DRG Coding Advisor: AHIMA wants to move from ICD-9-CM to ICD-10-PCS

A look at AHIMA’s testimony

Calling the ICD-9-CM procedural coding system outdated and unable to meet the needs of today’s health care industry, a HIM industry representative asked a national health statistics committee to replace the system with the new ICD-10-PCS system.

"The ICD-9-CM procedural coding system is obsolete and must be replaced," testified Sue Prophet, director of coding policy and compliance of the American Health Information Management Association (AHIMA) of Washington, DC, and Chicago, on April 9, 2002, to the National Committee on Vital and Health Statistics.

System on brink of collapse’

"Today, we are using a procedure coding system on the brink of collapse and unless this situation is addressed quickly and in concert with other coding system decisions that must be made, there will be serious consequences to the industry," Prophet testified.

"This coding system was designed and implemented over 20 years ago, and since that time dramatic advances in medicine and medical technology have occurred that were not anticipated and have not been adequately accommodated," Prophet told committee members. "For example, laser and laparoscopic surgery were not performed at that time, but are now utilized for many types of procedures."

Prophet discussed how AHIMA served on a technical advisory panel throughout development of the ICD-10-PCS system and how the system was formally tested by AHIMA-credentialed HIM professionals employed by the two Clinical Data Abstraction Centers.

"The results of the ICD-10-PCS testing by AHIMA were generally positive," Prophet said. "Individuals involved in the testing indicated that it is a clinically elegant and logical system, and that the system can be understood relatively quickly, resulting in reduced training time."

The problems with the ICD-9-CM coding system include a lack of granularity which causes a mingling of procedures that violates all normal coding system requirements, Prophet testified.

"We have run out of codes, and we are faced with choices such as replacement or a gerrymandering of coding rules and concepts just to keep the system going," Prophet said. "Such choices and delays in considering the obvious are decisions that only lead to more errors and more cost."

Prophet offered these examples of the coding system’s vagueness and problems:

  • A variety of different knee surgeries, including both open and arthroscopic repairs, are classified to code 81.47, "Other repair of the knee."
  • Numerous types of aneurysm repairs are classified to code 39.52, "Other repair of aneurysm."
  • Excision of skin lesions and all types of destruction of skin lesions (including that by laser, cryosurgery, cauterization, and fulguration) are classified to code 86.3, "Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue."

Other problems with the ICD-9-CM procedure coding system are the following, according to Prophet:

  • contains overlapping and duplicative codes;
  • includes inconsistent and outdated terminology;
  • lacks codes for certain types of services;
  • lacks sufficient specificity and detail (such as laterality or surgical approach);
  • has insufficient structure to capture new technology.

Also at issue are the goals and philosophy behind coded data, Prophet said.

While coding systems initially were designed as statistical analyses of mortality and morbidity and were used for indexing and retrieving medical and epidemiological research, education, and medical audits, they have many more uses today, Prophet testified. Here are some examples she gave the national health statistics committee:

  • payment system design and processing claims for reimbursement;
  • measuring the quality, safety, and efficacy of care;
  • managing care and disease processes;
  • research, epidemiological studies, and clinical trials;
  • setting health policy;
  • operational and strategic planning and the designing of healthcare delivery systems;
  • monitoring resource utilization;
  • identifying fraudulent practices;
  • tracking public health and risks;
  • providing data to consumers regarding costs and outcomes of treatment options.

"As I have noted, nothing has changed to negate the problems cited in this report, with the exception that now the problems have grown worse, such as the fact that we are running out of codes and these problems are impacting the healthcare industry at an even higher level," Prophet said.

  • The ICD-9 is an obsolete system that also is causing day-to-day problems for health care facilities, Prophet said. These are:
  • There are increasing requirements for submission of documentation to support claims.
  • Accurate data on new medical advances cannot be collected.
  • Requirements of the 2000 Benefits Improvement and Protection Act cannot be implemented; therefore, new services and technology cannot be accurately accommodated.
  • There is a lack of data to support performance measurement, outcomes analyses, and cost analyses.
  • There is an increasing need for manual review of medical records for research and "data mining" purposes.
  • The opportunity for fraud/abuse (due to the number of different procedures categorized to the same code, such as covered and noncovered procedures) keeps increasing.

Although AHIMA strongly recommends a switch to the ICD-10-PCS system, the organization acknowledges that this will require considerable training for coding personnel because the new system is substantially different from classification systems currently in use.

"After an initial learning period to familiarize themselves with the new system, AHIMA-credentialed coding professionals understood and applied the system with relative ease," Prophet testified. "The degree of specificity in ICD-10-PCS facilitates identification of the correct code."

Also, ICD-10-PCS requires a more extensive knowledge of anatomy and physiology than the ICD-9-CM procedural coding system, so some coders may need additional training in this area, Prophet said.