Study: Most ICD-10 Rheumatology Codes Still Unused a Decade Later

The transition from ICD-9 to ICD-10 wasn't expected to be easy. Healthcare providers and medical coders expected bumps in the road. But nearly a decade after ICD-10's release in the U.S., it still faces significant challenges. For example, the majority of rheumatology codes included in ICD-10 still aren't being used.

 

A group of researchers looking at medical data from Yale University discovered that, between 2015 and 2021, only 10-20 rheumatology codes were used with frequency. The remaining 380-400 haven't really been adopted. As to why this is the case, researchers speculate it is due to a lack of training.

 

International Classification of Diseases (ICD) codes were originally introduced to streamline medical billing by providing more specificity. The ninth iteration of the code set (ICD-9) contained a total of 14,500 codes. ICD-10 contains some 70,000 codes. That is an increase of more than 500%.

 

A similar jump is observed in the number of codes relating to rheumatology. ICD-9 offered just 14 rheumatology codes. That number jumped to an astonishing 425 in ICD-10. And yet just 10-20 are actually utilized by medical coders on a regular basis.

 

As previously stated, one of the explanations offered by researchers is a lack of training. Insufficient training certainly is a possibility. Yet there is another potential explanation: increased complexity. The more specific codes become, the greater the work involved for both clinicians and medical coders to figure out which one is the most appropriate. They are simply overwhelmed by the volume of possibilities.

 

There is one aspect to rheumatology that makes the research even more compelling: medical conditions treated by rheumatology specialists are very common. It is not as though clinicians and medical coders are attempting to describe rare conditions that don't get much billing action.

 

Researchers took a special look at inflammatory arthritis diagnostic codes for just over 5 million patients to inform their conclusions. They were split pretty evenly between ICD-9 and ICD-10.

 

Within the ICD-9 group, 4 of the 14 available codes were used most frequently. Within the ICD-10 group, 9 of the codes were used most frequently despite the total number of codes having increased fourfold. What does this suggest? That there may be too many codes for such common conditions.

 

We may never truly know why the vast majority of ICD-10 rheumatology codes are underutilized. A lack of training is mere speculation. So is assuming that the system is too complicated. What we can say for sure is that medical coders do their best to get it right. If they are underutilizing hundreds of codes but still getting the job done to the satisfaction of healthcare providers and payers, that is what matters.

 

As for the researchers, they are now speculating about what their data says for the eventual adoption of ICD-11. The eleventh iteration of the ICD code set was launched internationally years ago. We still have not adopted it in the U.S.

If we do, will even more codes remain underutilized? A trend in that direction would suggest that the code set may have finally reached a point of diminished returns. It doesn't seem reasonable to continue expanding the set if new codes aren't going to be adopted. It is food for thought, anyway.

 

As a medical coder, do you find that you are barely using only a handful of the ICD-10-CM rheumatology codes? It would be interesting to get a large group of coders together to discuss their thoughts on the matter. After all, they are the ones doing the work in the trenches. They understand ICD codes better than anyone.