Inflammatory arthritis codes increased 30-fold during the transition from the 9th to the 10th edition of the International Classification of Diseases (ICD-9 and -10), but the number of inflammatory arthritis codes used in clinical practice has increased, according to a new study. There are very few things.
Most of the new ICD-10 codes for inflammatory arthritis were rarely, if ever, used from 2015 to 2021.
“In ICD-10, about 10 to 20 codes accounted for the majority of use for patients with inflammatory arthritis,” said lead author Justin Chu, a researcher and medical student at Yale University in New Haven, Connecticut. Ta. Medscape Medical News. “Other 380 or 400 codes were not used much.”
He added that the findings demonstrate the difficulty of transitioning to the new system and highlight the need for additional training to improve ICD-11 adoption. The new coding system was launched globally in January 2022, but it is not clear when it will be implemented in the United States.
ICD-10 was launched in the United States in 2015 with the goal of allowing better identification of health conditions. For example, the new coding system allowed users to include information about laterality and anatomical location for the first time. The total number of codes increased from 14,500 in ICD-9 to 70,000 in ICD-10, and the number of diagnosis codes for inflammatory arthritis increased from 14 to 425.
To see how these ICD-10 codes are utilized compared to ICD-9, Zhu et al. used national multi-insurance administrative claims data for over 5.1 million patients. I found the inflammatory arthritis diagnosis code. Approximately half were coded with his ICD-9 and the other half with his ICD-10. Zhu et al. defined “frequently used codes'' as codes that were used more than 1% of the time.
The results of this study are JAMA network open April 18th.
For ICD-9, 4 of the 14 available codes (28.6%) were frequently used codes. In contrast, only 9 of the 425 ICD-10 codes (2.1%) were frequently used. Although ICD-10 improved diagnostic granularity, data showed that nonspecific codes were the most common. Of the 20 most commonly used ICD-10 arthritis codes, 65% included “unspecified or other specified” in the wording.
The researchers also found that there were no significant changes in these frequently used codes over the study period from 2015 to 2021, indicating any detectable changes in ICD-10 usage among physicians and programmers. This suggests that there was no learning curve. We also found that code usage patterns did not vary by clinician specialty.
“The proportion of codes used was no better for rheumatologists (who are expected to be more sophisticated users of such codes) than for primary care clinicians,” Zhu said. They write:
Transitioning to ICD-11 brings challenges as well as opportunities
Zhu noted that the study highlights the challenges of introducing new technological systems into daily work, which could help with the eventual transition to ICD-11.
“There is a need to not only invest more in improving ICD-11 implementation, but also to emphasize training,” he said.
Michael Pine, MD, MBA, of MJP Healthcare Innovations, LLC in Evanston, Illinois, added that for ICD-11 to be truly useful, it needs to be more user-friendly. Although ICD-10 allowed greater granularity in coding, it did not provide “usable granularity for what physicians really want to say,” he said. Medscape Medical News.
And the transition to ICD-11 may pose even greater challenges. Rather than the ICD-10 classification system, ICD-11 is formatted as an ontology.
“While ICD-11 retains several pre-tailored codes that convey multifaceted, complex concepts, its structure and syntax are designed to capture clinical nuances that were previously inaccessible. , we also offer post-adjustment, a new feature in ICD that supports customized combinations of concepts and modifier codes,'' he wrote in an invited commentary he co-authored.
However, he said this can make coding more complex because it adds clinical nuance. One of the solutions he says is to automate the coding. This allows the clinician to enter information in a natural clinical format that makes sense, and the program converts it into her ICD-11 code. (To ensure accuracy, this will be translated to the user in a natural clinical format.)
This type of process limits how much one person needs to know about ICD-11 to effectively code a diagnosis, while also maximizing the increased specificity of the new coding system. he said.
Such a program does not yet exist, but it could become possible through focused investment in the transition to ICD-11.
Pine said the findings serve as a wake-up call against future migrations to new systems without considering the importance of user experience and ease of use. If the US takes a similar approach to the adoption of ICD-11, he said, as was taken with his ICD-10, it will be “just an over-hyped transition” and users will be disappointed in future new systems. They may be reluctant to hire you. Frustration.
But the opposite could be true if the United States takes a different, innovative approach.
“In short, it is time for the United States to invest significant resources and efforts in 21st century information systems that can overcome obstacles such as information asymmetries for decision making, incomplete risk adjustment, and burdens in performance evaluation and payment schemes. “The decision must be made as to whether or not “imposed by current coding and documentation practices,'' the commentary reads.
“This will allow us to take full advantage of the power of computers and the power of clinicians, allowing them to work together in ways that were unimaginable 50 years ago,” Pine added.
No information regarding research funding was provided. Mr. Zhu and Mr. Pine declined to disclose any competing interests.