An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

Medical coding systems originated at the time of the bubonic plague. In the 1890s the French physician and statistician Jacques Bertillon further systematized death reporting by introducing the Bertillon Classification of Causes of Death, which was adopted and modified in many countries. It became an official global effort, which was periodically revised by an international commission. During the first half of the twentieth century, the number of entries naturally increased with improved understanding of science, and many countries began tabulating not just causes of deaths but also the incidence of diseases. In 1948 the World Health Organization took over stewardship and gave Bertillon’s system a new name to reflect a new broader focus: the International Statistical Classification of Diseases, Injuries and Causes of Death (ICD). The codes became an invaluable tool, a common language for epidemiologists and statisticians to use when tracking the world’s afflictions. But in the United States, the codes gradually took on a bedrock financial function as the basis for medical billing. In 1979 the U.S. government decided to use ICD codes in adjudicating Medicare and Medicaid claims, with some modifications added specifically for that business purpose, so the U.S. version is called ICD-CM. Other insurers followed. In multiple volumes, the U.S. version not only categorized and number-coded diagnoses but also introduced codes for procedures.