Anthelio’s Whittington agreed, adding that “pushing the deadline back one year means that we can’t complete all aspects of healthcare reform. Information the government needs to collect to provide effective research on what works and what doesn’t is tied to the more specific information gathered by the ICD-10 codes. Folks who haven’t read ICD-10 don’t understand the benefits of the more detailed coding.”

Not everyone buys that the U.S. even needs ICD-10 codes, though. The argument against: Cost in education, systems remediation, time and training won’t yield better data for analysis and outcomes because resource-crunched U.S. providers will take a band-aid approach, employing crosswalks, GEMs, step-up/step-down approaches rather than moving to ICD-10 exclusively. And the unfunded mandate promises little in the way of ROI to those who implement the new code sets.

Getting to a pure ICD-10 environment could take years. And while proponents maintain that the U.S. needs to catch up to other developed countries that adopted ICD-10 years ago, therein hides ICD-10’s great flaw: Other countries adopted it decades ago – it’s old and showing its age.

[Related: The imminent industry association Civil War over ICD-10.]

Furthermore, much of the rest of the world doesn’t even use ICD-10 for reimbursement in the inpatient and acute-care setting, as No World Borders’ Arrigo explains. As a one-payment system Canada, for instance, only uses ICD-10 codes for hospital services, so their total number of codes is smaller than the U.S., adds Deb Grider, senior manager of revenue cycle at consultancy Blue and Co (pictured at right).

“We have multi-payment systems,” Grider says. “We code for professional services, we code for radiology services, all different kinds of healthcare services that providers deliver.”

An even starker reality is that while ICD-9 was essentially completed in the early 1970’s it was created in accordance with theories of health and technology from the 1960’s and, likewise, the WHO finished ICD-10 in 1990 so it represents mid-1980’s thinking.

“We’re moving up 20 years, which is an improvement, but we’re still not in 21st Century thinking as far as an underpinning of ICD-10,” says Chris Chute, MD, DrPH, who spearheads the Mayo Clinic’s bioinformatics division and chairs the WHO’s ICD-11 Revision Steering Group.

What’s more, Chute participated in what he considers “a fairly objective comparison of the functionality of ICD-10 versus ICD-9. And we’re not getting a lot for our money. I don’t know how to say it more directly than that,” he explains. “The functional improvements in terms of representing patient data in a comparable and consistent way is not dramatically increased in ICD-10; in fact it’s almost negligibly increased.”

[Ed's note: The study to which Dr. Chute refers was since published in Health Affairs.]

That, despite the fact that the original cost estimates for converting to ICD-10 were off by an order of magnitude, Chute adds, and not in a manner favorable to those physicians, providers, and payers upon who’s back the burden of ICD-10 strains like many mythological enduring Atlas’s.

ICD-11: What is it?
If a bullet-proof technical reason that the U.S. could not simply leapfrog ICD-10 and adopt ICD-11 in it’s stead actually exists, then more than two years of asking just about everyone has yet to uncover it.

Political reasons are bountiful and powerful, to be certain. Spanning the gamut from potential lawsuits by providers who have spent millions already on the conversion being that it is, after all, a law to those who argue that charting a new course now would be more costly, more chaotic than seeing ICD-10 through – even though there is an existing argument that the conversion will be for naught. Add to that list that enormous undertaking of clinically modifying ICD-10 for the U.S.