November 15, 2011 | | Comments 9
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Don’t stop implementation plans because AMA opposes ICD-10-CM/PCS

The American Medical Association (AMA) House of Delegates voted to “work vigorously to stop implementation of ICD-10” during the closing session of its semi-annual policy-making meeting November 15.

The AMA cites the number of competing healthcare initiatives and the costs involved in the transition as reasons it opposed the switch. It’s a little late in the game to be figuring that out.

Providers should not put their implementation plans on hold. Many (hopefully most) providers and payers are already planning for the ICD-10-CM/PCS transition. Some have even started updating systems, forms, and processes. CMS representatives have repeatedly said the deadline isn’t changing. And really, too many good reasons exist for the switch.

Consider these factors:

The United States is the last industrial country to implement ICD-10-CM/PCS. We’re 10 years behind Canada and even farther behind Europe. Beyond how embarrassing it is to be so far behind the rest of the developed world, we can’t share data with other countries because we’re using a different code system. We can’t compare disease or mortality rates because it’s an apples to apricots comparison. And by the time we implement ICD-10-CM/PCS, most of the rest of the world will be looking at ICD-11.

ICD-9-CM is out of room. Every year, Centers for Disease Control and Prevention add more and more out of sequence codes, which creates confusion for coders because the code isn’t where it should logically be. ICD-10-CM contains thousands more codes already and has plenty of room to expand in the future.

Increased specificity is a good thing. Many ICD-9-CM codes lack detail, especially ICD-9-CM Volume 3 procedure codes. How can you justify your patient is really, really sick if you can’t explain why? In ICD-9-CM Volume 3, you can’t even distinguish between a central venous catheter insertion and a peripherally inserted central catheter. They both map to the same code (38.93). In ICD-10-PCS, coders can report percutaneous placement of venous central line in right internal jugular (05HM33Z) for example. Of course, the physician has to document enough information for the coder to select the correct code.

Documentation is going to continue to be a big problem. We all know that.. ICD-10-CM/PCS requires more information and in some cases different information than ICD-9-CM. But generally it’s information the physician already knows and he or she just isn’t writing it down. For example, if a physician sets a broken arm or removes a foreign object, he or she should be able to say which arm the patient broke or where the foreign body was.

The documentation will also help with quality of care indicators and outcome assessments. If a very ill patient makes a tremendous recovery because of a provider’s excellent care, the provider will be able to show just how sick the patient was and how well he or she recovered.

Change is never easy. The transition to ICD-10-CM/PCS won’t happen overnight and it won’t be easy. But it will benefit the healthcare profession all around from coders to HIM to physicians and (ultimately) patients. Instead of digging in its heels at this late date, the AMA should be looking for ways to make the transition better and easier.

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Michelle A. Leppert About the Author: Michelle A. Leppert, CPC, is a senior managing editor for JustCoding.com. JustCoding provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.

In addition, she writes and edits the HCPro publication, Briefings on Coding Compliance Strategies. Email her at mleppert@hcpro.com.

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  1. Good to read an article on the benefits of ICD 10, the Opposition to ICD-10 by the AMA is drastic , ICD 10 provides increased specificity and granularity and will help healthcare professionals to provide targeted,accurate treatment and diagnosis.Just read an informative whitepaper, ICD 9 to ICD 10 transition on strategies for successful transition to the new coding format @http://bit.ly/rUq4Jz

  2. The AMA’s vow to delay ICD-10 could not come at a worst time. We will begin Physician Education very soon, and solidifying physician engagement will be troubling enough without the AMA adding justification to any stalling behaviors.

    However, this news shines a spotlight on the specifics of physician engagement. What tactics are you taking to ensure physicians sign up for ICD-10 education? What incentives or penalties do you have in hand to assure physician compliance with education? No doubt we are going to have to bring in physicians and other leadership to discuss tactics with eliciting cooperation.

  3. Once again the AMA is not being realistic and not partnering with others in healthcare. They are in a silo and need to step up to the plate by working with AHA and AHIMA and others on making physicians prepared and ready for this change.
    It’s known that the AMA has opposed ICD-10 for years and now is NOT the time to try and stall the implementation process.
    Engagement is the message that the AMA should be voting upon and not opposing progress and advancement. Their actions do NOT benefit healthcare!!

  4. I absolutely agree with your article. It is a shame that the physicians are the only ones still not moving forward on ICD-10. These physicians demonstrate what we already know–that the problem with ICD-10 implementation is the physicians will not be ready on October 1, 2013 while the rest of the medical field is moving forward. By voting on this issue, they have publically declared their ignorance of compliant documentation and coding for patient services, disease tracking, epidemics, etc.

  5. I think the opposition of ICD-10 implementation has to do with the adoption of 5010, which is about 50+ days away. Last week there was a report by the MGMA Study—“96% Not Ready for HIPAA 5010”. Our industry is already at risk with 5010 compliance. During a presentation on Monday to a local professional organization, I asked the question on how many people have completed the ICD-10 Impact Assessment at their organization, only 2 out of the 40+ audience members raised their hands. I found that to be devastating as the Impact Assessment is crucial for an organization to evaluate the level of impact, the people impacted, and the technologies/systems impacted for the transition to ICD-10. Many of the audience believed that the go live date of Oct 1, 2013 will be pushed back, however, CMS representatives have constantly said the deadline isn’t changing, and really, too many good reasons exist for the switch. The United States is 10 years behind Canada and even farther behind Europe!! The transition to ICD-10 is well overdue!

  6. ICD-10 will put many physicians out of business. It is such a complicated system that doctors like myself will have to hire a coder in order to be compliant. That’s $80,000 added to my overhead. Then because of the complexity many charges and attempts at reimbursement will be kicked back from insurances who make it their goal to not pay. That’s why corporate America loves ICD 10, because it will cut down on Heath care costs…I.e. Not paying doctors because they coded the injury as occurring from a fall running versus a fall from walking. That may be success financially for the insurance companies and Medicare, but it’s going to put a lot of us out of business. Maybe $80,000 PLUS the lost income in reimbursements is not a lot to all of you. I know how non physicians think. We are rich doctors, we can afford it, but you all are wrong. We cant keep affording all the hits that we keep taking and with each of these stringent time consuming requirements placed on us, we are forced to see less and less patients. None of you actually treat patients so I wouldn’t expect you to understand. Find another way to compare data with Europe and Canada.

  7. The implementation of ICD-10 is long overdue and has been pushed back far too long. Our US healthcare industry must be able to compare data with the rest of the world for many reasons and the only way this can be accomplished is with the implementation of ICD-10. Individual physician practices will be minimally impacted and the resources are available to help with the transition. We all should be embracing this change instead of causing road blocks.

  8. Please, don’t be discouraged if hiring a coder is your only concern. I can understand your concerns as a physician about the costs to hire a coder. However, I don’t know many coders who make $80,000 per year. Most probably make about half that or less. And you may be surprised that hiring an experienced coder can actually make you money instead of costing you money. The salary you pay an experienced knowledgeable coder may actually pay for itself and maybe even generate more than their salary by catching errors, missing charges, etc.

  9. I agree with you 100% and to add to it. If we the coder are getting on the physician nerves right now trying to get specific documentation, without higher up having our backs. What make anyone trying to think it will happen with ICD-10. I think that trying to get specific documentation from a physician with ICD-10 will also send healthcare originizations out of business.

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