One year, seven months and roughly nine days separate today from October 1, 2013, which up until last week was the deadline for compliance with the ICD-10 code set (not that I or anyone else in the industry have been counting). I had actually circled September 30, 2013, as one of those fantasy retirement dates. On Thursday, however, things changed abruptly when Health and Human Services Secretary Kathleen G. Sebelius announced HHS would take steps towards postponing the compliance date. Organized medicine very quickly offered public support of the plan to delay the transition from ICD-9 to ICD-10.
Contemplating the implications of this announcement I am reminded of the line from a song by Talking Heads. Within this context, the best version is from the band’s aptly named concert movie “Stop Making Sense.” Can you hear David Byrne singing, ”You may ask yourself, well, how did I get here?”
How did we get here?
The story begins with our good friends at the World Health Organization (WHO), the caretaker of the ICD code sets. ICD, by the way, is the common abbreviation for International Statistical Classification of Diseases and Related Health Problems, understandably abbreviated with three simple letters. Technically we use a modification of the WHO code set, one that is called the International Classification of Diseases, Clinical Modification (ICD-9-CM). ICD-9-CM is slightly more clinically relevant for our use today in health care operations when compared with the unadulterated ICD-9 code set.
ICD-10 is the designation for the latest and greatest version of the ICD code set, which not surprisingly is the 10th edition of the WHO’s diagnostic code set. What may surprise you, however, is the ICD-10 code set has been available since 1992. That’s right. The current edition is 20 years old. In fact every other industrialized country on the planet, and many third world countries, adopted ICD-10 years ago.
So, why does the U.S. lag behind? In a word, money. The ICD-9 code system is intimately interwoven with the entire U.S. healthcare reimbursement system. Every claim submitted to every payer for services rendered includes a CPT code (what you did) and at least one ICD-9 code (why you did it). Changing something like this is not something that happens overnight.
Where does that highway lead to?
Which brings us back to Secretary Sebelius’ announcement last week. The October 1, 2013, deadline has been in place for several years, after several prior postponements in the so-called drop-dead date. In fact, the 5010 transaction standard we are all familiar with was purposefully rolled out the first of this year in anticipation of the arrival of ICD-10. Organized medicine certainly brought pressure to bear on the ICD-10 transition and many well-informed folks recognized this was an unfunded mandate. But I find the timing of this announcement remarkable, as providers, payers and health IT vendors alike are left to wonder about existing plans and work done to date on the ICD-9 to ICD-10 conversion. In an election year, one must consider whether re-election has influenced the timing of the announcement.
One could look at the body of work done to date on the 9 to 10 transition as an investment in the future, assuming HHS simply pushes the ICD-10 compliance date into 2014 or beyond. But suppose a decision is made to leap frog ICD-10 and simply wait for ICD-11? The 11th edition is due for endorsement in 2015 by our friends at WHO. In this scenario, everyone loses the bulk of the work done to date on the 9 to 10 conversion. But we have waited 20 years; what’s another three?
Once in a lifetime?
At the end of the day, I believe postponing the transition is a wonderful thing for nephrologists. Of course the devil is in the details and we will pay close attention as we learn more in the weeks or months ahead. In the meantime, I have scratched the Sept 30th retirement date from next year’s fantasy calendar.
What should we make of HHS missing deadlines? In the words of Mr. Byrne: “Same as is it ever was, same as it ever was, same as it ever was, same as it ever was.” Unlike Talking Heads, our readers do make sense. Join the conversation and let us know what you think about this delay.