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Clearing the Air on the ICD-10 Transition: AHIMA’s Policy and Coding Leader Speaks Out

September 12, 2014
by Mark Hagland
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AHIMA’s Sue Bowman shares her perspectives on the current moment in the journey towards the ICD-10 transition

When, this March, the U.S. Congress inserted a year-long delay in the mandate for the transition from the ICD-9 coding system to the ICD-10 coding system from Oct. 1, 2014, to at least Oct. 1, 2015, as part of a broader bill creating a temporary “SGR fix” (a delay in Medicare physician payment cuts under the program’s sustainable growth formula), it threw ICD-10 planning into disarray across the U.S. healthcare system.

At the Chicago-based American Health Information Management Association (AHIMA), the national association of health information management (HIM) professionals, the reaction to Congress’s March 31 action was one of shock and dismay. After the U.S. Senate passed the SGR-fix bill on March 31, and just before President Obama signed it into law on April 1 (the provision on ICD-10 had been slipped quietly into the SGR-fix bill by lobbyists representing medical specialty societies), AHIMA issues a press release saying that “The American Health Information Management Association (AHIMA) expressed deep disappointment that the U.S. Senate voted today to approve H.R. 4302, Protecting Access to Medicare Act of 2014, which included language delaying implementation of the ICD-10 code set until at least October 1, 2015.”

The press release included a formal statement from AHIMA CEO Lynne Thomas Gordon stating that, “On behalf of our more than 72,000 members who have prepared for ICD-10 in good faith, AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay.” The press release later went on to say that “It has been estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the already incurred costs from the previous one-year delay. This does not include the lost opportunity costs of failing to move to a more effective code set.” And it added that “The United States remains one of the only developed countries that has not made the transition to ICD-10 or a clinical modification, a more modern, robust and precise coding system that is essential to fully realize the benefits of the investments in electronic health records and maximize health information exchange.”

What’s more, the leaders at AHIMA have been very active in the Coalition for ICD-10, a group advocating for a speedy and comprehensive transition to ICD-10. That group includes a broad array of industry groups, including America’s Health Insurance Plans (AHIP), the BlueCross BlueShield Association, the Medical device Manufacturers Association (MDMA), the American Hospital Association (AHA), and American Medical Informatics Association (AMIA).

AHIMA strongly applauded the announcement on July 31 by the federal Centers for Medicare and Medicaid Services (CMS) that the new transition date would be Oct. 1, 2015 (the earliest day allowed by the congressional legislation), with the association saying in a statement  on July 31 that “Now, everyone in the healthcare community has the necessary certainty to move forward with their implementation processes, including testing and training.”

AHIMA’s leaders say they continue to do everything possible to help healthcare organizations prepare for the transition, while making it clear that they will oppose any further delays, and speaking out against what they see as myths propagated by the opponents of the ICD-10 coding system.

Sue Bowman

In that context, Sue Bowman, senior director, coding, policy, and compliance, at AHIMA, spoke recently with HCI Editor-in-Chief Mark Hagland regarding the current moment in the ICD-10 transition saga, and her perspectives on it. Below are excerpts from that interview.

In interviews I’ve done recently, I’ve heard some pushback about the usefulness of the ICD-10 system. Are you hearing any pushback right now?

Well, nothing new, really. In fact, as people become more familiar with ICD-10, their negative view is changing. And people are still saying there was no clinical input in the development of the coding system. But from the beginning, all of the content of it really came from the clinical community; and there’s actually something called the Coordination and Maintenance Committee, co-chaired by the National Center for Health Statistics, and CMS. They’re responsible for the maintenance of ICD-10 code sets in the U.S. NCHS maintains ICD-10-CM, which is a diagnosis system; and CMS maintains ICD-10-PCS, the new procedure coding system, for hospitals. So they’ve been guiding the development process.

So it’s a public process, where people can submit proposals for new and expanded codes. And so even from the development to how it’s being maintained now. On the one hand, you hear people complaining about the detail and specificity of it; but it’s physician organizations that want more codes—which is kind of funny.

Is it correct that ICD-10 in this country will be different from the ICD-10 systems in other countries, with ten times the codes of other ICD-10 systems? That’s what a few people have told me.