Inconvenient, Controversial, and Demanding: The Story of ICD-10

You've probably heard a lot of discussion about ICD-10 over the last several weeks. Although the transition to these new codes sparks contentious debate about reasoning and timing, the fact is that payors and providers are going to have to make this transition at some point. But the question is¦when?

You’ve probably heard a lot of discussion about ICD-10 over the last several weeks. Although the transition to these new codes sparks contentious debate about reasoning and timing, the fact is that payors and providers are going to have to make this transition at some point. But the question is…when?

The primary reason for the transition to ICD-10 from the 30-year old ICD-9 system, endorsers claim, is that the new coding system provides much greater granularity in terms of classifying diseases and injuries. The system is already in use in Europe, and many pundits (such as Department of Health and Human Services [HHS] Secretary Kathleen Sebelius) and organizations (such as AHIMA and HIMSS) who are endorsing the swift transition maintain that it will truly revolutionize the health care system by reducing costs and improving patient care. In essence, ICD-10 is being posed as a short-term burden that will give way to vast improvements in the long term. As you might imagine, not everyone completely agrees with those sentiments. But even those that are on board think that the powers that be are missing the point in terms of realistic timing, and this is where the discussion begins to get a bit contentious, especially on the provider side.

Currently, the deadline for healthcare providers, payors, and others to switch over their claims, billing, and other systems to ICD-10 codes is October 1, 2013. With many physicians also grappling with the challenge of meeting “Meaningful Use” criteria, the overhaul of the coding system does not come at a welcome time. However, physicians’ cries do not seem to be falling on deaf ears; on February 14th, acting administrator of the Centers for Medicare and Medicaid Service (CMS) said that CMS would “reexamine the timeframe” for ICD-10. Just days later, “examination” turned to “initiation,” when Sebelius finally succumbed to pressure from the American Medical Association and announced the beginning of a process to push back the deadline.

In response, Dr. Peter W. Carmel, President of the AMA, had the following to say:

The American Medical Association appreciates Secretary Sebelius' swift response to address the AMA's serious concerns with ICD-10 implementation. The timing of the ICD-10 transition could not be worse for physicians as they are spending significant financial and administrative resources implementing electronic health records in their practices and trying to comply with multiple quality and health information technology programs that include penalties for noncompliance. Burdens on physician practices need to be reduced - not created - as the nation's health care system undertakes significant payment and delivery reforms.

With a new deadline yet to be announced, the battle continues on both sides of the argument. While the AMA is certainly happen about the prospect of a delay, AHIMA is urging HHS to stay the original course. As this industry civil war continues to progress, all those affected continue to wait for a finalized timeline. In other words, a delicate situation has now become even more delicate, and the ball is now in the court of HHS. Finding a happy medium for both sides will be equivalent to changing the tires on a moving truck; however, decisions need to be made sooner or decision makers run the risk of transitioning to a system that will be outdated by the time all is said and done. No one wants to be worrying about ICD-11 just after they finally make the move to ICD-10.