A recommendation by a presidential advisory committee has the folks who developed the Snomed clinical terminology beaming and officials of a trade association of healthcare workers who deal with medical codes a bit concerned.
A subcommittee of the President's Information Technology Advisory Committee, or PITAC, released a list of draft recommendations calling for broad federal support for healthcare information technology, including one encouraging the government to perform a cost-benefit study of using Snomed Clinical Terms as an alternative to switching to the International Classification of Dis-eases, 10th Revision, Clinical Modification coding system.
In November 2003, the National Committee on Vital and Health Statistics voted to recommend that HHS adopt ICD-10 to re-place several of the decades-old ICD-9-CM code sets as the new transactions and codes sets under the Health Insurance Portability and Accountability Act of 1996. Cost estimates for the conversion range from $425 million to $14 billion.
Northfield, Ill.-based Snomed International, which developed Snomed CT, is a division of the American College of Pathologists. The idea of the cost-benefit study of Snomed CT and ICD-10 intrigues Snomed officials.
Experts generally agree the Snomed terminology is more complex and precise-the term "granular" is commonly used-than the ICD-9 codes now in use or even the ICD-10 codes. The argument is whether Snomed CT could fully substitute for ICD-10, as the presidential advisory committee's study recommendation implies.
Officials from Snomed and the American Health Information Management Association, a trade group of 46,000 medical records professionals, disagree.
"It's something we ought to test," says Kent Spackman, M.D., chairman of the editorial board of Snomed and a professor of pathology and medical informatics at Oregon Health & Science University, Portland. "What this PITAC recommendation is saying is people are willing to take a look at where we're going and maximize our resources. That's a very positive direction."
But Snomed is too fine, too granular for use as a reimbursement coding system, says Dan Rode, AHIMA's vice president of policy and government relations. "There's a misnomer that you can just put Snomed in and not do ICD-10 at all," Rode says. "You wouldn't want to adjudicate a claim in Snomed. It's way too gritty."
Linda Kloss, AHIMA's executive vice president and CEO, sent a letter to PITAC subcommittee co-chairman Jonathan Javitt, M.D., expressing "strong opposition" to the Snomed study.
Spackman advocates using Snomed for clinical applications and building translations, or mapping systems, to the new billing codes. Snomed already is mapped to ICD-9, he says, and a computer could combine the many Snomed codes into fewer ICD-10 codes for public health and billing purposes.