In brief: Decoding politics
Chances are, you've probably never heard of the International Classification of Diseases (ICD) coding system, developed by the World Health Organization and used by the U.S. government and private insurers for billing and tracking purposes. But you're probably familiar with Philip Morris. According to an article in the July/August 2005 issue of Health Affairs, the giant tobacco company tried to influence the ICD system to prevent the collection of evidence linking secondhand smoke to disease.
The ICD code for secondhand smoke has existed since 1994, but a decade later it still wasn't an option on the standard Medicare billing form (the "Form 1500"). Philip Morris budgeted $2 million for the "ICD-9 Project" to stymie use of the secondhand smoke code, according to the article written by researchers at the University of California–San Francisco and based on internal company documents available from court proceedings.
The California researchers assert that Philip Morris, through a lobbyist, tried — and failed — to prevent the code's initial adoption, through a private meeting with officials at the National Center for Health Statistics and by appealing to the Office of Management and Budget. The company was successful, though, in challenging the practice of coding for external causes (so-called E codes) of disease — such as secondhand smoke — on the Form 1500. Philip Morris also backed an effort to overhaul the entire ICD system. The impact of this proposal remains to be seen.