Blog | Monday, October 31, 2016

ICD-10 keeps getting more painful


As I previously discussed, a year ago we transitioned from the disease classification ICD-9 to ICD-10. That has been painful, but they keep making tweaks that require more work.

I guess the powers that be decided that more than 155,000 diagnoses were not enough when they recently changed many diabetes diagnoses (my organization implemented the latest edition). Now it's no longer sufficient to say that someone has Type 2 Diabetes Mellitus with Diabetic Neuropathy [E11.40], for example, but I now have to specify in addition whether it's with or without long term insulin use, or if it's unspecified. That means all my carefully constructed Problem Lists on my patients no longer work. Every diabetic medication I reorder will have to be changed as they are associated with a diagnosis.

Across all my patients I'd estimate that's close to 1,000 changes I will need to make. Assuming it takes me 30 seconds each time (I'm probably a lot faster than most of my colleagues) that's over 8 hours, so a full work day. Multiply that across all the primary care doctors and that's a lot of time, about 1,000 people working years! We have a shortage of primary care physicians and I think there are many better ways to spend our time.

I typed “type 2 diabetes mellitus” into my electronic medical record. I eventually scrolled to the bottom to see a message that there were 3,158 diagnoses loaded, but that the results had been limited due to it being a common phrase! Many of these were synonyms, and 1 can save favorites, but I think it's ludicrous that we have so many codes for just 1 disease. Those who promulgated moving to ICD-10 claimed the higher specificity would lead to all kind of advantages by being more precise, but in reality physicians can't spend all day just to pick a diagnoses and they are going to pick something close that will satisfy the billing system. For many diagnoses you can't even get precise agreement. There are various codes for uncontrolled diabetes, for example, but if you ask different doctors what that means, you'll get different answers.

Patients with diabetes have to suffer from complications of their disease, increased medical costs, and being stuck more often for blood or injections. It's too bad their physicians have to suffer more as well.

Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington. This post originally appeared on his blog, World's Best Site.