The ICD-9 Project, also known as the "ICD-9 CM Issue," was an internal Philip Morris project to impede the creation of a medical billing code that would indicate illnesses that are attributable to secondhand tobacco smoke exposure.
The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is a joint compilation by the National Center for Health Statistics (NCHS) and the Health Care Finance Administration (HCFA). The ICD-9-CM is an official code book that designates a code number for every medical ailment, procedure, treatment and cause known. The codes in the ICD-9 book are widely used on medical billing forms used to obtain reimbursement for treatments, medications, etc., particularly from government health programs like Medicare and Medicaid.
The ICD-9 has three types of codes: one code designates the diagnosis, another the treatment, and the third, called the E-Code, designates the causative agent of the diagnosis. The E-Code is used more for statistical purposes than for billing, but the designation of a code indicating secondhand smoke as a causative agent of disease would facilitate easier collection of statistics showing what diseases are caused by secondhand smoke, and how much secondhand smoke costs the government (and hence taxpayers) in medical expenses.
The designation of an ICD-9 code for secondhand tobacco smoke exposure in the ICD-9 threatened the tobacco industry because of liability implications, as well as workers compensation implications, due to the wide exposure of people to secondhand smoke in workplaces. Defeating the institution of such a code was the goal of Philip Morris' ICD-9 Project.
Tobacco industry documents regarding the ICD-9 Project
- The Proposal to Include Secondary Tobacco Smoke as an External Causative Agent, by Thorne Auchter of Philip Morris contractor Multinational Business Services, March 8, 1994, Bates No. 2046073521/3523] Memo to Mayada Logue of Philip Morris describing the ICD-9 situation and steps MBS had take to hinder creation of the code.
- Options, Philip Morris report dated December 1993. Bates No.2024201166. Discusses a variety of strategic options for dealing with ICD-9 Code situation.
- The power of paperwork: How Philip Morris neutralized the medical code for secondhand smoke. Cook DM, Tong EK, Glantz SA, Bero LA. Health Affairs 2005; 24:993-1004.
Abstract: A new medical diagnostic code for secondhand smoke was created in 1994, but as of 2004 remained an invalid entry on a common medical form. The process for creating and utilizing medical codes is open to influence by lobbyists with undisclosed private industry clients. Tobacco industry documents reveal that Philip Morris budgeted over $2 million for an “ICD-9 Project” in the mid-1990s. Tactics to prevent adoption of the new code included third-party lobbying, Paperwork Reduction Act challenges, and backing an alternative coding system. A secondhand smoke code should be allowed on the Medicare form, and physicians should be made aware of its utilization within the new ICD-10 coding system.