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The Great ICD-10 Debate

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The adoption of ICD-10 has been one of the most hot topics in the health care industry especially since the implementation of Version 5010. No one could have predicted that 5010 would be so problematic for medical providers. This has given providers more fuel for their argument that the US is still not ready for an October 2013 implementation of ICD-10.

The change to this new coding system is inevitable due to the fact that the current system is so outdated. So why is there so much resistance? How much difference will extending the deadline to 2014 make? Both sides of the argument make some interesting points but time is running out. Plans for implementation should be underway now in order to be prepared by the deadline.

The Pros

  • Many are concerned that the current ICD-9 classification system is outdated. New technology and medical advancements of the 21st century requires an expansion of the coding system which will be reflected with the ICD-10 implementation.
  • Other countries have already using ICD-10 for years beginning in 1995 up until 2004 leaving the US behind the rest of the world. Upgrading to ICD-10 will be another step towards keeping up with health care trends around the world.
  • Experts state that ICD-10 will improve claims processing resulting in faster payments and less hassle for providers and patients. Because diagnosis and procedure codes will be more accurately reported to payers, there should be a substantial decrease in the number of delayed or denied claims.

The Cons

  • Physician practices have been hit hard financially already with the implementation of the electronic health record and Version 5010. It has been estimated that it will cost between $80,000 up to over $2 million dollars per office depending on the number of physicians in the practice.
  • The challenges of Version 5010 have rattled the entire health care industry. No one anticipated that the 5010 implementation would have experienced so many challenges. If 5010 is this difficult, then imagine what will happen with ICD-10? Again, will all possible problems caused by ICD-10 be anticipated early?
  • Those that promote ICD-10 predict the ability to have more specified coding will improve patient care and improve insurance payment rates. The argument against this is that not enough is known about ICD-10 to make such predictions.

AMA versus HHS

The American Medical Association (AMA)has been the leader in the fight against ICD-10 implementation. In a recent letter to the Department of Health and Human Services(HHS), AMA stated:

"The timing of the ICD-10 transition that is scheduled for October 1, 2013, could not be worse as many physicians are currently spending significant time and resources implementing electronic health records (EHRs) into their practices."

The letter further gave recommendations on how to ease the burdens placed on physician practices due to heavy penalties anc costly implementation expenses by halting ICD-10 and assessing an appropriate placement for ICD-9 within a reasonable time frame. Several days later, HHS announces an intent to delay ICD-10.

Although, no official date has been set, ICD-10 implementation is not a matter of if, but when. AMA wants HHS to approve an update to ICD-9 and abandon plans for implementing ICD-10 instead of a simple delay of ICD-10. HHS stands firmly with its plans to continue with ICD-10 transition while AMA stands firmly against it. Only time will tell what side will win.

Meanwhile, organizations must begin to plan now for the transition. Don't delay hoping for the best, improve your outcome by preparing for the worse.

Source: http://www.ama-assn.org/resources/doc/washington/icd-10-comment-letter-02feb2012.pdf

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