ICD-10 Might Be Too Little Too Late

Not many know that ICD-10, the medical coding set that’s slated to replace the "now-antiquated ICD-9-CM"—and due to be incorporated into online medical billing and medical coding courses—is actually based on an international version that’s two decades old. This was revealed recently by Health Affairs, journal of health policy and research, in an article on Systematized Nomenclature of Medicine-Clinical Terms, or SNOMED. The article proposed that healthcare might be better off preparing for ICD-11.

The five authors of the article, all leading medical informatics experts, concede that in certain areas, such as diabetes coding, ICD-10 significantly improves on ICD-9, which is too limited to code for some of today’s medical procedures and practices. They point out, however, that the "base knowledge structures" of ICD-10 cannot properly code for what healthcare has acquired in the 21st century. For instance, ICD-10 does not use any genomic information.

"When a woman receives a bilateral prophylactic mastectomy because of family history and the presence of the BRCA2 gene (a genomic variant that dramatically increases the risk of breast cancer), there is no mechanism for coding this genomic variant as an indication for surgery," the authors lamented in the article.

The authors proposed that U.S. healthcare should move instead toward ICD-11, which is strongly associated with SNOMED.  If ICD-10 is to be implemented at all, the authors recommended that the ICD-10 compliance date be delayed with a grace period.

Still, delaying the implementation date of ICD-10 may have been the correct decision after all, says a survey which shows that almost 50 percent of health providers are not sure when they will finish their impact assessment, a major milestone in their ICD-10 preparedness efforts and which should have been reached in 2011.

The poll, conducted in February by the Workgroup for Electronic Data Interchange (WEDI), involved about 2,600 respondents (2,118 providers, 231 vendors, and 242 health plans). Results reveal that although some 33 percent of providers planned to launch their testing in 2013, a half of the respondents reported that they still had no definite date when they would begin testing.

"The survey results were not that surprising. WEDI has been conducting these surveys since 2009, so we were able to see that the industry was falling behind," said Jim Daley, WEDI board chairman-elect, in an interview with InformationWeek Healthcare. "In 2010, we revised the timeline based on organizations' status, and then we began to see the organizations falling behind based on that new revised schedule. Given all of the activity around the 5010 migration, not all organizations were able to use the full resources needed for ICD-10 compliance."

The survey also found that most health plans are looking at 2013, and no sooner, to begin testing.  Specifically, a fourth of the health plans are less than halfway done and one half of the vendors are also less than 50 percent done with their product development cycle. Among the reasons cited were: competing priorities, regulatory mandates, staffing, vendor readiness, and customer readiness.