Those who are convinced that money makes the world go round will be skeptical of the following claim: the ICD system did not start out as a methodology for billing healthcare services. Its roots go all the way back to Francois Bossier de Lacroix (1706 - 1777), also known as Sauvages, who was a contemporary of the great taxonomist Linnaeus. Sauvages was interested in making epidemiological studies of infant and child mortality and he used the reported causes of death (including such labels as "thrush," "rickets" and "overlaid") for these early efforts at public health investigation.
Modern efforts are traceable to a committee of the International Statistical Institute which was charged in 1891 with creating a listing of causes of death. This effort was successfully completed by 1893 under the leadership of Jacque Bertillon and was adopted internationally over the next several years as the International Classification of Causes of Death. A conference in 1900 was convened with representatives of 26 countries to carry out the first revision of the Bertillon classification.
Those who are interested at the progress of this work over the 20th century, including work in the US and internationally that lead to the more expansive goal of an International Classification of Diseases may find this article of interest (http://www.who.int/classifications/icd/en/HistoryOfICD.pdf).
The 9th revision of the ICD system was completed in 1986. Within six years, however, it was clear that ICD-9 would not support scientific and medical advances in the understanding and classification of disease entities and a replacement was sought. Again, the principle need was for a classification system that would support research at the clinical and epidemiological level. A final report of the federal committee to create ICD-10 was submitted to HCFA (now the federal Center for Medicare and Medicaid Services or CMS) in December of 1998. Over 100 countries have adopted ICD-10, and after several false starts and postponements, it looks like the most recent October 1st deadline for US adoption will actually stick. Here at NSLIJ, efforts are being made to ensure that we are prepared for this coding change, which has potential implications for both publicly reported quality metrics, like risk-adjusted mortality rates, and for collecting third party reimbursement.
What do we physicians need to do? First, take part in our system-wide education. AMA Category 1 CME will be awarded for taking the online modules posted in HealthPort under I-Learn. As this education is rolling out in three "Waves" you will receive department-specific information about when you can find your modules. Second, expect queries from the nurses who do chart audits for Clinical Documentation Improvement (or "CDI") - they will ask us to clarify items to ensure that the record contains enough detail to all coding in the new system.
Common issues will include laterality and the characterization of certain diseases. For example, patients with asthma will need to be described with attention to the NIH guidelines. Is this intermittent or persistent disease? Mild, moderate or severe?
Your medical leaders are acutely aware of the many burdens that the regulatory environment places on us as physicians, and the list just seems to keep growing. Writing informative notes, however, is good medico-legal practice. And ultimately, insofar as the chart is a critical communication tool, it is good for our patients. Thoughts on the matter? Feedback? Recommendations? Let me know!
