Leaving the Walkman and ICD-9 Behind: Modernizing the Disease Classification System Used by Canadian Physicians

Abstract

The International Classification of Diseases, Ninth Revision (ICD-9) was released in the 1970s and adopted in Canada for physician billing claims in 1979 (CIHI n.d.b.; WHO & International Conference for the Ninth Revision of the International Classification of Diseases 1977 ). ICD-9 is no longer adequate for representing our modern healthcare environment and patient needs. We summarize the findings from a small survey of ICD-9 users across Canada – such as family physicians, researchers and decision makers – who describe the limitations of ICD-9 and the features that they would desire in a new or updated classification system.

Commentary – From Mixtapes to Playlists: Evolving Options for Capturing Diagnoses in Canadian Physicians’ Data

“…There is no obvious mechanism for considering a pan-Canadian change, though jurisdictions could explore the possibility of adopting ICD-11 for this purpose. An evaluation such as the one recommended by Garies et al (2022) would be extremely valuable, and it would complement the range of activities that currently comprise the Canadian Institute for Health Information' s (CIHI)' s assessment of ICD-11 for health system implementation. This is work on which we are collaborating with colleagues at the Universities of Calgary and Ottawa and the Canadian Health Information Management Association.…”

“…has been incorporated into the Foundation (Kühlein et al 2018), and there is hope that ICD-11 will be fit for use in the primary care context, perhaps in the form of a primary care linearization (Chute and Çelik 2021). Garies et al (2022) are right to emphasize the need for rigorous testing of ICD-11 in primary care contexts to explore the possibilities it may offer over and above its use for billing.…”

“…Still, the point is well taken: International Classification of Diseases, Ninth Revision (ICD-9) ( WHO & International Conference for the Ninth Revision of the International Classification of Diseases 1977 ) should be consigned to history. In what follows, I tease out some details of the two linked but discrete issues addressed by Garies et al (2022) : physician billing and terminological tools for use in primary care.…”

Provincial Health Systems: Are They Imploding?

“…A second Discussion and Debate paper focuses on the backbone of provincial physician remuneration systems – the International Classification of Diseases, Ninth Revision (ICD-9) classification system– by Garies et al (2022) . They argue that ICD-9 has not matured with medical and technological advances over the decades, nor does it reflect the complexity of modern patient care.…”

“… Denny's (2022) rejoinder to Garies and colleagues' (2022) paper suggests that classification systems have evolved in a number of directions, though each alternative to ICD-9 should be considered relative to its intended uses – not all of which are synonymous with physician billing. The author concludes that while ICD-9 indeed has significant limitations for physician billing, selecting from the options will require careful consideration of its uses, and provinces may differ in their priorities for classification systems.…”