JOURNAL OF PALLIATIVE MEDICINE Volume 18, Number 8, 2015 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2015.0099
ICD-10: What the Palliative Care Provider Needs to Know Sarah Gebauer, MD
Case 1
A
59-year-old man with sarcoma is your patient on the palliative care consult service. When you first see him on Day 1, his main complaint is of pain in his right thigh, in the area of the tumor. Over the next several days, his pain control improves with a combination of opioids and adjuvants. On Day 3 he complains of ‘‘not having enough energy to read the newspaper,’’ and on Day 10 it is hard to wake him.
Case 2
A 28-year-old woman is seen as a palliative care consult after an anoxic brain injury due to a boating accident. She is intubated but not sedated when you see her on Day 1, the day of the accident. She opens her eyes to pain but has no other responses. You examine her and hold a family meeting on Day 2, and find that she no longer has any response to pain. On Day 8 you examine her and support the family, when the family decides to withdraw the ventilator. At that point she continues to have no motor response to stimuli. How would you code these cases in ICD-10-CM? How would it be different from ICD-9-CM? Background
Many fields are struggling with the upcoming transition from ICD-9-CM to ICD-10-CM. Initial implementation was delayed,1 and concerns about implementation include the estimated cost of $83,000 to $2.7 million per practice, as well as disruption in claims processing.1 ICD-10, which was formally accepted in May 1990,2 was developed prior to the widespread use of palliative care. It ‘‘includes *68,000 codes, compared with 14,000 codes in the ICD-9-CM,’’3 which may increase diagnosis accuracy but also may increase administrative difficulty.4 ICD-10 has been adopted internationally but has not been widely used yet in the United States, although the Centers for Medicare Services (CMS) has announced that ICD-10-CM will be required as of October 1, 2015.5 As the implementation of ICD-10-CM is imminent, practices, hospitals, and physicians are attempting to identify possible issues with the conversion and methods to minimize administrative disruptions. The specialty of palliative care
has yet to determine how the changes might affect coding practice. To aid in the transition, the Center for Medicaid and Medicare provided general equivalence mappings (GEMs), which ‘‘provide distinct directional mapping tables from ICD-9-CM to ICD-10-CM and from ICD-10-CM to ICD-9CM because the mappings are not necessarily reciprocal.’’6 Methods
Lussier and colleagues have created an online tool to identify the percentage of code crosswalks in each of five categories: ‘‘identity, class-to-subclass, subclass-to-class, convoluted, and no mapping.’’6 The Lussier group created these categories to help define which codes would present challenges in the transition from ICD-9-CM to ICD-10-CM. Identity codes are one-to-one matches, class-to-subclass codes describe ICD-9-CM codes that map to multiple ICD10-CM codes; subclass-to-class codes describe ICD-10-CM codes that map to multiple ICD-9-CM codes, and no mapping codes refer to ICD-9-CM codes for which there is no clear ICD-10-CM equivalent. Convoluted codes are ICD-9-CM codes that do not adhere to the definitions of the other four categories.6 Specialty codes that have already been reviewed in the literature include emergency medicine,6 pediatrics,3 and oncology.7 These studies found significant percentages of convoluted codes in all the specialties evaluated. A paper from 2000 by one of the leaders in the field lists often-used ICD-9 codes for palliative care. All of the codes were related to symptoms, such as anorexia, dyspnea, and pain in various locations.8 To evaluate the proportions of each category of code in the field of palliative care, I used each of the unique codes listed in the paper and evaluated them using the Lussier lab’s online mapping tool.6 Some of the codes were not listed in the CMS ICD-9 Lookup tool, and thus the software was unable to map them. Other codes from the von Gunten paper, when run through the CMS ICD-9 Lookup tool,9 did not correlate with the diagnosis it listed alongside it. If the code listed in the von Gunten paper could feasibly describe the associated symptom when run through the ICD-9 Lookup tool, the code was kept intact. If not, the symptom was entered into the CMS ICD-9 Lookup tool and the closest match code was chosen. If descriptions of conditions were thought to be sufficiently similar that use of the same code in ICD-9 by a palliative
Department of Anesthesiology, University of New Mexico, Albuquerque, New Mexico. Accepted April 21, 2015.
