Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The real reason doctors hate ICD-10

Ira Nash, MD
Physician
March 10, 2014
Share
Tweet
Share

It has been freezing cold in much of the country for the last two months, but things have been heating up in the controversy over the implementation of ICD-10. First, a quick primer for those of you who have not been following this.

The “ICD” in ICD-10 stands for International Classification of Diseases. The “10” refers to the version of the taxonomy, which is maintained and revised periodically by the World Health Organization (WHO) and “is the standard diagnostic tool for epidemiology, health management and clinical purposes.”

Although conversion from the ICD-9 standard, which is still in use in the US, to ICD-10 is causing a major kerfuffle, it is important to note that ICD-10 has been around since 1990, and the WHO is poised to release ICD-11 in 2017. The 9th and 10th editions differ primarily in their specificity of coding, with the 10th differentiating between acute and chronic states of the same condition, left and right sided findings, initial and ongoing treatment, etc. The net result, of course, is that there are a lot more ICD-10 than ICD-9 codes to describe the full array of human disease and unfortunate mishaps, even though humans and the things that befall them have not gotten much more complicated since 1990.

The current controversy arises from the fact that the Centers for Medicare & Medicaid Services (CMS) has mandated that hospitals and physicians submit their bills using the new codes as of October 1, 2014, effectively creating a new national standard for reimbursement determinations. The timing of the changeover means that doctors and hospitals must implement this as they simultaneously struggle with new quality mandates and IT meaningful use requirements. No wonder, then that the AMA has renewed its call for a delay in implementation, citing, among other things, a study (that it funded) that estimates that it will be financially “disastrous” for physicians to implement ICD-10.

Although these are legitimate concerns, I think the objections that many physicians have to ICD-10 goes deeper than having to change some old habits of how we write our notes and drop our bills. I think it has to do with a fundamental disconnect about the role of documentation.

As students and trainees, we were taught that the medical record is a tool for patient care. That it is intended to share information with other providers; or create a narrative over time, so that a patient’s progress (or lack thereof) can be observed; or provide a repository of reference information that may serve a future, as yet unidentified, clinical need. Yes, including enough information in our records for others to summarize into ICD-10 codes based on hospital documentation, or selecting the codes ourselves for office-based encounters, serves those ends. But the problem is that most clinicians believe that they can achieve the fundamental goals of clinical documentation without the constraints and complexity of ICD-10 coding.

Here is the real problem. Just as I pointed out with EMRs, we have accepted a system that pays doctors and hospitals for “doing stuff.” Naturally, those paying the bills want to make sure that the stuff they are paying for is both appropriate and actually getting done, and have demanded that we document both. The language chosen for that exchange (we tell you what we did, and you pay for it) is an epidemiologic classification scheme that was not designed for that purpose.

Is it any wonder that doctors hate it?

Ira Nash is a cardiologist who blogs at Auscultation.

Prev

One physician's story of weight loss

March 10, 2014 Kevin 4
…
Next

Whine or win: How retail clinics will affect pediatricians

March 11, 2014 Kevin 7
…

Tagged as: Primary Care

Post navigation

< Previous Post
One physician's story of weight loss
Next Post >
Whine or win: How retail clinics will affect pediatricians

ADVERTISEMENT

More by Ira Nash, MD

  • Let’s stop trying to change what doctors do

    Ira Nash, MD
  • Keeping up with the rapid developments in mobile health technology

    Ira Nash, MD
  • Not all doctors are physicians

    Ira Nash, MD

More in Physician

  • The backbone of health care is breaking

    Grace Yu, MD
  • Why doctors must ask for help before burnout escalates

    Diane W. Shannon, MD, MPH
  • Why medicine is like a jazz solo

    Arthur Lazarus, MD, MBA
  • Why so many patients ask for drips—and what doctors wish they knew

    Dr. Akintola Aminat Olayinka
  • Reproductive care after Roe: Why silence is not an option

    Christine Petrin, MD, MPH and Susan Thompson Hingle, MD
  • When your identity is your job: Why it’s dangerous in medicine

    Brooke Buckley, MD, MBA
  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • Why doctors must ask for help before burnout escalates

      Diane W. Shannon, MD, MPH | Physician
    • Why medicine is like a jazz solo

      Arthur Lazarus, MD, MBA | Physician
    • Why so many patients ask for drips—and what doctors wish they knew

      Dr. Akintola Aminat Olayinka | Physician
    • Reproductive care after Roe: Why silence is not an option

      Christine Petrin, MD, MPH and Susan Thompson Hingle, MD | Physician
    • When your identity is your job: Why it’s dangerous in medicine

      Brooke Buckley, MD, MBA | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 13 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • The backbone of health care is breaking

      Grace Yu, MD | Physician
    • Why doctors must ask for help before burnout escalates

      Diane W. Shannon, MD, MPH | Physician
    • Why medicine is like a jazz solo

      Arthur Lazarus, MD, MBA | Physician
    • Why so many patients ask for drips—and what doctors wish they knew

      Dr. Akintola Aminat Olayinka | Physician
    • Reproductive care after Roe: Why silence is not an option

      Christine Petrin, MD, MPH and Susan Thompson Hingle, MD | Physician
    • When your identity is your job: Why it’s dangerous in medicine

      Brooke Buckley, MD, MBA | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The real reason doctors hate ICD-10
13 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...