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A 10 Beats A Nine, No Matter How You Cut The Cards

September 16, 2008
by Joe Bormel
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Accepting the Inevitable is No Way to Implement ICD-10




Those who have long fought the transition to and implementation of ICD-10 in the United States are now quickly being silenced by the forthcoming government mandate for providers and payors alike to move forward with this long overdue improvement to our healthcare system.




If you haven’t yet read the two recent blog postings to this site concerning ICD-10 by

Reece Hirsch and

Mark Hagland, I suggest you do so. They have some very insightful things to say on this subject.




Over the past several weeks, I have tried to become “smarter” about ICD-10. To a great degree, my efforts have been rewarded with a troubling deluge of information about the billion or so dollars it will cost to transition from the existing 30-year old ICD-9 coding methodology, the problematic learning curve, and the potential for interim reimbursement problems. But what has troubled me most is an overriding position expressed by many highly reputable experts that we might as well shrug our shoulders, accept the inevitable and prepare for the worst. Now I ask you, is that any way to efficiently and effectively manage change?




Five years from now, the arguments against ICD-10 will be as laughable and ridiculous as:




• MS-DOS works fine, why Windows?


• X-rays are sufficient.


• Who needs air bags when we have seat belts?


• Cell phones are just a novelty.


• Louis Pasteur's theory of germs is ridiculous fiction.


• Airplanes are interesting toys but of no military value.


• Drill for oil? You mean drill into the ground to try and find oil? You're crazy.


• With over 50 foreign cars already on sale here, the Japanese auto industry isn't likely to carve out a big slice of the U.S. market.


• While theoretically and technically television may be feasible, commercially and financially it is an impossibility.


• There is no reason anyone would want a computer in their home.


• Sensible and responsible women do not want to vote.




Gartner has called the transition to ICD-10 “a momentous change.” However, it also states that, “In the long run, ICD-10 is a key enabler for quality improvement, better management planning and better care.” Better care, isn’t that what every provider organization is trying to achieve?




For more than a decade,

AHIMA has warned of the problems that exist with the ICD-9-CM system, while

artfully promoting the value proposition of ICD-10. The AHIMA site offers a wealth of information from which CIOs and other senior executives can benefit.




We need first to understand some of the baseline deficiencies inherent as we continue to use the ICD-9-CM system. ICD-9-CM is obsolescent. The system is quickly running out of space for new codes, thereby limiting the inclusion of new procedures and diagnoses. Further, it is not sufficiently precise to fully enable an EHR, conform to pay-for-performance reporting requirements, adversely affects DRGs by grouping different procedures into a single code, and decreases our already considerable investment in SNOMED-CT.




Additionally, because ICD-9CM is imprecise and uses terminology inconsistently, not only is it difficult or impossible to capture new technology, the system lacks the codes necessary to cover preventative services. This hinders the progress of personalized medicine, and discourages the use of advanced diagnostic testing. I suggest you read “

Realizing the Promise of Personalized Medicine” in the Harvard Business Review to learn more.




We now have the gist of the current problem, so let’s get an overview of the ICD-10 solution. According to HHS, as we adopt ICD-10 code sets, we can expect to realize:




• More accurate (and realistic) reimbursement for new procedures with fewer rejected claims, better disease management, and standardized international disease monitoring and reporting.


• Support for comprehensive quality data reporting.


• Value-based purchasing based upon accurately defined services providing specific diagnoses and treatment data that should speed reimbursement while deterring Medicare fraud and abuse.


• Enable us to compare U.S. data worldwide to track the incidence and spread of disease, as well as treatment outcomes.




To further put the transition and implementation of ICD-10 into perspective, the ICD-9-CM system contains roughly 24,000 codes, as compared to the 200,000 available in the ICD-10-CM. This added capacity and functionality of both ICD-10-CM and ICD-10-PCS have been identified by AHIMA as catalysts for developing computer-assisted coding (CAC) applications. And CAC has already been generally accepted as the technology that will best facilitate streamlining an across-the-board improvement in the healthcare coding process.




The United States is the only industrialized nation that has not transitioned to ICD-10. In fact, almost 100 countries have implemented and are using the system. It’s time we move into the 21st century. We will realize the benefits of improved care and faster, more accurate reimbursement for substantially more and better defined services. All advantages that support change.




But what about cost? Where’s the ROI? Those questions are best answered by the

Rand Corporation, which conducted research on the cost-benefit relationship of an ICD-10 transition sponsored by NCVHS in 2004. In short, although the transition will likely cost more than a billion dollars, the investment is projected to be recouped in five or fewer years.




As you would expect, the naysayers are preparing a new argument against ICD-10. There are rumblings that because ICD-11 is now in development and may be ready for implementation by 2014, we should wait until it’s ready and implement both systems at once.




That argument is hardly worth addressing in light of the benefits our healthcare system will realize by adopting ICD-10 now and paying for improvements incrementally. Our nation is already a decade behind the curve when it comes to raising our coding standards and being able to clearly communicate with other members of the World Health Organization.




Let’s get started on planning to manage our change to ICD-10. This will take more than a cursory internal review. We need to tap the resources offered by ICD-10 savvy professional organizations, begin reviewing the challenges with our consultants, and sit down with our vendors to discuss their plans for ICD-10 functionality. We have the tools to create a positive environment for change and manage it to maximize our benefits. What do you think?






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