It has been 15 years since the National Committee on Vital and Health Statistics recommended that ICD-9 should be replaced, and eight years since that body recommended that ICD-10 should be adopted.
On Aug. 22, the proposed rule for Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS was finally issued. The proposal calls for replacing the ICD-9-CM for all morbidity and mortality classification, and replacing the ICD-9 procedure classification with ICD-10-PCS in acute care. The proposed effective date for the switchover is Oct. 1, 2011.
Meanwhile, the comment period ends Oct. 21 of this year.
Developed in the 1970s, the ICD-9-CM classification system does not effectively represent 21st century medical concepts and technology and therefore cannot support the many ways these data are used today. Clearly, ICD-9 lacks sufficient specificity and detail, and no longer reflects current knowledge of disease processes, contemporary medical terminology or diagnostic and therapeutic procedures. And while the diagnosis and procedure classifications have been updated nearly every year for the past 30 years, ICD-9 has, literally, run out of codes to accommodate advances in medicine and medical technology.
There is no question that the changeover from ICD-9 to ICD-10 CM and ICD-10 PCS for hospitals is a significant undertaking, but there are three key reasons why our industry needs to make this happen soon.
ICD-10-CM will provide far greater information value by better describing conditions, comorbidity and complications. ICD-10-PCS will permit comparative effectiveness research on new medical technologies. The finer detail and cleaner logic of the codes will better support clinical research. For instance, knowing whether and under what circumstances laparoscopic surgery improves healthcare outcomes as compared with open surgery would affect thousands of lives and could save billions of dollars. There are many other similar examples of very important improvements that will add real value and aid decisionmaking.
ICD-10-CM is also simply more effectively designed to capture public health diseases than ICD-9-CM. Research shows that its greater specificity more fully captures nationally reportable public health diseases, diseases related to the top 10 causes of mortality and conditions potentially related to terrorism.
Application developers will be encouraged to invest in computer-assisted coding solutions because the logical structure of ICD-10-CM and ICD-10-PCS simplifies the development of map rules and algorithms used in these applications. This will save money, improve work flow and allow highly skilled coders to move into data quality roles. In short, ICD-10 will be a catalyst for advances in health data analytics.
I have not once mentioned billing or reimbursement. Coded data are the basis for DRG-based payment systems, but disease and procedure classification (read coding) is not merely a billing function. This is a very important use that adds to the complexity of the transition to ICD-10. However, payment systems neednt be changed until sometime after the transition when there is sufficient data to develop improvements.
We have reached the witching hour on this decision. The American Health Information Management Association goes on record supporting the transition to ICD-10. Well aware of the cost, burden and nuisance of this change, the U.S. has no choice. We must end 15 years of debate and begin serious national planning for a successful transition.
Updating our information infrastructure is fundamental to healthcare reform, patient safety and quality improvement. ICD-10 is an important building block in that infrastructure.
Linda KlossChief executive officerAHIMAChicago
This story initially appeared in this week's edition of Modern Healthcare magazine.
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