711
712
GEBAUER
Table 1. Code Mapping of Commonly Used Palliative Care ICD-9 Codes Mapped Using Lussier Lab Networking Software1 Duplicate codes deleted 729.5 (‘‘Pain: foot’’ and ‘‘Pain: arm’’) 719.45 (‘‘Pain: hip’’ and ‘‘Pain: leg’’) 786.09 (‘‘Dyspnea’’ [changed from 286.6] and ‘‘SOB’’) Codes changed to fit with diagnosis and the CMS ICD-9 Lookup 286.6 (‘‘Dyspnea’’) listed as ‘‘Defibrination syndrome’’; changed to 786.09 (‘‘Other dyspnea or respiratory abnormalities’’) 780.09 listed twice (‘‘Delirium’’ and ‘‘Unconscious’’); 293.0 (‘‘Delirium’’) added 780.9 (‘‘Pain: unspecified’’) unlisted; changed to 780.96 (‘‘Generalized pain’’) 780.9 (‘‘Mental status change’’) unlisted; changed to 780.97 (‘‘Altered mental status’’) 780.7 (‘‘Weakness’’) not listed; changed to 728.87 (‘‘Muscle weakness [generalized]’’) 298.9 listed twice (‘‘Confusion’’ and ‘‘Dementia’’); ‘‘Dementia’’ changed to 294.20 (‘‘Dementia, unspecified, without behavioral disturbance’’) 558.9 listed twice (‘‘Diarrhea’’ and ‘‘Fatigue’’); ‘‘Fatigue’’ changed to 780.79 (‘‘Other malaise and fatigue’’) 789.1 (‘‘Pain: throat’’) listed as ‘‘Hepatomegaly’’; changed to 784.1 (‘‘Throat pain’’) 783.2 (‘‘Weight Loss’’) not listed; changed to the more specific 783.21 (‘‘Loss of weight’’) SOB, shortness of breath. 1 Thirty-eight codes were mapped; 3 duplicates were deleted; 9 codes were changed to reflect increased accuracy; 35 remaining codes were analyzed to determine mapping motif.
practitioner would be reasonable, then they were only listed once. A detailed list of codes that were modified or deleted is described in Table 1. Results
Of the 35 unique codes (omitting duplicates as noted above) in the von Gunten group’s paper,10 31.4% were oneto-one matches; 28.6% described ICD-9 codes that had multiple ICD-10 subclass codes, including the notable diag-
nosis code of coma, which under ICD-10-CM has 37 possible iterations; and 14.3% were ICD-9 codes that were identified as subclasses of an ICD-10 code. None of the codes had no association, and 25.7% of the codes were noted to be convoluted. A list of which codes map to particular motifs is included in Table 2. This distribution of motifs is quite similar to that present in other fields including emergency medicine.6 Discussion
Table 3 shows the differences in coding from ICD-9-CM to ICD-10-CM for the case vignettes described at the beginning of the paper. Case 1 illustrates that limb pain now requires much more specificity and also laterality. Additionally, symptoms that were formally indistinguishable from a coding standpoint, like fatigue and malaise or somnolence and stupor, now require the coder to choose one or the other. The differences between these categories are nuanced and may not be described directly in a clinician’s note. Case 2 demonstrates the enormous level of detail for patients in a coma. ICD-10-CM codes describe best motor and verbal response, location where those responses were recorded (such as the emergency room, in the field, or at admission), and the duration of best response. The patient in Case 2, whose diagnoses throughout her admission could have been recorded simply as ‘‘Coma’’ with the same ICD-9-CM code, now requires three different codes to describe the change in her best response and its duration. Most of the specific ICD-9-CM codes likely to be used by palliative care practitioners map to ICD-10-CM in either ‘‘convoluted’’ or ‘‘class-to-subclass’’ fashion. This suggests that palliative care providers will need to be much more sophisticated and exact in the wording of their notes. The variability of coding, and the nuances that are gained—or sometimes lost—with the conversion to ICD-10-CM using the CMS GEM makes it imperative that palliative care providers review their most commonly used codes and familiarize themselves with the descriptions and level of specificity they will need to facilitate accurate coding. Debility, for example, maps to codes describing malaise, fatigue, or weakness, though palliative providers may find these descriptions do not reflect the same clinical picture as ‘‘debility.’’ Clinicians and coders will also need to be specific about small changes in a patient’s day-to-day condition.
