Talk to your doctor and ask about how much time is spent on the 21st century’s version of paperwork. Also ask about the sense of satisfaction he gets from spending more time in front of a computer than he does interacting with his patients. Having just been confronted with with ICD 10, which contained an exponential increase in the number of codes from ICD 9, the physician is now being told that ICD 11 is coming in 2022.
The International Statistical Classification of Diseases and Related Health Problems (ICD), is a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Work on ICD-10 began in 1983 and was completed in 1992. The US to its credit did not mandate use of the coding system until 2015. But we finally caved in moving from 15,000 codes to about 150,000. Now we’re about to update the system to ICD 11 which will bring another exponential increase in the number of codes. You can read all about our steady coding progress in this article by Margaret Skurka, MS, RHIA, CCS. I’m not sure what all the letters after her name signify, but she’s billed as “Coding educator and consultant [in] Chicago, Illinois.”
Thus, she personally gains in direct proportion to the complexity of the coding system while being free from the mayhem it causes physicians who have to use it. The US has successfully put soccer in its proper place unlike the rest of the world, but we can’t evade the coders and others who want to make the world safe for bureaucracy. You will doubtless be relieved to know that Video Game Addiction has been added to the new codes.
Ms Skurka quotes the AMA’s reaction the new and improved system:
There is a long way to go before the World Health Organization finalizes the eleventh edition of the ICD code set. With actual implementation still several years away, now is the time for US physicians to work with their national medical specialty societies and the National Center for Health Statistics at the CDC to shape how ICD-11-CM is developed for the US healthcare system.
So I can see all those busy, but enthusiastic docs, delirious with delight lining up at the offices of their various specialty societies, red cheeked with post it dotted papers clutched in their callused typing fingers ready to help the National Center for Health Statistics freshen the latest draft of the ICD 11. You can readily understand why membership in the AMA is steadily declining. Oh, if only Wordsworth were still alive: “Bliss it was in this dawn to be alive. But to be young was very heaven.”
Ms Skurka is charged with excitement about these new codes:
Didn’t we just go to ICD-10 in 2015? Yes, we did. But the WHO’s process to implement ICD-10 began way back in 1992. It took the United States 23 years to adopt it; we finally did so in 2015. We were the last country in the world to move to ICD-10. If we follow that same pattern of being the last country to adopt, we won’t have ICD-11 until 2041.
We can’t allow that to happen. Good data are too important. The purpose of ICD and the WHO sponsorship is, in the CDC’s words, to “promote international comparability in the collection, processing, classification, and presentation of mortality statistics.” Revisions to the ICD are implemented periodically so that the classification more accurately reflects current advances in medical science. We need to be on the same system as the rest of the world for data comparability.
God, the romance of this entire enterprise has me vibrating with anticipation of the excitement that these new codes will introduce into the practice of medicine. Especially, as I’m retired and won’t have to deal with them. Well, I will have to listen to my former students complain about them. But this number of complainers is rapidly diminishing as they rush to early retirement.
The title of this screed contained “The Banality of Evil” a phrase popularized by Hannah Arendt referring to really big league evil. I wouldn’t for a moment suggest that Ms Skurka is any was comparable to those about whom Ms Arendt wrote . I’m sure she’s a really good person, who buys Girl Scout cookies and who has a well behaved dog, and who thinks that she’s contributing to the general good by playing her small part in binding modern society with the chains of Prometheus. She’s an enabler in the terminology of video game addiction or something close to it. She’s just doing her job. After all, is she didn’t do it somebody else would. Arendt screwed up big time by linking banality and true evil. If banality is your goal, look to the bureaucrats who write, enforce, and endorse the infinity of little rules and petty regulations that litter our lives like crabgrass on a putting green.
No important enterprise can be left alone for an instant, for if liberated it will surely run amok like a toddler driving a tank. ICD 11 is said to contain 1.5 million codes. I don’t know or care if that’s the right number. This number might be worth the fuss if it had a net positive balance. But no one in favor of systems like the ICD or its myriad doppelgängers ever bothers to measure the beneficial, or opposite, effect of the deluge of impositions they impose on society. All that counts is good intentions, which in the mind of poor Ms Skurka whom I’m probably unfairly picking on will vastly increase the common good. When in doubt regulate, but not evaluate.
Banal is as banal does; it’s just one more step back to cave 57. If you don’t get the reference, check with Mel Books.