ICD-11 advocates are talking once again about leap-frogging over ICD-10 coding but it's hard to take such arguments seriously because the leapfroggers seem to be more interested in delaying ICD-10 implementation than implementing ICD-11 codes. Mark Braunstein sees ICD-11 advocacy as a delaying tactic too:

 

"Is ICD-10 too complicated to be accepted here in the US? That is a difficult argument to make because virtually every other major advanced country -- and many not so advanced -- is already using ICD-10 and it is now available in 42 languages. In fact, ICD-11 is now just around the corner in 2017! Some here are even arguing that we wait for ICD-11 before making the change, an argument I suspect is more of a delaying tactic than anything else."

 

The World Health Organization (WHO) is supposed to present the ICD-11 code set to the world in May 2017. That's only a year and half after the United States implements ICD-10 coding.

 

But ICD-11 won't be ready to use then. We had to add ICD-10 codes to the code set to work with our reimbursement and reporting needs. That's why there so many more ICD-10-CM codes than ICD-10 codes.

 

How long do you think it will take for the U.S. government to come up with ICD-11-CM/PCS?

 

I'm guessing the U.S. healthcare system could have usable ICD-11 codes in 2020. But then how long before the HIT industry can install the new code set?

 

[See also: AMA breaks silence on ICD-10 delay with SGR patch.]

 

It's a database, not a list

 

By the way, the WHO is building a database. The ICD-11 content model is described as:

There's nothing wrong with this. It should lead to robust data. What's not to love?

 

I'm having trouble believing that people who complain about the cost and complexity of an ICD-9 to ICD-10 transition will be good with the ICD-9 to ICD-11 transition. Especially since  healthcare vendors will be building the cost of scrapping ICD-10 systems into their ICD-11 systems.

 

I'm going to need to channel Jack Nicholson in "A Few Good Men" and say "You want ICD-11? You can't handle ICD-11." It's complicated but not too complicated for the level of technology in most medical practices and hospitals. Medical coders can still use paper books to look up codes. Digital might be faster. But most healthcare professionals can relate to ICD-10 coding. It's basically more of the same thing they're used to.

 

Or is that why ICD-10 must die?

 

Matt Murray doesn't believe ICD-10 coding is much better than ICD-9 coding. He wants us to avoid the cost and embarrassment of using a so-last-century taxonomy and get ready for ICD-11 implementation.

 

Murray, I take more seriously than the usual leapfrogger. He seems genuinely interested in what's right for healthcare not avoiding the cost and effort of change.

 

Although he is quick to quote Christopher Chute, one of the developers of ICD-11 coding and one of the five wise guys of HIT who argued for a two-year ICD-10 delay. (It is interesting that they sort of got their way.) The problem is that Chute didn't argue for leapfrogging.

 

So what is a healthcare system to do?

 

Murray actually lays it out nicely:

 

"ICD-x codes are used by non-clinicians for important administrative and financial purposes. SNOMED-CT, on the other hand, is what physicians will actually use to communicate information about patients in their electronic health records (EHRs). In fact, physicians must use SNOMED vocabulary in their EHRs, not ICD-x codes, for their problem lists in order to achieve Stage 2 Meaningful Use for incentive payments and to avoid Medicare penalties in the future."

 

If physicians can work with SNOMED, the ICD-x  codes become less important. Upgrades will cost less and be less disruptive. Of course clinicians still need to learn the appropriate level of specificity to support billing and public health reporting.

 

[See also: The dark side of the bill pushing back ICD-10, SGR.]

 

Let's hijack the ICD-10 development process

 

In life, we have two choices:

And the WHO gives us both options when it comes to ICD-11 codes. We can wait for them to release it in May 2017.

 

Or we can become part of the process and help create the ICD-11 code database. The process allows for collaborators to:

ICD-11 may be a work in progress but we have a chance to work on it and help mold it into something more useful in the United States.