Table 2. ICD-9-CM to ICD-10-CM Code Mapping by Motif One-to-one matching
Class-to-subclass
Subclass-to-class
Convoluted
Anorexia Anxiety Cough Hemorrhage Nausea alone Nausea with vomiting Weakness Weight loss Pain: chest Pain: throat Pain: neck
Confusion Coma Headache Unconscious Pain: abdomen Pain: back Pain: bone Pain: hip Pain: muscle Mental status change
Dementia Depression Delirium Inanition Pain: nonspecified
Agitation Debility Diarrhea Fatigue Fever Vomiting alone SOB Pain: arm Pain: sacroiliac
SOB, shortness of breath.
THE EFFECT OF ICD-10-CM ON PALLIATIVE CARE PRACTICE
713
Table 3. Coding for ICD-9-CM and ICD-10-CM for Cases 1 and 2 Case 1
ICD-9-CM
ICD-10-CM
Day 1 Day 5 Day 8
729.5 ‘‘Pain in limb’’ 780.79 ‘‘Other malaise and fatigue’’ 780.09 ‘‘Other alteration of consciousness’’
M79651 ‘‘Pain in right thigh’’ R5381 ‘‘Other malaise’’ or R5383 ‘‘Other fatigue’’ R400 ‘‘Somnolence’’ or R401 ‘‘Stupor’’
Case 2
ICD-9-CM
ICD-10-CM
Day 1 Day 2 Day 8
780.01 ‘‘Coma’’ 780.01 ‘‘Coma’’ 780.01 ‘‘Coma’’
R402123 ‘‘Coma scale, eyes open, to pain, at hospital admission’’ R402310 ‘‘Coma scale, best motor response, none, unspecified time’’ R402314 ‘‘Coma scale, best motor response, none, 24 + hrs’’
Altered consciousness and delirium, for example, fluctuate frequently, meaning that a code used to describe confusion in a patient one day may not be accurate the next. There are several limitations to this study. Nine of the codes had to be changed to reflect the current CMS ICD-9 Lookup code, as the computer software could not match codes that were not specifically listed in that system. This may lead to an artificially high number of one-to-one matches, since codes may have been chosen that are more specific than those commonly used by practitioners. However, since the analysis was based mostly on the described symptoms, the codes used in the study should still reflect frequently used codes in a palliative care practice. Another limitation is that the percentage of diagnoses may be different from the distribution used in clinical practice. For example, one practice may use a handful of convoluted codes very frequently and a larger number of one-to-one codes rarely. Another important consideration is the development of ICD-11, which has a planned worldwide introduction date in 2017, though CMS may not require implementation for years afterward.10,11 ICD-11 uses the SNOMED CT terminology standard, which has a controlled terminology that could integrate into an electronic health record and make it easier to extract relevant useable information.2,12 Although SNOMED CT is used in 50 countries, a 2013 survey of implementation noted a few key issues. Clinicians were dissatisfied by the loss of nuance that came with splitting a clinician’s usual wording into distinct terms, as well as the amount of time and effort it took to properly link the terms.13 The complexity displayed by ICD-10-CM, in addition to the impending introduction of ICD-11, highlights the need for a working group to further elucidate the optimal coding strategies in palliative care. Author Disclosure Statement
3. 4. 5. 6.
7.
8. 9. 10. 11.
