Limitations of ICD-9

ICD-9 has several limitations that prevent complete and precise coding and billing of health conditions and treatments

ICD-9-CM limits operations, reporting, and analytics processes because it:

1. Follows a 1970s outdated medical coding system.

2. Lacks clinical specificity to process claims and reimbursement accurately.

3. Fails to capture key details of patient conditions for recording and exchanging pertinent clinical information.

4. Limits the characters available (3-5) to account for complexity and severity.

The ICD-10 is copyrighted by the WHO. The WHO authorized a US adaptation of the code set for government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. Currently, the United States uses the ICD code set, Ninth Edition (ICD-9), originally published in 1977, and adopted by this country in 1979 as a system for classification of morbidity data and subsequently mandated as the Medicare claims standard in 1989 in the following forms:

• The 35-year old code set contains outdated terminology and is inconsistent with current medical practice.
• The code length and alphanumeric structure limit the number of new codes that can be created, and many ICD-9 categories are already full.
• The codes themselves lack specificity and detail to support the following:
• Accurate anatomical descriptions
• Differentiation of risk and severity
• Key parameters to differentiate disease manifestations
• Optimal claim reimbursement
• Value-based purchasing methodologies
• The lack of detail limits the ability of payers and others to analyze information such as health care utilization, effectiveness, changes in population disease patterns, costs and outcomes, resource use and allocation, and performance measurement.
• The codes do not provide the level of detail necessary to further improve the accuracy and to streamline automated claim processing.