New Coding System Must Be Adopted, Experts Say

NEWS TRENDS

Frahler: ICD-9 does not account for implantable devices.

The United States, home to manufacturers that develop some of the most novel medical devices in the world, is far behind in adopting a coding system that many other countries have been using for more than 10 years. Industry was urged to push for an upgrade to the newer system by speakers at the Medical Device Manufacturers Association's (MDMA's) annual Coverage, Reimbursement, and Health Policy Conference in November. Adopting a better system could reduce reimbursement headaches for device manufacturers, they said.

Developed by WHO (Geneva), the International Classification of Diseases (ICD) 9th Edition has been used by the United States since 1979. The coding system is for specifying payment, determining coverage, reporting statistics, and assessing quality.

In 1994, WHO member states began using ICD-10, an updated coding system. The United States is the only one of the world's eight largest economic powers that has not adopted the newer version. One of the problems with ICD-9 is that it doesn't accurately reflect emerging technologies. It has no way to account for implantable devices, said Jori Frahler, director of federal affairs at MDMA. ICD-9 is a five-digit system that has only 24,000 diagnosis codes, whereas the ICD-10 Procedure Coding System is seven digits and has more than 200,000 codes. ICD-10's structure provides a more-detailed description of procedures, added Frahler.

According to a 2003 statement from the National Committee on Vital and Health Statistics, ICD-9 is “increasingly unable to address the needs for accurate data for healthcare billing, quality assurance, and health services research.” It is in the “best interests” of the United States to move quickly to replace it.

Both HHS and Congress have discussed the adoption of ICD-10. Last July, the House of Representatives passed the Health Information Technology Promotion Act of 2006, which requires the implementation of ICD-10 by October 1, 2010. However, under the current law, the Congressional Budget Office expects it to be adopted by the end of FY 2012.

Despite monetary disadvantages cited by opponents—a study by Rand Corp. (Santa Monica, CA) priced the implementation of ICD-10 between $425 million and $1.15 billion—industry needs a system that is interoperable, accurate, and reflects 21st century medicine, urged Dan Rode. Rode is vice president of policy and government relations at the American Health Information Management Association (Washington, DC).

Opponents of ICD-10 should also consider that WHO no longer supports ICD-9, said Rode. And with fewer than 50 codes left in the current system, codes are running out.

Industry has a lot of work to do to push ICD-10 adoption, said Rode. Aside from continuing to educate the government about the need to upgrade to ICD-10, Rode suggested that data vendors begin building the capacity to handle ICD-10 classification and terminologies.