ICD-10 Debate Receives Renewed Attention

Now more than 15 years old, the International Classification of Diseases version 10 (ICD-10) and its yet-to-be-implemented status in the United States are well-worn topics of debate among medical device executives and other industry stakeholders. But in light of pending legislative initiatives calling for expedited implementation and current efforts on behalf of health insurers to further delay ICD-10 in the United States, the topic is receiving renewed interest from parties on both sides of the issue.

“Moving to ICD-10 is not an if, but rather a when,” says Jo Ellen Slurzberg, vice president of reimbursement and health policy for Almyra Inc. ( Boxborough, MA). “The current system is antiquated and the United States really pales in comparison to the rest of the Group of Eight world powers. All of the other G8 countries—Canada, France, Germany, Italy, Japan, Russia, and the United Kingdom—have already moved on to ICD-10 for diagnosis codes. U.S. adoption is just critical from a safety and world health perspective.”

At the end of May, America's Health Insurance Plans (AHIP; Washington, DC), a national association of health insurers, released a statement advocating a longer transition period to ICD-10 than would be put in place by pending legislation. Released in conjunction with a new study from IBM Corp. that recommends adoption of the new system beginning in 2012, the AHIP statement says that a gradual transition to the new coding system is necessary in light of the substantial undertaking required of healthcare stakeholders.

“This massive effort of moving from 24,000 to 207,000 codes calls for all healthcare stakeholders to completely rework operations for claims processing, provider contracting, medical management, quality reporting, information technology, disease management, and other business and healthcare activities,” said Karen Ignagni, AHIP president and CEO. “Planning for an adequate implementation period will help provide a smooth transition to the new codes by allowing for pilot testing that will help minimize unintended consequences for consumers, physicians, and other providers without unnecessarily increasing administrative costs.

“Before this implementation period can begin, the nation first must adopt the new version of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) electronic transaction standards (ANSI X12 v.5010), which will require at least two years,” she added. “The 5010 transition is an essential first step in achieving the goals of any legislation that seeks to transform health information technology.”

The AHIP release falls in line with a statement issued several months ago by the Blue Cross and Blue Shield Association. In that document, the association expressed concern over a provision in the Health Information Technology Promotion Act of 2006 (H.R. 4157), proposed legislation that was approved by health subcommittee and referred to the House Committee on Ways and Means in June. The provision questioned by Blue Cross and Blue Shield would require all providers and payers to switch from ICD-9 to ICD-10 billing codes by October 1, 2009. The bill has received significant support from the medical technology industry.

“To recognize changing technology, the healthcare blueprint must from time to time be affirmatively adjusted,” says Ted R. Mannen, a member of Epstein Becker & Green PC and managing director of EBG Advisors Inc. (Washington, DC). “If this doesn't happen, the blueprint will remain locked into yesterday, oblivious to technologies that have advanced beyond the established categories and codes. The transition to ICD-10 is an important example of this adjustment process. Indeed, the need for ICD-10 is graphically underscored by the fact that the ICD-9 code series is literally running out of space to house references to new technologies and services.”

“It used to be that new procedures were fairly readily granted ICD-9 procedure codes when they were submitted,” Slurzberg says. “This is no longer the case. This means that the newest procedures are currently the least likely to be adequately tracked in the inpatient setting. The lack of specificity leaves too much room for interpretation, and this results in inaccuracies and misrepresentation.

“Given the proposed changes in the inpatient prospective payment system (IPPS) to refine the diagnosis-related groups (DRGs) to be cost-based and severity-based, it would be very important to merge the move to ICD-10 with the implementation of the revised IPPS,” Slurzberg adds. “There is no doubt that implementation of both systems will be costly and will require retraining of staff—providers, doctors, nurses, codes, billers, and so on. It seems counterintuitive to implement these systems in silos since the benefits of each will be enhanced by the other.”

Slurzberg says that 2012 is too late for the implementation of both systems—and that a compromise is critical. “2010 seems to represent a timeframe that is reasonable for both,” she says. “This would allow hospitals to implement the changes simultaneously and train personnel on both systems together. It would also avoid the inevitable confusion that would result in implementing a revised DRG system and later changing the very codes that feed that system.”

© 2006 Canon Communications LLC

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