ICD-11 and Acupuncture

Dec 1

Abstract

The International Classification of Disease codes exists to identify a disease for research and clinical situations internationally. On January 1, 2022, a new revision will be adopted that includes many traditional medicine diagnoses that fall within the scope of practice for an acupuncturist. This is a huge step for acupuncture, otherwise known as traditional medicine, to validate philosophies and techniques, draw funding towards research, and potentially increase insurance reimbursement. This paper will outline how the new ICD-11 codes will affect the traditional medicine community and what practitioners must do to encourage the quick implementation of the codes to overcome community concerns.

ICD-11 and Acupuncture

The International Classification of Disease (ICD) consists of a full collection of diagnostic codes that are used globally and maintained by the World Health Organization (WHO) as the standard for all research and clinical situations. Having this international list allows the world to better understand how diseases work, how people are affected by it, and where it is most prominent. With a long history of existence, beginning as the International List of Causes of Death in 1893, traditional medicine has not been included in the ICD codes until the 11th revision.

On May 25, 2019, the WHO voted to implement the new ICD-11 and put it into effect by January 1, 2022, allowing each country to transition at their own pace (2019). The inclusion of traditional medicine in ICD-11 is a monumental step for complementary and alternative medicine, like acupuncture and herbalism, worldwide. It means that diagnostic patterns widely used in the traditional medicine community are being integrated and accepted by mainstream medicine, which will lead to, at minimum, more funding for research and more reimbursement options. In addition to including more diagnostic codes in the IDC-11 revision, it has also changed to a completely digital format, making statistical health information easier to access.

Clinical Practice

To remain in compliance with charting performed in a hospital setting, billing requirements, and legal patient documentation to support herbal formulas, acupuncture, or other TCM modalities, it is important to provide traditional medicine diagnosis and ICD codes. In clinical practice, acupuncture practitioners are limited to using symptomatic codes rather than actual western diagnosis. In an interview with Galina Roofener, L.Ac, she uses the example of having to use an ICD code for a cough rather than pneumonia to remain within the scope of medicine for acupuncture practitioners (Rosen, S., 2016). When acupuncture practitioners have a diagnosis rather than symptomology that they can use in coding, it will allow the WHO to assess how many patients suffering from this diagnosis seek acupuncture for treatment.

Funding for Research

Emphasizing funding for traditional medicine could ultimately save money in health care by providing scientifically valid options for preventative medicine and expanding the understanding of herbal formulas' mechanism of action.

The practice of acupuncture and traditional medicine is already widely accepted but needs further research to continue to be validated by the western community.

According to a study by the WHO, in some Asian and African countries, 80% of the population uses traditional medicine as the primary source of health care (World Health Organization, 2019). With these overwhelming statistics, it is necessary to continue validating traditional medicine to benefit practitioners and vulnerable populations in need of alternative options for health care. While the vast majority of funding in the overly exhausted American health system goes towards technology, costs would go down if an emphasis is put on preventative modalities such as those that traditional medicine can provide.

Significant herbal practices continue to influence western medicine and the pharmaceutical industry. A plant commonly used in Chinese medicine for 2000 years, Artemisia, has even led to the discovery of new antimalarial drugs. More funding for research could lead to even more potent discoveries in the western pharmaceuticals while validating the use of raw herbs.

Reimbursements

Insurers primarily base their reimbursements on ICD codes, while public health organizations use the data to distribute health resources. ICD codes are used in conjunction with Current Procedural Terminology (CPT) codes for billing in the United States. CPT codes are used to determine procedures used to treat diseases that fall under the ICD. While CPT codes for acupuncture have existed since 2005, the ability to use them with proper traditional diagnoses, like Liver Qi rising, will be a new development. It is also likely that more CPT codes will be developed to support the treatment of traditional medicine's diagnoses to include herbal prescriptions, moxibustion therapy, or cupping therapies.

Concerns

While the benefits of the updated ICD-11 codes are extensive and include recognition in mainstream medicine that would lead to more research and reimbursements for practitioners, there are still concerns. The WHO has concluded that although ICD-11 codes will be available by January 1, 2022, there will not be a strict date as to when they will go into effect. Each country will be able to transition to adopting them at their own speed. Many countries still use ICD-9 codes and have never adopted IC-10, which raises concerns regarding how quickly they will be implemented.

Because there are few scientific studies to confirm a traditional diagnosis, there is room for practitioners to diagnose the same patient differently. Different schools of thought exist worldwide regarding how to identify disease in the traditional patient base. Ultimately this room for error in diagnosis could lead to a misrepresentation of world health statistics.

Solutions

It is the responsibility of those who will benefit from them to pressure the U.S. Department of Health and Human Services for a quicker transition to ICD-11. Acupuncture practitioners can join state boards and form stronger committees to help protect and support their practice.

For acupuncture practitioners to take advantage of this open door that will affect validity in the medical community, more funding, and more research, they will also need to educate themselves. This includes reviewing the new electronic ICD-11 book and actually using the diagnostic codes when billing insurance or providing superbills. Updating patient record systems to be strictly electronic will also help the TCM community obtain more research data that can be used globally to understand traditional methods better.

It is also necessary for practitioners to follow up with insurance companies and ensure that they play their part through nonbiased reimbursing. Ultimately, the system's success lies in the responsibility of practitioners to stand firm and man together to continue the acceptance of traditional medicine and equal fairness in opportunity.

Community Education

Educating the community regarding the growing validity of TCM in the medical system is also necessary to achieve optimal outcomes. This can be done by hosting informational workshops at Medical Doctors clinics or community events like weekend markets. The success of ICD-11 codes being implemented quickly and efficiently does not have to lie exclusively on the practitioner. The more community members that can become aware of traditional medicine's acceptance in the classification of disease, the easier it will be to get the ball rolling.

References:

Shellie Rosen, (2016) Acupuncture Today Vol. 17, Issue 04

https://www.acupuncturetoday.com/mpacms/at/article.php?id=33171

World Health Organization, (2019.) World Health Assembly update.

https://www.who.int/news-room/detail/25-05-2019-world-health-assembly-update.

admindxrw, (2019) World Health Assembly adopts ICD-11: When will member

states start using the new edition? https://dxrevisionwatch.com/2019/06/17/world-health-assembly-adopts-icd-11-when-will-member-states-start-using-the-new-edition/

World Health Organization. (2019) ICD-11 Joint Linearization for Mortality and

Morbidity Statistics: project plan 2015–2018.

https://www.who.int/classifications/icd/revision/icdprojectplan2015to2018.pdf. Accessed 06 November 2020.

World Health Organization (2019) ICD-11 Implementation or Transition Guide

https://icd.who.int/docs/ICD-11%20Implementation%20or%20Transition %20Guide_v105.pdf