The Next Generation of Health Condition Classification

ICD-9 codes switch to ICD-10; Requires billing system overhaul within medical community and provides new targeting possibilities for marketers

On October 1, 2015, the World Health Organization’s longstanding ICD-9 code system was officially replaced with ICD-10 (International Classification of Diseases, Tenth Revision), a major change in the way doctors describe conditions within medical billing systems. ICD-10 codes allow for far more detail, with 68,000 codes describing conditions and procedures compared to just 13,000 in the ICD-9 system, with goals of enhancing public health data, improving medical record platform interoperability and advancing the implementation of eHealth initiatives.  CPM and our media partners also use ICD coding systems to allow brands to precisely target relevant ads and marketing communications to specialized groups of physicians.

ICD-10 code structure:

“Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of any or all of the 4th, 5th, and 6th characters. Digits 4-6 provide greater detail of etiology, anatomical site, and severity.”[1]

Implications

ICD-10 impacts the way physicians describe diagnoses, allowing HCPs to more precisely code patient conditions based on severity and prognosis.

More detail will allow for greater transparency in databases like EMRs and EHRs. In this way, pharma companies and their marketers can reap benefits from the additional detail and granularity within currently available data streams. Marketers can now include or exclude targets based on the severity or progression of a diagnoses or disease state, which was not possible for many conditions under ICD-9.

According to Mary Ann Liebert, “ICD-10-CM diagnosis codes will tell the story of each patient encounter, describe etiologies of the disease process, explain the complications of care, provide a basis for medical necessity, support coverage for payment purposes, identify incidence of disease, and support statistical tracking for healthcare practices, as well as provide disease state information on medical practices across the continuum of care. The new system’s granularity will play an important role in determining the severity of the patient’s condition and contribute to research on treatment outcomes.”[2]

CPM has reached out to relevant vendors and will be monitoring how ICD-10 might provide enhanced solutions for our marketing objectives.

Additional Reference Material

www.cms.gov/Medicare/Coding/ICD10/Index.html

www.cdc.gov/nchs/icd/icd10cm.htm

Brett Landry