ICD

There are two related classifications of diseases with similar titles, and a third classification on functioning and disability.

The International Classification of Diseases (ICD) is the classification used to code and classify mortality data from death certificates.

The International Classification of Diseases, Clinical Modification (ICD-CM) is used to code and classify morbidity data from the inpatient and outpatient records, physician offices, and most National Center for Health Statistics (NCHS) surveys.

NCHS serves as the World Health Organization (WHO) Collaborating Center for the Family of International Classifications for North America and in this capacity is responsible for coordination of all official disease classification activities in the United States relating to the ICD and its use, interpretation, and periodic revision.

The Collaborating Center also is responsible in North America for the WHO Family of International Classifications, which includes the International Classification of Functioning, Disability and Health (ICF).

International Classification of Diseases, Ninth Revision (ICD-9)

The International Classification of Diseases (ICD) is designed to promote international comparability in the collection, processing, classification, and presentation of mortality statistics.

This includes providing a format for reporting causes of death on the death certificate. The reported conditions are then translated into medical codes through use of the classification structure and the selection and modification rules contained in the applicable revision of the ICD, published by the World Health Organization. These coding rules improve the usefulness of mortality statistics by giving preference to certain categories, by consolidating conditions, and by systematically selecting a single cause of death from a reported sequence of conditions. The single selected cause for tabulation is called the underlying cause of death, and the other reported causes are the non-underlying causes of death. The combination of underlying and non-underlying causes is the multiple causes of death.

The ICD has been revised periodically to incorporate changes in the medical field. To date, there have been 10 revisions of the ICD. The tenth revision is due to be implemented next year in 2015.The years for which causes of death in the United States have been classified by each revision are as follows:

At the present time making a diagnosis, remains a physician’s domain.  However, inroads are being made. Sometimes these are being made without our awareness. When my present insurance biller started several years ago, she said I could not and had not been paid for my pulmonary function tests. I needed to place “wheezing” as a diagnosis or I would continue not to be paid. So my lack of being reimbursed for years depended not upon an additional diagnosis, since wheezing is a physical finding in the diagnosis of asthma and emphysema, and not a diagnosis in and of itself. I had been denied being paid for an important pulmonary procedure in my specialty of pulmonology, all because of a medical illiterate imposing his or her understanding of healthcare or medicine on those too busy to cross-check every item of coding. In this case an erroneous ICD code was required to pay for a valid CPT code which meant that a correct ICD code negated a valid CPT code which, in turn, cancelled payment for the pulmonary function test.

One of the reasons for the ICD codes was the correct coding of the cause of death. Physicians think in a pathophysiologic sequence of causality. For instance diabetes may cause renal disease which is an etiology of hypertension, which can be the cause of renal failure, stroke and death. If that is the sequence, the physician would normally list them as such. Lay medical examiners, may rearrange this sequence in a non-causative sequence. Or they may insert benign hypertension as causative of death and a sequence to diabetes in the absence of renal disease.

With all these intrusions into the practice of medicine, the massive coding changes of October 1, 2015, may be the best time to close your practice to avoid the risk of coding errors, or errors in coding your patients by medical illiterates, even though not caused by you. In an increasing litigious society, with prosecution for irrelevant variations of irrelevant medical issues, retirement by the date the ICD 10 codes are implemented may prevent retirement to a prison cell.

Those places with cement walls, floors and bars in place of windows sometimes get very cold in winter and warm in summer. Not the most comfortable or healthy retirement villa. But it does help you remember that it all started with an accusation of gluttony for up-coding when you were totally unaware of it.

To be continued next month . . .

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