12. 13.
zation. www.who.int/classifications/icd/factsheet/en/. (Last accessed February 14, 2015.) Caskey R, Zaman J, Nam H, et al.: The transition to ICD10-CM: Challenges for pediatric practice. Pediatrics 2014; 134:31–36. Henderson T, Shepheard J, Sundararajan V: Quality of diagnosis and procedure coding in ICD-10 administrative data. Med Care 2006;44:1011–1019. Centers for Medicare Services: ICD-10. cms.gov/Medicare/ Coding/ICD10/index.html?redirect = /icd10. Boyd AD, Li JJ, Burton MD, et al.: The discriminatory cost of ICD-10-CM transition between clinical specialties: Metrics, case study, and mitigating tools. J Am Med Inform Assoc 2013;20:708–717. Venepalli NK, Qamruzzaman Y, Li JJ, et al.: Identifying clinically disruptive International Classification of Diseases 10th Revision Clinical Modification conversions to mitigate financial costs using an online tool. J Oncol Pract 2014;10: 97–103. von Gunten CF, Ferris FD, Kirschner C, Emanuel LL: Coding and reimbursement mechanisms for physician services in hospice and palliative care. J Palliat Med 2000;3:157–164. Centers for Medicare Services: ICD-9 Code Lookup. www .cms.gov/medicare-coverage-database/staticpages/icd-9-codelookup.aspx. (Last accessed February 16, 2015.) Rodrigues JM, Schulz S, Rector A, et al.: ICD-11 and SNOMED CT common ontology: Circulatory system. Stud Health Technol Inform 2014;205:1043–1047. Oberliesen E: ‘‘Experts Discuss Reasons Why ICD-11 Must Wait.’’ healthcare-executive-insight.advanceweb.com/WebExtras/Online-Extras/Experts-Discuss-Reasons-Why-ICD-11Must-Wait.aspx. (Last accessed March 20, 2015.) SNOMED CT. www.ihtsdo.org/snomed-ct/. (Last accessed February 16, 2015.) Lee D, Cornet R, Lau F, de Keizer N: A survey of SNOMED CT implementations. J Biomed Inform 2013; 46:87–96.
No competing financial interests exist. References
1. ‘‘AMA to Sebelius: Stop ICD-10.’’ February 6, 2012. www.healthdatamanagement.com/news/icd-10-hhs-sebeliusamerican-medical-association-43967-1.html. (Last accessed February 16, 2015.) 2. World Health Organization: International Classification of Diseases (ICD) Information Sheet. World Health Organi-
Address correspondence to: Sarah Gebauer, MD Department of Anesthesiology University of New Mexico 2211 Lomas Boulevard NE Albuquerque, NM 87106 E-mail: [email protected]
ICD-10: What the Palliative Care Provider Needs to Know Sarah Gebauer, MD
Case 1
A
59-year-old man with sarcoma is your patient on the palliative care consult service. When you first see him on Day 1, his main complaint is of pain in his right thigh, in the area of the tumor. Over the next several days, his pain control improves with a combination of opioids and adjuvants. On Day 3 he complains of ‘‘not having enough energy to read the newspaper,’’ and on Day 10 it is hard to wake him.
Case 2
A 28-year-old woman is seen as a palliative care consult after an anoxic brain injury due to a boating accident. She is intubated but not sedated when you see her on Day 1, the day of the accident. She opens her eyes to pain but has no other responses. You examine her and hold a family meeting on Day 2, and find that she no longer has any response to pain. On Day 8 you examine her and support the family, when the family decides to withdraw the ventilator. At that point she continues to have no motor response to stimuli. How would you code these cases in ICD-10-CM? How would it be different from ICD-9-CM? Background
Many fields are struggling with the upcoming transition from ICD-9-CM to ICD-10-CM. Initial implementation was delayed,1 and concerns about implementation include the estimated cost of $83,000 to $2.7 million per practice, as well as disruption in claims processing.1 ICD-10, which was formally accepted in May 1990,2 was developed prior to the widespread use of palliative care. It ‘‘includes *68,000 codes, compared with 14,000 codes in the ICD-9-CM,’’3 which may increase diagnosis accuracy but also may increase administrative difficulty.4 ICD-10 has been adopted internationally but has not been widely used yet in the United States, although the Centers for Medicare Services (CMS) has announced that ICD-10-CM will be required as of October 1, 2015.5 As the implementation of ICD-10-CM is imminent, practices, hospitals, and physicians are attempting to identify possible issues with the conversion and methods to minimize administrative disruptions. The specialty of palliative care
