Shirah Vollmer MD

The Musings of Dr. Vollmer

ICD-10 Is Here!

Posted by Dr. Vollmer on October 7, 2015

ICD-10 has arrived, October 1, 2015, changing our charting system, creating a much more detailed diagnostic system. Instead of saying, for example, that a patient has “polysubstance abuse,” I need to say they have “cocaine use disorder-severe, alcohol use disorder-severe, cannabis use disorder-severe, Tobacco use disorder-severe,” etc. Theoretically this new diagnostic system will create a more accurate database in which to do research studies on disease trends. I am excited by that prospect, but at the same time, this added detail adds inaccuracies. In the case of substance abuse, it is more accurate to say “polysubstance abuse,” as most drug addicts use a variety of drugs at different times during their years of addiction, and so to write each drug separately does not convey the narrative of their journey from prescription opiates to street heroin and back to prescription drugs. In general, more specificity is helpful, but people are not robots and being specific can come at the price of the nuances in their history. I return to the major thrust of this blog. The history remains the most important part of psychiatry and now with ICD-10, there will be more focus on a reductive approach to diagnosis and treatment. The narrative gets lost for the sake of big data. For other areas of medicine, where there are objective findings, more specificity makes sense. For psychiatry, it will be garbage in, garbage out, as computer programmers like to say. ICD-10 has a broad reach, and as such, psychiatry should not be included in this wide net. Our field remains in its infancy. We are not ready for the adult table. Once again, I think we should be honest about that.

2 Responses to “ICD-10 Is Here!”

  1. Shelly said

    Who will use ICD-10, physicians or the insurance companies? Will it be for physicians to use the results to increase research manuscript writing? Why do you need to be so exacting? Would you ever need to be so exacting as to say, “cocaine use disorder-severe, alcohol use disorder-mild, cannabis use disorder-intermediate, etc…?” How is ICD-10 different than the DSM?

    • For now, insurance companies are using it for billing, but in the future it will be used for research purposes. The more exacting diagnosis allows for more precise data analysis. DSM is more general, and so now we must specify more details about the diagnoses, but since our diagnoses are so vague most of the time, it is very hard to do that. Thanks.

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