Limitations of ICD-9 Codes

The US still uses the old ICD-9 coding system. The limitations of this outdated system are increasing as new diagnostic and treatment procedures become available, because 

1) ICD-9 does not have the ability to add new codes for them. 

2) The same is true for new diagnoses. 

3) The system also cannot provide granularity of sub-classifications of diagnoses or related problems from socioeconomic or lifestyle issues. 

4) Moreover, because one of the main uses of the ICD codes is in the medical billing – health insurance payment transaction, and that transaction is now almost universally done electronically, there is a need for the transaction to be able to use the new HIPAA electronic transaction forms. ICD-9 codes are not set up to do this.

What does this mean?

One thing it means is that healthcare providers cannot always give the most accurate diagnosis and procedure information. This generates more work on the part of health insurance companies, as claims analysts must review ambiguous codes in billing, and medical reviews must be done case-by-case for tests and treatments that might otherwise be standardized by codes. It means valid medical care bills are sometimes denied or that payments for them are determined incorrectly because the true value cannot be easily seen from the codes. 

It can potentially seriously affect patient care, as inaccurate coding can lead to missing the true diagnosis and prescribing the wrong treatment. It means that public policy does not have the most accurate information from their research. And it means that, because the US is behind a whopping 153 other countries in getting up to speed, we do not have the capability of interoperability with them.

Tags: ICD Coding | EMR | EHR