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January 12, 2004

Possible ICD-9 Update Looms on Horizon
By Kara McDonald
Vol. 16 No. 1 p. 8

It could soon be “out with the old and in with the new” for the ICD-9-CM coding system. After more than 20 years of ICD-9 use, steps are being taken to implement ICD-10-CM and ICD-10-PCS, an updated version of ICD-9 that would “move the quality of health data and patient care into the 21st century,” according to officials at the American Health Information Management Association (AHIMA).

The National Center for Vital Health Statistics (NCVHS) recently voted to advise Health and Human Services (HHS) Secretary Tommy G. Thompson to begin action for adoption of ICD-10 as the national standard under the Health Insurance Portability and Accountability Act. It is now up to Thompson and the HHS to decide whether or not the implementation of ICD-10 is necessary.

Why Change?
Many healthcare organizations advocate that the change is necessary due to a variety of problems with ICD-9, including vagueness of coding groups, numbering constraints, and a lack of sufficient chapters to keep up with new codes.

According to a statement given to the HHS and NCVHS in spring 2002 by Nelly Leon-Chisen, RHIA, director of coding and classification at the American Hospital Association, ICD-9 is “long due for an overhaul. Many of the new procedures and innovations in medical practice are not adequately captured in the ICD-9. The ability to expand enumeration for a particular procedure category is limited because of the physical numbering constraints contained in the current system. Consequently, some categories provide vague and imprecise procedure codes.” She added that the more detailed ICD-10 system would not only considerably reduce hospitals’ administrative burdens, but would also benefit healthcare organizations in the following ways:
• reduce the requirements for submission of additional documentation to support claims;
• allow the capture of accurate data on new medical advances; and
• provide data to support performance measurement, outcomes analysis, cost analysis, and monitoring resource utilization.

For many, this progression toward the update has been a long time coming. “Discussion on the need for updated code sets was identified over 10 years ago by NCVHS and AHIMA,” says Linda Kloss, MA, RHIA, AHIMA’s executive vice president and CEO. “Migration to [ICD-10] is necessary and critical. These revisions have been specifically designed to describe today’s practice of medicine and handle healthcare well into the future and are better suited for use in electronic record systems.”

Sue Prophet-Bowman, RHIA, CCS, director of coding compliance and policy at the AHIMA, echoes Kloss’s sentiments: “Most of the world has already moved on to ICD-10 or a clinical modification of it. We are really behind the times in this aspect.”

The Price of Progress
Leon-Chisen admitted in her testimony that “implementation of ICD-10 will be a complex and costly process,” with most of the expenses stemming from conversion to the new system, modifications to information systems, and formatting changes. But, for hospitals, the most expensive aspect of the change could be staff training.

Because ICD-10 is a much more specialized system, Leon-Chisen said, “Hospital support staff, such as coders and billers, will have to attend training seminars to familiarize themselves with the new coding guidelines, rules, and definitions… This greater level of specificity may also require that coders and billers expand their knowledge of medical terminology, anatomy and physiology, and disease process.”

However, Prophet-Bowman says that hospitals should not feel too much of a financial impact since most already pay for annual coder and biller training. She adds that vendors have indicated that they will bear some of the cost for the changeover as well. As for other costs associated with the update, suggestions of who should front the bill are plenty. Leon-Chisen recommended splitting the cost between Medicare, other health plans, and grants through Congress.

Prophet-Bowman acknowledges that some people might not see the need for ICD-10 because of the costs, time, and hassle, but she argues that “the cost of delaying could mean not only a significant loss of data quality, but an increase in the cost for the healthcare industry in the long run. Enacting ICD-10 sooner rather than later will most certainly lessen the cost.”

The Road Ahead
The next step in determining the fate of ICD-10 lies with the HHS. It must first issue a notice of the proposed rule in the Federal Register, a daily publication of the National Archives and Records Administration that publishes proposed rules, final rules, and announcements of federal organizations for public notice. Once published, the ICD-10 proposal will be subject to a comment period—a 60-day time frame when the general public can submit comments, ideas, suggestions, pros, and cons for the HHS to consider, says Prophet-Bowman. If the HHS opts to proceed after reading the comments, it will publish a final rule in the Federal Register. Following publication of the final rule, two years will pass before ICD-10 is officially implemented.

If these steps proceed smoothly, ICD-10 could be in use within the next few years. “We are advocating that the final rule be in place by October 1, 2004, so that ICD-10 is implemented on October 1, 2006,” says Prophet-Bowman. “I think the chances of that happening are very good.”

If ICD-10 is approved, most of the training and transition will take place during the two-year period after the final rule is published, says Prophet-Bowman. “It won’t be a gradual ‘phasing out’ of ICD-9,” she says. “In the healthcare system, that just wouldn’t be feasible. It will all happen at once so that all bills and records are consistent. We will do everything in our power to make the ultimate transition as smooth, painless, and cost-effective as possible for everyone involved.”

— Kara McDonald is an editorial assistant at For the Record.

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