ICD-10 Implementation Date Unlikely to Change

The new ICD-10 code set is coming, and though it represents a radical enough departure from the current codes to require systemic procedural changes and training at healthcare organizations around the country, its implementation probably won't be delayed.

And that's a good thing, according to a panel of experts who spoke Monday at the ICD-10 Summit, a gathering in Baltimore of coding, billing, and administrative professionals sponsored by the American Health Information Management Association (AHIMA).

On the summit's agenda: helping organizations find a path from their current ICD-9 coding methodology to the new ICD-10 code set, which will have tens of thousands of additional codes and a new alphanumeric coding system. The new code set is to slated to be implemented on Oct. 1, 2013. AHIMA officials and other speakers urged attendees not to expect an extension, noting that rumors that CMS might delay the implementation appear unfounded, they say.

"Clearly what we're seeing is an ever-growing demand for data, and that data has been and will be based on these new code sets," said Sandy Fuller, executive vice president and chief operating officer of AHIMA.

Sue Bowman, AHIMA's director of policy and compliance said in an interview that smaller organizations are behind their hospital counterparts, "simply because [hospitals] have more resources." Private practices should be working with their state medical societies to get training on ICD-10, as well as with their practice management system and EHR vendors, she said.

While challenging to physician practices, hospitals, and other healthcare providers that have become accustomed to ICD-9 and rely on it to get paid, that system provides too little specificity to drive quality improvements in the future, experts said. Although ICD-10 contains in excess of 50,000 more codes than ICD-9, most of these are concerned with the causes and physical locations of injuries. Bowman said, "It's not like there are that many new diseases." Moreover, the new code set is "more clinically relevant," than ICD-9," so when physicians are looking at it, they'll find that they understand the terminology better."

Because providers must code each service to get paid for providing it, a more thorough code set offers both challenges and opportunities for providers and researchers.

"For a researcher like me," said Bill Rudman, AHIMA's vice president for education and the editor of its research journal, waiting for the start of ICD-10 is "like waiting for Christmas morning."

Domestic violence researchers, for example, have been stymied by the lack of information available to them in medical records. Of the tens of millions of medical records generated in the United States each year, said Rudman, no more than 1,200 or so contain domestic violence codes, even though a quarter of women are believed to be victims of domestic violence at least once in their lives. The reason: the current code set doesn’t allow for suspected incidents of domestic violence, only confirmable ones, and few such incidents can be confirmed at the initial point of care.

But ICD-10 contains codes for suspected cases of domestic violence. "So now we'll be able to see when the nurse or the physician first suspects domestic violence, all the way to the point where it is actually confirmed," Rudman said, which will allow researchers to gain clearer insight into domestic abuse patterns with record reviews.

Still, many physicians remain skeptical of the change. Audience members wanted to know where they could find data from other countries that have implemented ICD-10 that indicate that the change has had a positive effect on patient care. "If there is such data," said one audience member, identifying himself as a physician charged with persuading fellow doctors in his group to embrace ICD-10, "then it would be great if you cite it. … And if there isn’t, then I think I'd be better off selling this thing [to doctors] as, 'Well, this is just something we have to do.'"

Speakers noted that some such research has been done in Canada and Australia. But they struggled to cite specific instances where the ICD-10 transition has been proven to improve patient care.