When ICD-10 Works and ICD-9 Doesn’t, or Why ICD-10 Detail is Good Stuff

While we were testing the next version of the ICD-10 MS-DRG grouper, we came across a real world record I want to share with you. It is a great example of how the detailed codes in ICD-10 will work in the data-driven world of healthcare, and why their less-detailed ICD-9 counterparts in ICD-9 don’t work well at all.

About 270,000 records into the MedPAR data we were using, our attention was drawn to the record of a severely ill patient who had pressure ulcers—bedsores—all over the place. From the ICD-9 codes on the record, we learned there were pressure ulcers at six separate sites —the upper back, lower back, hip, ankle, heel, and “other site.” We also learned there were stage 2 pressure ulcers and stage 4 pressure ulcers. Stage is essentially a measure of the depth of an ulcer, stage 4 being deepest—open craters with exposed bone or tendon…