Filtering the Muddy Waters of the ICD-10 Debate

The American Medical Association (AMA) has taken a strong position against implementation and adoption of ICD-10. The dust had settled after their resolution at their 2011 Interim Meeting in November, mandating that the group "vigorously work to stop the implementation of ICD-10 and reduce its unnecessary and significant burdens on the practice of medicine”.  This week, they asked the Speaker of the House, John Boehner, to stop the ICD-10 implementation so the healthcare industry can instead update ICD-9.

No surprise

The AMA’s formal opposition to ICD-10 comes as no surprise to those of us with a long career in the healthcare industry.  Regulatory requirements in healthcare are always met with opposition which threatens to pull us off course.  In the latest debate:

AHA

The AHA supports ICD-10 in theory, but is concerned that ICD-10 is a critical factor in achieving Stage 2 Meaningful Use and believes the Meaningful Use deadline should be extended.

CMS

CMS has proposed to extend the Stage 2 deadline to 2014. 5010 transactions, which are a prerequisite to ICD-10, had a deadline of Jan 1, 2012, but as of now, that deadline has been delayed to April 1, 2012.

American Academy of Professional Coders

Some in the industry, such as the American Academy of Professional Coders, say coding productivity will be permanently impacted with the move to ICD-10, which can be used as another argument to delay. The American Academy of Professional Coders uses Canada, who has already adopted ICD-10, as an example for loss in productivity. While a decline in productivity goes against the goal of cost reduction, it hasn’t seemed to be a critical consideration in regulatory requirements.

How do those of us in the midst of ICD-10 implementations sift through the opposition?  How do we move through these muddy waters? 

Stop asking “what if” because —ready or not—

History has shown me that we should continue to embrace ICD-10 because — ready or not — here it comes. What we should be asking is the same question we have been asking all along: “Is my healthcare organization ready for ICD-10?” The deadline is still October 1, 2013. Of course, there are a lot of what ifs to the deadline—what if it’s pushed back, what if the requirements are changed, what if…? As organizations we should be planning for the most likely, not the what ifs.

Minimize the chaos through reverse engineering

History also shows us that regardless of “The Date”, not everyone will be ready. Our plan should be focused on minimizing the chaos. I suggest organizations prepare to support two coding methods. The current focus is on converting from ICD-9 to ICD-10, when perhaps we should be reverse engineering from 10 to 9. There are many training classes available for coders, and if the productivity declines as predicted, more coders will be needed.

 An organization that starts now with ICD-10 can take advantage of having the coders use their newfound ICD-10 knowledge before it becomes stale. They will also be able to build staff now to meet the new demand instead of begging for resources when the shortage becomes a reality. As we begin to use the ICD-10 coding system, the documentation deficits will come to light. This will help build the content requirement in our EMRs. All of this can be accomplished in a thoughtful manner if we drive the process.

Once we clear our vision, we can see that the most important outcome is a successful integration of ICD-10 into the clinical workflow. And that effort can begin now.