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Why ICD-9-CM Needs to be Replaced

The ICD-9-CM coding system is in serious crisis. Developed in the 1970s, it no longer fits with the 21st century healthcare system. ICD-9-CM should have been replaced 10 years ago. ICD-9-CM is used for many more purposes today than when it was originally developed and is no longer able to support today’s health information needs. The US is virtually the only industrial nation that has not upgraded its morbidity classification system. This failure threatens our ability to track and respond to international public health threats. Continued use of ICD-9-CM also diminishes the value of the US investment in SNOMED-CT®. The anticipated benefits of an electronic health record cannot be achieved if SNOMED-CT® must be aggregated into an antiquated classification system.

Specifically, ICD-9-CM:

• Lacks insufficient specificity and detail,
• Is running out of space, and the limited structural design cannot accommodate advances in medicine and medical technology and the growing need for quality data,
• Is obsolete and no longer reflects current knowledge of disease processes, contemporary medical terminology, or the modern practice of medicine,
• Hampers the ability to compare costs and outcomes of different medical technologies, and
• Cannot support the US transition to an interoperable health data exchange in the US

Replacing ICD-9-CM with ICD-10-CM is necessary in order to maintain clinical data comparability with the rest of the world concerning the conditions prompting healthcare services. The longer the healthcare industry continues to use ICD-9, the more difficult it becomes to share disease and mortality data at the time when such global data sharing is critical for public health. For example:

• ICD-10-CM would have better documented the West Nile Virus and SARS complexes for earlier detection and better tracking
• ICD-10-CM also provides the ability to track bio-terrorism events and other public health outbreaks.

The need to replace ICD-9-CM was identified more than 10 years ago, in 1993, when the National Committee on Vital and Health Statistics (NCVHS) reported that ICD-9-CM was rapidly becoming outdated and recommended immediate US commitment to developing a migration to ICD-10 for morbidity and mortality coding. Similarly, the Health Care Financing Administration (HCFA), now the Centers for Medicare and Medicaid Services (CMS), recommended that steps should be taken to improve the flexibility of ICD-9-CM or replace it with a more flexible option sometime after the year 2000.

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