
V944 Injury to barefoot water-skier
In conclusion
ICD-11, like its predecessors, is being pitched as a great data source and a fix to interoperability of electronic medical records. The problem is identifying a code that corresponds with pneumonia acquired from aspirating while fighting an eel during a night-time swim in a lake during a snowstorm (which is already detailed in the doctor’s note) is redundant, cumbersome and a poor use of a health provider’s limited time in the real, not theoretical world of the busy practitioner. Correctly coding does not impact patient diagnosis, treatment or management of disease; instead it co-opts the visit. Health insurers and systems should not be the priority in the exam room or at the hospital bedside. For the purposes of patient well-being, aspiration pneumonia should suffice.
