The Boondoggle Money Grab That Is ICD-11 Will Not Help Patients (Or Healthcare)

Related articles

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.