has yet to determine how the changes might affect coding practice. To aid in the transition, the Center for Medicaid and Medicare provided general equivalence mappings (GEMs), which ‘‘provide distinct directional mapping tables from ICD-9-CM to ICD-10-CM and from ICD-10-CM to ICD-9CM because the mappings are not necessarily reciprocal.’’6 Methods
Lussier and colleagues have created an online tool to identify the percentage of code crosswalks in each of five categories: ‘‘identity, class-to-subclass, subclass-to-class, convoluted, and no mapping.’’6 The Lussier group created these categories to help define which codes would present challenges in the transition from ICD-9-CM to ICD-10-CM. Identity codes are one-to-one matches, class-to-subclass codes describe ICD-9-CM codes that map to multiple ICD10-CM codes; subclass-to-class codes describe ICD-10-CM codes that map to multiple ICD-9-CM codes, and no mapping codes refer to ICD-9-CM codes for which there is no clear ICD-10-CM equivalent. Convoluted codes are ICD-9-CM codes that do not adhere to the definitions of the other four categories.6 Specialty codes that have already been reviewed in the literature include emergency medicine,6 pediatrics,3 and oncology.7 These studies found significant percentages of convoluted codes in all the specialties evaluated. A paper from 2000 by one of the leaders in the field lists often-used ICD-9 codes for palliative care. All of the codes were related to symptoms, such as anorexia, dyspnea, and pain in various locations.8 To evaluate the proportions of each category of code in the field of palliative care, I used each of the unique codes listed in the paper and evaluated them using the Lussier lab’s online mapping tool.6 Some of the codes were not listed in the CMS ICD-9 Lookup tool, and thus the software was unable to map them. Other codes from the von Gunten paper, when run through the CMS ICD-9 Lookup tool,9 did not correlate with the diagnosis it listed alongside it. If the code listed in the von Gunten paper could feasibly describe the associated symptom when run through the ICD-9 Lookup tool, the code was kept intact. If not, the symptom was entered into the CMS ICD-9 Lookup tool and the closest match code was chosen. If descriptions of conditions were thought to be sufficiently similar that use of the same code in ICD-9 by a palliative
Department of Anesthesiology, University of New Mexico, Albuquerque, New Mexico. Accepted April 21, 2015.
711
712
GEBAUER
Table 1. Code Mapping of Commonly Used Palliative Care ICD-9 Codes Mapped Using Lussier Lab Networking Software1 Duplicate codes deleted 729.5 (‘‘Pain: foot’’ and ‘‘Pain: arm’’) 719.45 (‘‘Pain: hip’’ and ‘‘Pain: leg’’) 786.09 (‘‘Dyspnea’’ [changed from 286.6] and ‘‘SOB’’) Codes changed to fit with diagnosis and the CMS ICD-9 Lookup 286.6 (‘‘Dyspnea’’) listed as ‘‘Defibrination syndrome’’; changed to 786.09 (‘‘Other dyspnea or respiratory abnormalities’’) 780.09 listed twice (‘‘Delirium’’ and ‘‘Unconscious’’); 293.0 (‘‘Delirium’’) added 780.9 (‘‘Pain: unspecified’’) unlisted; changed to 780.96 (‘‘Generalized pain’’) 780.9 (‘‘Mental status change’’) unlisted; changed to 780.97 (‘‘Altered mental status’’) 780.7 (‘‘Weakness’’) not listed; changed to 728.87 (‘‘Muscle weakness [generalized]’’) 298.9 listed twice (‘‘Confusion’’ and ‘‘Dementia’’); ‘‘Dementia’’ changed to 294.20 (‘‘Dementia, unspecified, without behavioral disturbance’’) 558.9 listed twice (‘‘Diarrhea’’ and ‘‘Fatigue’’); ‘‘Fatigue’’ changed to 780.79 (‘‘Other malaise and fatigue’’) 789.1 (‘‘Pain: throat’’) listed as ‘‘Hepatomegaly’’; changed to 784.1 (‘‘Throat pain’’) 783.2 (‘‘Weight Loss’’) not listed; changed to the more specific 783.21 (‘‘Loss of weight’’) SOB, shortness of breath. 1 Thirty-eight codes were mapped; 3 duplicates were deleted; 9 codes were changed to reflect increased accuracy; 35 remaining codes were analyzed to determine mapping motif.
