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45% % 21% 37% Key: lth The implementation of ICD-10 portends deep changes in how we quantify health trends in the United States. The United States implemented ICD-10 for mortality reporting in 1999. The National Center for Health Statistics found substantial discontinuities in cause of death trends when they analyzed the same set of deaths by each code set. Will ICD-10 lead to changes of the same magnitude when we look at population morbidity? Deaths due to diseases of the heart decreased 1.5%. ICD-9 624,405 ICD-10 615,564 ICD-10 focuses on the underlying causes of heart disease deaths. Chronic respiratory disease deaths increased by 5%. ICD-9 90,022 ICD-10 94,326 Many of these deaths were attributed to pneumonia in ICD-9. Bronchitis deaths decreased by 60%. ICD-9 2,320 ICD-10 913 ICD-10 codes this cause of death as Other—specified chronic obstructive pulmonary disease. Chronic liver disease and cirrhosis deaths increased 4%. ICD-9 20,920 ICD-10 21,688 ICD-9 coded many instances of death due to liver disease and cirrhosis as resulting from alcoholism. Septicemia increased 20%. ICD-9 17, 791 ICD-10 21, 258 ICD-9 prioritized pneumonia over septicemia when both contributed to the death. HIV deaths increased 6%. ICD-9 23,586 ICD-10 25,089 In ICD-9, only certain cancer deaths could be attributed to HIV. In ICD-10, any neoplasm sequelae to HIV could be reported as a HIV death. Syphilis deaths decreased 37%. ICD-9 33 ICD-10 21 Sequelae of syphilis were recategorized in ICD-10. Alzheimer's deaths increased 55%. ICD-9 19,121 ICD-10 29,707 Many instances of Alzheimer's were categorized in ICD-9 as dementias or psychotic conditions. Deaths due to falls decreased 16%. ICD-9 6,152 ICD-10 5,173 In ICD-9, falls were the default cause of unspecified fractures. Intrauterine hypoxia and birth asphyxia deaths increased 45%. ICD-9 277 ICD-10 401 Hypoxic ischemic encephalopathy, respiratory problems after birth and some other conditions were reassigned. Even a change to a new version of the same code set can have dramatic results. When the United Kingdom moved from ICD-10 v2001.2 to v2010 public health reporting experienced spikes and dips, according to the UK Office for National Statistics. Mental and behavioral disorders increased 32%. Many of these Alzheimer's-type deaths were attributed to cerebrovascular disease under the previous version. Under v2010, they were corrected to vascular dementia. Diseases of the genitourinary system decreased 21%. Tables were modified to allow a death certificate recording both urinary tract infection and dementia to assign dementia as the underlying cause of death. MDNEWS.COM I MD NEWS Twin Cities | 31

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