ICD-10: Is it for clinicians or reimbursement?

There's a division among physician informaticists about whether the national conversion to ICD-10 should—or even will—take place next year, despite the latest line in the sand deadline by the CMS for compliance by Oct. 1, 2015.

The bigger issue at play here is whether a new diagnostic coding system should first answer doctors' needs for care delivery, or answer healthcare business needs for a system that facilitates reimbursements for care.

While many physician informaticists may be resigned to the fact there will be a conversion, that doesn't mean all are happy about it, said Dr. William Bria, president of the Association of Medical Directors of Information Systems, a professional association for physician informaticists.

The CMS Thursday issued a final rule on ICD-10, providing only the minimum amount of delay permitted by Congress in March when it pushed back for at least one year the conversion date from the previous compliance deadline, Oct. 1, 2014.

“Part of the government's problem is that the delay gives people a chance to think about it,” Bria said. “Now, there's the opportunity for people to say, wait a second.”

Not that change isn't needed. The ICD-9 coding system in current use can't distinguish between the right eye or the left, for example, and that is “a travesty. It's a joke,” Bria said. On the other hand, the more complex ICD-10 coding system isn't the first choice for physicians, who instead favor the even more fine-grained SNOMED clinical coding system.

The choice between SNOMED or ICD-10 reflects “the dichotomy in American healthcare,” Bria said, a choice between clinicians' needs for a coding system, “a way of making sense of the world for delivering care, understanding disease processes, what services we're providing, how does it turn out, what did you use,” and the business need “to account for services rendered and, therefore, reimbursement.”

“If we're trying to disambiguate the costs of healthcare with the services rendered, then why are we trying to confuse the situation?” Bria said. “Why don't you use the one that makes more sense to the people who actually know healthcare?” which, to Bria's way of thinking, is SNOMED and clinicians.

The 47,000-member Texas Medical Association has been in the forefront of AMA affiliates pushing back on ICD-10.

With ICD-10, “We're implementing something that's 25 years old,” said Dr. Joseph Schneider, chairman of the TMA's practice management committee. “It predates modern health information technology.”

“We have so much to concentrate on, including implementing SNOMED, let's make ICD-10 optional and work like banshees to get ICD-11 implemented as quickly as we can,” Schneider said. “If it's optional, some people will do it.” That way, those innovators can learn what's good and bad about ICD-10 “and that will help us get to ICD-11 quicker.”

While the CMS has set yet another ICD-10 compliance date, Schneider said Congress may not be through with the controversy.

“I wouldn't be surprise before the midterm (elections) that there is one more run at getting this put off again,” Schneider said. “I would give it a 60-40 chance that it's going to happen, or at least someone will try to make something happen.”

“Obviously, all of us are back in the mode of preparing for October of next year, but we're also limiting exposure,” Schneider said. “I'm advising the TMA to not give courses on ICD-10, but steering people to other people's courses.” That way, the society isn't on the hook, spending for training programs if the deadline is delayed yet again, he said.

Follow Joseph Conn on Twitter: @MHJConn