practitioner would be reasonable, then they were only listed once. A detailed list of codes that were modified or deleted is described in Table 1. Results
Of the 35 unique codes (omitting duplicates as noted above) in the von Gunten group’s paper,10 31.4% were oneto-one matches; 28.6% described ICD-9 codes that had multiple ICD-10 subclass codes, including the notable diag-
nosis code of coma, which under ICD-10-CM has 37 possible iterations; and 14.3% were ICD-9 codes that were identified as subclasses of an ICD-10 code. None of the codes had no association, and 25.7% of the codes were noted to be convoluted. A list of which codes map to particular motifs is included in Table 2. This distribution of motifs is quite similar to that present in other fields including emergency medicine.6 Discussion
Table 3 shows the differences in coding from ICD-9-CM to ICD-10-CM for the case vignettes described at the beginning of the paper. Case 1 illustrates that limb pain now requires much more specificity and also laterality. Additionally, symptoms that were formally indistinguishable from a coding standpoint, like fatigue and malaise or somnolence and stupor, now require the coder to choose one or the other. The differences between these categories are nuanced and may not be described directly in a clinician’s note. Case 2 demonstrates the enormous level of detail for patients in a coma. ICD-10-CM codes describe best motor and verbal response, location where those responses were recorded (such as the emergency room, in the field, or at admission), and the duration of best response. The patient in Case 2, whose diagnoses throughout her admission could have been recorded simply as ‘‘Coma’’ with the same ICD-9-CM code, now requires three different codes to describe the change in her best response and its duration. Most of the specific ICD-9-CM codes likely to be used by palliative care practitioners map to ICD-10-CM in either ‘‘convoluted’’ or ‘‘class-to-subclass’’ fashion. This suggests that palliative care providers will need to be much more sophisticated and exact in the wording of their notes. The variability of coding, and the nuances that are gained—or sometimes lost—with the conversion to ICD-10-CM using the CMS GEM makes it imperative that palliative care providers review their most commonly used codes and familiarize themselves with the descriptions and level of specificity they will need to facilitate accurate coding. Debility, for example, maps to codes describing malaise, fatigue, or weakness, though palliative providers may find these descriptions do not reflect the same clinical picture as ‘‘debility.’’ Clinicians and coders will also need to be specific about small changes in a patient’s day-to-day condition.
Table 2. ICD-9-CM to ICD-10-CM Code Mapping by Motif One-to-one matching
Class-to-subclass
Subclass-to-class
Convoluted
Anorexia Anxiety Cough Hemorrhage Nausea alone Nausea with vomiting Weakness Weight loss Pain: chest Pain: throat Pain: neck
Confusion Coma Headache Unconscious Pain: abdomen Pain: back Pain: bone Pain: hip Pain: muscle Mental status change
Dementia Depression Delirium Inanition Pain: nonspecified
Agitation Debility Diarrhea Fatigue Fever Vomiting alone SOB Pain: arm Pain: sacroiliac
SOB, shortness of breath.
