ICD-10 Is Coming

A pair of papers discuss the looming implementation deadline for ICD-10.  The International Classification of Diseases system is created by the World Health Organization and is designed to identify what was wrong with a patient.  Another major coding system, CPT, is maintained by the AMA and generally identifies what a physician or other provider did for the patient’s problem.  The new version of ICD will dramatically expand the number of codes available to describe the patient’s condition and will also allow description of what the provider did.  Among other things, this sets up a potential test of whether the AMA will ultimately be allowed to continue to maintain a widely-used coding system, which some have viewed as potential conflict.  For the time being, the exact version of ICD-10 to be used in the US for diagnosis has been prepared by the Centers for Disease Control and the procedural codes to be used for hospital inpatient services were developed by CMS.

ICD-10 is to be implemented in the United States by 2013.  Shifting information systems to use the new system is not a trivial task, especially when organizations are working on EHRs, HIEs, etc.  But the additional information, assuming the coding is accurate, never a given, will greatly facilitate research.  It will also impact all the various performance measurement systems, which will need to be redefined using the new codes.  America’s Health Insurance Plans estimates that the total cost for insurers to comply is about $2-3 billion.  (Note that this is an administrative expense under the MLR calculation!)  On a per member basis, it is much more expensive for small health plans.   (AHIP Estimate) The cost to providers will likely be several times this.

The National Quality Forum also put out a paper regarding the implementation of ICD-10.  The paper largely discusses the need to convert certain quality measures maintained by the NQF to use of the new coding system.  NQF notes the obvious interaction with meaningful use requirements but did not attempt to address that complication.  Converting to the new system needs to be done in a way that allows the greatest possible consistency between measurement years, so that actual changes in the delivery and outcome of care are being measured, not a change in the coding system.  The report contains an expert panel’s recommendations for creating this consistency.   (NQF Report)