In Defense of Granularity: Why there are so many ICD-10 codes

Carl Natale
by Carl Natale

If you're going to argue against the need to implement ICD-10-CM/PCS, you need to explain how specific the medical codes can be. Apparently that's a bad thing.

Physicians don't seem to have any tolerance for it. The argument seems to be specificity causes them to spend too much time and money finding medical codes.

Even more important, ICD-10 diagnosis codes can be funny. That must mean they're not useful for serious medicine.

[See also: ICD-10 Humor: A man walks into a lamppost...]

Apparently granularity is one of the "Good Things to Say About ICD-10." In Elizabeth Gardner's Health Data Management article, she got this explanation:

"Someone asked for each of those levels of granularity or they wouldn't have gotten it," says Meryl Bloomrosen, vice president of public policy and government relations for the American Medical Informatics Association. "Someone articulated and made the case for these codes-no one sat around just thinking them up for fun."

What are some of those reasons?

Cheryl Clark at Health Leaders Media listed some of the reasons why we should be "Feeling Better About ICD-10" and the comedic level of granularity. Some of the benefits for healthcare providers include:

  • "Improves public health tracking"
  • "Detailed data on injuries, accidents"

These two reasons are pretty much the same. If a healthcare system wants to understand what is making people sick or injuring them, they need data on specific injuries. It does us no good to know that we suffer x amount of head injuries a year without understanding what causes those injuries. It's the first step to preventing injury and illness.

  • "Tracking of healthcare-associated conditions"
  • "Precision in reporting complications from medical devices "

Remember "Do no harm." I know physicians take that oath seriously. But not everything goes according to plan. Healthcare providers need to know when their procedures and facilities are causing injury. Collecting this data helps us understand if there is a problem.

This evidence-based medicine will allow physicians to compare patients more effectively, according to Wendy Wittington, M.D. and chief medical officer of Anthelio Healthcare Solutions. She argues for granularity in Gabriel Perna's "The Switch to ICD-10: Let’s Get Serious, Urges One Expert":

"As a physician, I don’t care and have nothing to lose that there’s a code for walking into a lamppost. It will never get in my way. We have a lot more to gain by that tremendous granularity if we do things correctly.”

Whose idea is this anyway?

Of course some healthcare professionals still aren't convinced. They're blaming the federal government for inflating the medical codes. Daniel Duvall, medical officer for the Centers for Medicare & Medicaid Services (CMS) Hospital and Ambulatory Policy Group, sees it differently.

During a national provider call in August, Duvall wanted to make sure everyone knew that the reason there is so much detail in ICD-10 codes was that private organizations and physicians wanted it. They asked for a code set that recognized specific diagnoses for their reporting and tracking.

Rhonda Butler, a senior clinical research analyst with 3M Health Information Systems,  defends the granularity in ICD-10 coding by citing such a request:

"Gastrointestinal chapter: ICD-9 = 529 codes, ICD-10 = 691 codes. If you are a gastroenterologist, you will notice additional detail for coding hepatitis, Crohn’s disease and cholecystitis with associated cholelithiasis. And you will probably be glad to see the new codes, since the increased detail was added because your specialty society at the national or international level requested it."

It sounds like the extreme specificity is the result of vigorous support of medical societies.