New coding system gives military health care providers more flexibility, specificity in ailment ID
MILItary doctors and other health care providers are using a new set of international codes to identify more easily and accurately what ails their patients. The 10th revision of the International Classification of Diseases and Related Health Problems, better known to the medical community as ICD-10, replaced an aging and outdated coding system.
“The previous version, ICD-9, had been around since the 1970s,” said Daniel Sawyer, the Military Health System’s (MHS) lead for transitioning to the new system. “It was running out of space, and it wasn’t keeping up with the medical needs: new diagnoses, new medical procedures and new devices that are being used. ICD-10 allows health care staff to document more specifically what a disease or injury is and where it is on a person’s body.”
For example, Sawyer said ICD-9 would classify an index finger, but ICD-10 allows a provider to specify that it’s the right index finger, and it even targets which segment of that right index finger has an issue. For the MHS, it actually means more work for providers up front, but it will pay dividends soon through better information down the road.
“It’s more specific, so you can really drill down to what type of injury or disease it was,” said Michele Gowen, medical coding program manager for the MHS. “ICD-10 has a completely separate disease classification and procedure coding system. This gives us more opportunities to update information.”
Gowen added this new code set allows for the building of codes that describe unique procedures. In the procedure coding system (ICD-10-PCS), there is a seven-character code that breaks the procedure down in sections, describing whether it is medical or surgical, where the injury is and its severity, plus additional characters that provide more information. These codes are only used by the coders for inpatient procedures. In other words, instead of making the foot fit the shoe, the shoe is built to fit the foot. “Under ICD-9, we had to make the code fit the procedure or ailment. With ICD-10-PCS, we build the code to describe the problem. The procedure now doesn’t have to fit that pre-made code,” said Gowen.
For example, codes for new laser eye surgery procedures, commonly known as lasik, will be built based on what is done and where it happens. The entire process allows for newer, innovative procedures to be described more accurately.
Sawyer added the information gathered will help in looking at larger health trends for the MHS beneficiary population.
“We’ll have more specifics in our health surveillance system,” said Sawyer. “For example, ICD-9 couldn’t handle the kind of specificity for diseases, such as Ebola or Zika, which didn’t necessarily have all the codes needed. ICD-10 provides or allows for the specifics we need.”
Getting the MHS up-to-speed on the new system has been a five-year process and included working with all of the service medical departments, as well as the Departments of Veterans Affairs and Health and Human Services and the civilian health care industry. Each of the services trained their providers and coders to use the codes correctly, with refresher training expected periodically. MHS and the civilian sector all officially came on board Oct. 1, 2015.
While officials said it might take a while for the general population to see tangible benefits from the change, Sawyer said it could translate into more positive health care experiences down the road.
“It’s not something they’ll notice immediately,” said Sawyer. “But through better detailed information, there could be better shaping of health plans and better delivery of health care.”