Healthcare software colleagues of mine often describe a recurring discussion they have with their outsourced development teams. They recount that when they try to explain the difference between a billing diagnosis and a clinical diagnosis, the engineers on the other end deliver a common platitude: “a diagnosis is a diagnosis.” 

That answer is defensible in ordinary English. In healthcare data, however, it is wrong in a way every team that accepts it inherits. The formal name of the “diagnosis” system is the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Statisticians created it in 1893 to count causes of death, and around 1938, leaders suggested that the codes might be useful to health insurers. Medicare then tied hospital reimbursement to those codes in 1983, and the rest is history.

Accordingly, I have started referring to ICD-10 as a billing category rather than a diagnosis code. Colleagues tell me the phrasing sounds pedantic, but we have all witnessed what has happened due to this lack of differentiation. Software analysts carry the loose usage into product requirements documents, data dictionaries and integration specifications. Developers then build software that treats a category as though it were a clinical finding. We are all suffering the consequences of asking a statistical instrument to carry the complexity and nuance within clinical meaning.

The vocabulary distinction reminds me of when clinical informaticists once asked each other whether they were groupers or splitters. Groupers gather related conditions under a shared heading, while splitters separate them down to the specific entity.

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