The American Medical Informatics Association (AMIA), American Health Information Management Association (AHIMA), and AdvaMed, have issued a summary of their joint position on the adoption of the International Classification of Diseases, tenth revision (ICD-10). The implementation deadline for ICD-10 is October 2009.  

The Joint Position on Adoption of ICD-10 includes the following four key points: 

1. The ICD-9 CM (International Classification of Diseases, ninth revision, clinical modification – a U.S. version of ICD-9 developed by the World Health Organization) is obsolete. It is no longer adequate to support the information requirements of the U.S. healthcare industry. The need to replace ICD-9CM was acknowledged more than 10 years ago. Its continued use with adversely impact the value of healthcare data as well as hinder medical decisions based on imprecise data. Further delay adds to the cost of modification and the investment in electronic medical records (EMRs). 
2. ICD-10 is needed to improve the quality of health information. It is designed to provide better data to meet the needs of today’s electronic healthcare environment and of an increasingly global healthcare system. ICD-10 will enable more accurate and improved information to be captured. ICD-10 will provide better data to support improved public health and bio-terrorism monitoring, more accurate reimbursement rates, patient safety improvement, medical error reduction, quality measurement, and pay-for-performance initiatives. 
3. ICD-10 is needed to support interoperable EMRs and a National Health Information Network (NHIN). EMRs and NHIN networks require a modern classification system in order to accurately summarize and report healthcare data. EMR system benefits cannot be achieved fully by utilizing the 30-year-old ICD-9 classification system. ICD-10 must be incorporated into EMR systems with SNOMED-CT in order to realize the benefits of a NHIN and information interoperability. SNOMED-CT and ICD-10 will allow data to be shared between EMR systems in their common medical language. 
4. An implementation date of October 2009 reflects a compromise between an increased demand for better data and the complexity and size of the transition. Now the industry can dedicate resources in order to complete detailed planning and development.   

Did You Know? 

The transition to ICD-10 has been under consideration for over 10 years.  

Formal testing of ICD-10 was conducted by the Clinical Data Abstractions Centers, AHIMA and AHA. The testing showed that ICD-10 was easier to use than ICD-9 and that it leads to more accurate coding and billing.

ICD-10 is more precise than ICD-9 and it allows coders to select the appropriate code to use more easily, which helps ensure coding accuracy. It is also very user-friendly, enabling coders to avoid unnecessary data sections. 

ICD-10’s benefits outweigh its costs. An independent study conducted by the Rand Corporation estimated that the total costs of implementation will range from $425 million to $1.15 billion, one-time costs for system changes, training and lost productivity for payers, providers and vendors. The estimated benefits of using ICD-10 are between $700 million and $7.7 billion due to more accurate payments, fewer miscoded and rejected claims, better understanding of the value of new procedures and improved disease management. The longer the transition to ICD-10 is delayed, the more it will cost to adopt the system. 

The Johnson-Deal bill eliminates the Notice of Proper Rule Making and Order (NPRM) process for upgrading software versions of ICD-10 as required by HIPAA, to enable adoption by October 1, 2009. A process for public notice and comment for software upgrades to version 5010 and beyond has been ongoing for over a year, allowing public comments.  

Changes are needed to our fraud management systems that will require an investment. These fraud management systems, based on the old ICD-9 system, are mostly ineffective, as shown by fraud estimates, which show that only a fraction of healthcare fraud is ever identified or recovered. The Office of the National Coordinator for Health Information (ONCHIT) conducted a study on fraud, which determined that updated classification systems and a standardized reference terminology are essential to the adoption of EMRs and the related electronic healthcare fraud management programs. 

The use of ICD-10-CM and ICD-10-PCS will help reduce the opportunities for fraud and improve fraud detection capabilities. Field testing has shown that ICD-10’s greater specificity results in improved data accuracy. The transition to a revised coding system could present a short-term opportunity for error while people are learning how to use it, but the long-term benefits are much greater. ICD-10 reduces misinterpretation and ambiguity, and it provides the ability to more effectively audit claims and improve coding accuracy. A standardized reference terminology and up-to-date classification systems are essential to the adoption of EMRs, according to an anti-fraud study done by the Office of the National Coordinator for Health Information Technology (ONC). ICD-10 offers improved logic and increased specificity, which will facilitate the development of sophisticated tools for detection of questionable patterns and suspected fraud. 

ICD-9 codes are running out in many important categories, such as orthopedic and cardiac procedures. Centers for Medicare & Medicaid Services (CMS) has been placing these procedures in completely unrelated categories for procedures performed on ears and eyes. 

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