To move forward, or to hold back? That is the question

WASHINGTON – When Acting CMS Administrator Marilyn Tavenner said Feb. 14 that CMS would take another look at the timeline for converting from the ICD-9 billing code set to ICD-10, she unleashed a barrage of response – for and against – across the healthcare industry. The next day Health and Human Services Secretary Kathleen Sebelius said HHS, indeed, intended to push back the deadline.

She gave no specifics – and at the beginning of March, there were none – just more adamant positions on either side.

This after government officials – before Sebelius – had stressed, there would be no delay this time. The switch had been delayed time and time again. If the Oct. 1, 2013 deadline were to stand, it would have taken the United States 23 years from the time ICD-10 was ready for use until this most recent deadline to adopt the new code system.

“Why can’t we stick to what we commit to,” asked Wendy Whittington, MD, chief medical officer, at Anthelio Healthcare Solutions. Whittington, who focuses on ICD-10 issues at Anthelio, said she recognizes that conversion to ICD-10 will be costly and time consuming.

“But changing the date at this late juncture only makes things worse,” she said, noting that many healthcare systems have already invested time and money to meet the Oct. 1, 2013 deadline.

For more on ICD-10, see the commentary from Government Health IT Editor Tom Sullivan on P. 15 and the trends piece by Contributing Editor John Andrews on P. 37.

The American Medical Association (AMA) cheered Tavenner’s willingness to reconsider the timeline, while the American Health Information Management Association (AHIMA) urged everyone to stay the course.

The AMA released the following statement from AMA President-elect Jeremy A. Lazarus, MD:

"The AMA appreciates that Ms. Tavenner and the administration have heard our concerns and have recognized the significant challenges and burdens ICD-10 implementation will create on the practice of medicine, and that they are committed to reviewing the pace of implementation. The AMA welcomes the opportunity to discuss ICD-10 implementation, along with many overlapping regulatory requirements that are burdening physician practices."

AHIMA, which has advocated conversion to ICD-10 and sticking to the Oct. 1, 2013 deadline all along, also issued a statement, again urging healthcare systems to continue their work on ICD-10.

“This is a promise from CMS to examine the timeline, not to change it,” said Dan Rode, vice president for advocacy and policy at AHIMA. “But government officials are sending mixed signals that many in the healthcare community will interpret as a reason for delay.”

Rode said that any delay in the transition preparation for ICD-10 would both increase costs and could diminish the value of other programs, including meaningful use.

Whittington agreed. “How long are we willing to use a coding system that doesn’t work for us and that prevents us moving forward with meaningful comparative-effectiveness research and ultimately evidence based medicine?,” she asked. “The decision to put off ICD-10 is a setback in modernizing our healthcare system and brings more uncertainty into an already chaotic environment.”

ICD-9 consists of 17,500 codes, while ICD-10 has about 157,000 codes. However, ICD-9 is 30 years old, and ICD-10 offers the granularity and specificity that ICD-9 does not, proponents say. The additional codes will help to enable the implementation of electronic health records because they will provide more detail in the electronic transactions, they add. This granularity would also help to identify specific health conditions.

Also, the greater precision that ICD-10 codes provide is viewed as a way to provide better public health statistics and a way to support value-based purchasing.

The indication by government officials that a delay of the Oct. 1, 2013 deadline for ICD-10 might be forthcoming resulted in a flurry of opinions from camps in favor and against delay.