THE EFFECT OF ICD-10-CM ON PALLIATIVE CARE PRACTICE
713
Table 3. Coding for ICD-9-CM and ICD-10-CM for Cases 1 and 2 Case 1
ICD-9-CM
ICD-10-CM
Day 1 Day 5 Day 8
729.5 ‘‘Pain in limb’’ 780.79 ‘‘Other malaise and fatigue’’ 780.09 ‘‘Other alteration of consciousness’’
M79651 ‘‘Pain in right thigh’’ R5381 ‘‘Other malaise’’ or R5383 ‘‘Other fatigue’’ R400 ‘‘Somnolence’’ or R401 ‘‘Stupor’’
Case 2
ICD-9-CM
ICD-10-CM
Day 1 Day 2 Day 8
780.01 ‘‘Coma’’ 780.01 ‘‘Coma’’ 780.01 ‘‘Coma’’
R402123 ‘‘Coma scale, eyes open, to pain, at hospital admission’’ R402310 ‘‘Coma scale, best motor response, none, unspecified time’’ R402314 ‘‘Coma scale, best motor response, none, 24 + hrs’’
Altered consciousness and delirium, for example, fluctuate frequently, meaning that a code used to describe confusion in a patient one day may not be accurate the next. There are several limitations to this study. Nine of the codes had to be changed to reflect the current CMS ICD-9 Lookup code, as the computer software could not match codes that were not specifically listed in that system. This may lead to an artificially high number of one-to-one matches, since codes may have been chosen that are more specific than those commonly used by practitioners. However, since the analysis was based mostly on the described symptoms, the codes used in the study should still reflect frequently used codes in a palliative care practice. Another limitation is that the percentage of diagnoses may be different from the distribution used in clinical practice. For example, one practice may use a handful of convoluted codes very frequently and a larger number of one-to-one codes rarely. Another important consideration is the development of ICD-11, which has a planned worldwide introduction date in 2017, though CMS may not require implementation for years afterward.10,11 ICD-11 uses the SNOMED CT terminology standard, which has a controlled terminology that could integrate into an electronic health record and make it easier to extract relevant useable information.2,12 Although SNOMED CT is used in 50 countries, a 2013 survey of implementation noted a few key issues. Clinicians were dissatisfied by the loss of nuance that came with splitting a clinician’s usual wording into distinct terms, as well as the amount of time and effort it took to properly link the terms.13 The complexity displayed by ICD-10-CM, in addition to the impending introduction of ICD-11, highlights the need for a working group to further elucidate the optimal coding strategies in palliative care. Author Disclosure Statement
3. 4. 5. 6.
7.
8. 9. 10. 11.
12. 13.
zation. www.who.int/classifications/icd/factsheet/en/. (Last accessed February 14, 2015.) Caskey R, Zaman J, Nam H, et al.: The transition to ICD10-CM: Challenges for pediatric practice. Pediatrics 2014; 134:31–36. Henderson T, Shepheard J, Sundararajan V: Quality of diagnosis and procedure coding in ICD-10 administrative data. Med Care 2006;44:1011–1019. Centers for Medicare Services: ICD-10. cms.gov/Medicare/ Coding/ICD10/index.html?redirect = /icd10. Boyd AD, Li JJ, Burton MD, et al.: The discriminatory cost of ICD-10-CM transition between clinical specialties: Metrics, case study, and mitigating tools. J Am Med Inform Assoc 2013;20:708–717. Venepalli NK, Qamruzzaman Y, Li JJ, et al.: Identifying clinically disruptive International Classification of Diseases 10th Revision Clinical Modification conversions to mitigate financial costs using an online tool. J Oncol Pract 2014;10: 97–103. von Gunten CF, Ferris FD, Kirschner C, Emanuel LL: Coding and reimbursement mechanisms for physician services in hospice and palliative care. J Palliat Med 2000;3:157–164. Centers for Medicare Services: ICD-9 Code Lookup. www .cms.gov/medicare-coverage-database/staticpages/icd-9-codelookup.aspx. (Last accessed February 16, 2015.) Rodrigues JM, Schulz S, Rector A, et al.: ICD-11 and SNOMED CT common ontology: Circulatory system. Stud Health Technol Inform 2014;205:1043–1047. Oberliesen E: ‘‘Experts Discuss Reasons Why ICD-11 Must Wait.’’ healthcare-executive-insight.advanceweb.com/WebExtras/Online-Extras/Experts-Discuss-Reasons-Why-ICD-11Must-Wait.aspx. (Last accessed March 20, 2015.) SNOMED CT. www.ihtsdo.org/snomed-ct/. (Last accessed February 16, 2015.) Lee D, Cornet R, Lau F, de Keizer N: A survey of SNOMED CT implementations. J Biomed Inform 2013; 46:87–96.
No competing financial interests exist. References
1. ‘‘AMA to Sebelius: Stop ICD-10.’’ February 6, 2012. www.healthdatamanagement.com/news/icd-10-hhs-sebeliusamerican-medical-association-43967-1.html. (Last accessed February 16, 2015.) 2. World Health Organization: International Classification of Diseases (ICD) Information Sheet. World Health Organi-
Address correspondence to: Sarah Gebauer, MD Department of Anesthesiology University of New Mexico 2211 Lomas Boulevard NE Albuquerque, NM 87106 E-mail: [email protected]
