F 60.9*

Let me offer a notice to trolls, or even mere jerks, who wander in. I”ll be showing you the door quickly, very quickly if it appears you are particularly stupid. I avoid pissing contests with skunks.

Let's take the example of a genius who wandered in here last June and started ranting about my comments in support of ICD-10. Only trouble was, this fool couldn't read a calendar. I had posted those remarks 14 months earlier. I didn't expect to be blogging again and I didn't keep track of my last posts. So I replied, none too nicely, asking WTF had set this jerk off and pointing out the 14 month lapse.

ICD-10 was introduced on October 1 last, with about the same amount of sturm und drang which accompanied Y2K (remember that manufactured hysteria?) It's now a very done deal, so let's recap who was agin it and why.

1. First, people in the health professions who had fears, legitimate and otherwise, about the effect of introducing a new diagnostic coding system. Some were older coders who didn't want to face learning something new. Most of them were gradually won over by discovering that it's not that much different to what they were already doing. Others were physicians who were afraid implementation would cost too much. Well, it hasn't: chiefly because coders and other health information specialists had planned for a process of holding physicians' hands during the transition.
   
   
2. One special interest group in particular opposed it. ICD-10 CM (the diagnostic system) is just one part of the coding toolbox, as was ICD-9. There is also an ICD coding system for inpatient procedures, and Current Procedural Terminology (CPT), a procedural coding system for physician practices and outpatient services. Whilst ICD is an international standard, CPT is a proprietary system owned by...wait for it...the American Medical Association (AMA). Guess which organisation has been at the forefront of opposition to ICD-10? And why? Chiefly because of persistent rumours and fears that a version of the ICD-10 procedural system could supplant CPT, at great financial loss to the AMA. In the post my anonymous ranter hated so much, I posed the question cui bono? Who benefits from the opposition to ICD-10? Well, there, now I've named the favourite heavy of most ICD-10 proponents.
   
3. Journalists of the snarky and simple-minded variety didn't exactly oppose it, but mocked it, and my troll had clearly got hold of the mockery, As a proudly recovering reporter, I don't mind saying that most journalists today are both snarky and simple-minded, and show a consistent failure to get the whole story. It's true that of itself, the introduction of ICD-10 is a non-story, less interesting than the introduction of a new brand of men's underwear. But add a clever story line that makes it look like a bureaucratic boondoggle, and it has legs.
   
   The legs are supplied by a chapter of ICD (9 and 10) called External Causes of Morbidity. In ICD-10, this is just one of 21 chapters, and the only one that doesn't deal directly with clinical diagnosis. It exists chiefly for compilation of statistical data on morbidity. Because of that, this chapter, as in ICD-9, tries to anticipate all possible external causes of morbidity, based on previous evidence. In other words, the people who put those wacky things into code did so not because they guessed that some strange thing or other might happen, but because it had happened somewhere. We work from evidence, and we don't guess. To take two examples that cause great hilarity, patients in the third world can acquire a deadly fever from being pecked or bitten by a parrot. If an one airport worker has been sucked into a jet engine, it is an indictment of that airport's safety record. The funny or supposedly useless things in this chapter are neither, although we in the business laugh too. The media neglect to mention that ICD-9 contains equally incomprehensible codes in its External Causes chapter, for that would spoil the story.
   
4. Then we have trolls like mine (let's call him Mr. Dunning-Kruger) who only know what Google tells them, and then regurgitate it like a bird or animal vomiting food for its young. Neither reporters nor the Dunning-Krugers grasp that medicine is vastly more complicated than it was in ICD-9's heyday, 30 years ago. Some people who do grasp it are offended by the increase in complexity. I think it's fucking fine that we need a diagnostic system that matches the granularity necessary in the clinic today: one that vastly increases the possible descriptions of cardiovascular disease, for example, and also simplifies the list of diagnoses for hypertension. That's what's going on in the other 20 chapters of ICD-10, and it's not foolish at all.

I'm not going to make the same mistake the troll made, and post a rant six months old. These things have a shelf life. In this case, the successful adoption of a coding system whose purpose is beyond a troll's comprehension makes his rant especially rancid.

*The title is an ICD-10 code I chose in honour of Mr. Dunning-Kruger. He threw at me the classic troll line of “Do your research,” completely overlooking the context: that I've done done my research on this topic for six years: real research, not half an hour on Google, and sat an examination on the subject. Although (disclaimer) I do not diagnose or treat disease, the code in the title seems to fit the average troll admirably. Do your research, pilgrims, and see what you think.