The National Committee on Vital and Health Statistics voted today to recommend that HHS adopt the International Classification of Diseases, 10th revision, or ICD-10, as the new coding system for the transactions and code sets rule under HIPAA.
Meeting today in Washington, D.C., the 18-member committee that advises the HHS secretary on health data and statistics voted unanimously to replace ICD-9-CM, Vols. 1, 2 and 3 with ICD-10-CM and ICD-10-PCS.
However, the NCVHS-approved letter to HHS Secretary Tommy Thompson also says, "This would not affect the usage of other code sets under HIPAA, such as CPT-4 and Level II HCPCS (Healthcare Common Procedure Coding System)."
The qualification comes as a relief to physician groups that have lobbied against a switch to ICD-10 codes for all settings and are particularly concerned about their use for physician practice. Some 55 medical organizations sent a letter to the committee on Sept. 23 stating their "strong and unequivocal position" that possible uses of ICD-10-PCS should be limited to the replacement of ICD-9-CM, Vol. 3. for inpatient hospital services.
The physicians support the continued use of CPT, or Common Procedural Terminology, which is owned and licensed by the AMA for significant income. They argue that ICD-10-PCS never was designed or intended to describe professional services and lacks provisions for coding evaluation and management services and codes for certain specialties.
"PCS is not equipped to handle physician services," says Jack Emery, assistant director for federal affairs for the AMA. "The committee knows this, and the department knows this. We are pleased the committee confined its recommendation to inpatient hospital care."
NCVHS chair John Lumpkin, M.D., senior vice president and director of the health care group at the Robert Wood Johnson Foundation, says the committee's finalized letter of recommendation likely will be signed and sent to Thompson by the end of this week.
"We'll make the recommendation that will continue to keep the United States in sync with the rest of he world," Lumpkin says. "It will allow us to overcome obstacles that an antiquated system like ICD-9 has presented."
The committee's letter says ICD-9-CM has structure and space limitations that constrain its ability to accommodate advances in medical knowledge and technology. Potential benefits of adopting ICD-10-CM and ICD-10-PCS as replacements, the committee says, include quality and safety improvements, fewer rejected claims, improved information for disease management and more accurate reimbursement rates for emerging technologies.
The benefits "appear to outweigh the costs," the NCVHS letter says.
But a report from the BlueCross BlueShield Association, released last week, says the switch to ICD-10 could cost the healthcare system as much as $14 billion and that spending over a two- to three-year adoption period could be costlier than healthcare industry preparations for Y2K.
A study by RAND, commissioned by NCVHS, estimates the cost of implementation in the hospital setting could range from $425 million to $1.5 billion, plus $5 million to $40 million a year in lost productivity. However, the RAND analysis also concluded the benefits of adopting ICD-10 could range from $700 million to $7.7 billion.