Electronic Health Reporter

We are nearly three months removed from the oft discussed ICD-10 deadline, currently scheduled to take effect Oct. 1, 2015. Barring any last-minute shenanigans by those in Washington, there is little do but wait, and prepare as best as possible for the transition to the new code set in the time remaining.

While there remains plenty of activity on Capitol Hill to, in the very least, delay parts of the roll out of ICD-10, there are countless organizations and individuals who are actively lobbying against a change to the 10^th version of the International Classification of Diseases. For example, the American Medical Association has been a staunch antagonist rallying its members against the change. And, as recently as May 2015, the Heritage Foundation, with its report titled, “The New Disease Classification (ICD-10): Doctors and Patients will Pay,” made some strong recommendations against it: “While an updated diagnostic system for disease classification might be in order, there are significant costs and trade-offs,” write Heritage authors John O’Shea, MD, and John Grimsley, reported by Healthcare IT News. “To protect practicing physicians and other healthcare workers from such an unfunded mandate, Congress should delink the disparate goals of research and reimbursement, and develop a more appropriate coding system that makes the billing process less, not more, burdensome.

“In the interim, Congress should allow providers to have the choice of continuing to use the current ICD-9 system or adopt the new ICD-10 system until the alternative reimbursement arrangement is complete.”

However, given this level of dissent toward ICD-10, or the level of dissent that’s reported by the major healthcare news organizations, there’s actually a good deal of support for the change in code sets. When asked about moving ICD-10 forward or further delaying it, the responses received by Electronic Health Reporter were overwhelmingly in favor proceeding with the current timeline, and by no small margin. The following  comments from some of healthcare’s insiders provide proof of that, and show that there are those among us that want to move on as soon as possible, and put the past to rest.

Dr. Jon Elion, MD, FACC, founder and CEO of ChartWise Medical Systems
I’m in favor of the transition to ICD-10 this October. The ICD-9 code set no longer provides the level of specificity necessary to adequately account for many of the patient ailments physicians are seeing today. After 30 years, the code set is outdated and cannot describe all of the diagnoses and procedures that have been discovered or created during that time. Many codes have been “lumped” together so that meaningful statistics and data analysis are not possible. For example, suturing the aorta (largest artery in the body) has the same ICD-9 code (39.31) as suturing an artery in the hand, despite the fact that they are vastly different in the resources the hospital expends in supporting the different procedures. Furthermore, delaying the transition again will only serve to prolong the limbo hospitals, medical centers and physicians have been in for the past few years. Waiting until ICD-11 also isn’t an option as the first versions won’t be ready until 2017 at the earliest and it will be years after that before a version is prepared that will work for the complexities of coding inpatient morbidity and mortality. ICD-10 is the best option we have right now to provide the level of detail physicians and coders need to properly convey patient symptoms and diagnoses.”

Keith Eggert, FHFMA, executive vice president and general manager, healthcare, VisiQuate

“In the short term, converting to ICD-10 has been a significant undertaking for the industry. But in the long run, it’s a valuable investment because more specific Dx and inpatient procedure codes can lead to more precise diagnostic, utilization and billing data, which positively affects revenue capture. They can also have a positive impact on clinical outcomes. Fortunately, there are third-party vendors who have solutions that eliminate much of the staff time and expense needed to convert to ICD-10 manually.”

Kimberly Vegter CPC, CPC-I, AAPC certified ICD-10 Trainer; coding services for MediRevv

I can honestly say with a resounding yes, I am in support of the ICD-10 transition. At this point, I feel any provider that is not ready for the transition, will never be ready and any further delay will add more burden than relief. I have been teaching ICD-10 since 2011 and I know the providers that I spoke to before the last delay were frustrated with the amount of time and most of all money that was spent only to have it delayed one more year.

Bonnie Cassidy, senior director of health information management innovation, Nuance Communications

I strongly support the ICD-10 implementation. Many roadblocks and delays have already been put in place. While every other industrialized nation across the globe is documenting their diagnoses using ICD-10, the United States is still relying on the antiquated code sets of ICD-9, which is nearly 40 years old. This can be dangerous, especially in an industry where new discoveries are made every day. This means that when a health crisis arises, we are not able to track it the same way other countries can, by documenting a patient’s specific condition using an ICD-10 code. The disparity between the ICD-9 and ICD-10 code sets can have dire consequences when it comes to a public health threat, such as the recent Ebola outbreak. The lack of a designated ICD-9 code for Ebola posed some challenges for global agencies, such as the World Health Organizations (WHO), that document and track such diseases to ensure better public health response measures and reduce the risk of contagion. ICD-10 isn’t about getting physicians to learn anything new, it is about reminding them to document those specifics so they can be properly coded. This level of detail is an important piece of creating a robust picture of the patient’s health and is needed to ensure high quality of care is provided across the healthcare continuum. I support the change to ICD-10, as it will impact the important component in the healthcare industry’s shift from volume-based care to value-based care, and enable us to participate in global health monitoring, identifying public health threats and ensuring we have the right resources in place to deal with them readily and appropriately.

Suzi Grizancic, healthcare advisory, EY Americas

From a practical perspective, we continue to try and make our 30-year-old system of coding work, but new conditions have been discovered, new treatments have been developed and new medical devices are in use. Our current coding system is no longer able to keep pace with advancements and expansion. As a healthcare industry, both payers and providers have invested heavily in preparing for the transition to ICD-10 and have spent years in transition mode. These ongoing activities should be reflected in better preparedness, but organizations have spent more funds than anticipated and leadership teams have found it difficult to maintain priority and attention on the transition to ICD-10, as well as allocate funding because of continued delays. Additional delays would just continue to expend more funds and more energy from employees and providers without experiencing the benefits of transitioning.

Completing the transition on Oct. 1, 2015, will allow payers and providers to turn their attention to other major forces affecting the industry, such as patient-centered healthcare, transitioning new entrants into the health insurance market and helping them to navigate services, using analytics to better predict outcomes for personal and population health, and attacking healthcare costs.

Diane Harayda M.Ed., coder and former coding instructor

ICD-10 has been used elsewhere since 1994. It’s was used in early detection and classification of signs and symptoms of diseases before most cause of disease was discovered. ICD-9, currently used, has been modified for American hospital, physicians and other providers to be called ICD-9 CM (clinical modification). It has hundreds of codes and required modifications to best explain a diagnosis or procedure. ICD-10 removes those modifications and nuances. For example, there is code 824 fracture of ankle. If you add 824._ .0 to .9 the ICD will specify open or closed fracture and give you nine variations without good epidemiological statistics. ICD-10 has added numerous codes beginning with M84 that qualify if the fracture is stress, pathological, which ankle, stress or injury, etc. with nearly 300 variations.

So, yes, I support ICD-10 as we need to get on the band wagon with other countries epidemiologically and to support better financing of healthcare specific to needs and trends identified in coding.