Changing coding methodologies remain as contentious and divisive as ever within the healthcare industry.
The extent of that division has become more apparent than ever in recent weeks, as the industry considers a deadline for implementing a new version of the key standardized code set used for payments.
A bill long-desired by the industry, the Health Information Technology Promotion Act of 2006, contains a provision mandating the use of the new code set, the 10th version of the International Classification of Diseases, known as ICD-10.
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The move to ICD-10 has polarized segments of the industry in recent years, with battle lines drawn after Congress included an October 1, 2010 deadline for implementing the new version of the code set.
Those favoring a quick transition to the new code set contend that the existing ICD-9 code set is outdated and unable to provide accurate data for billing, quality assurance and research.
Those opposing a rapid adoption of ICD-10 say it will cost the industry billions of dollars to make the conversion, disrupt care and consume valuable time and resources that otherwise could be directed to implementing healthcare information technology.
Both sides fired off press releases and formed coalitions after the details of HR 4157 became known. At least one organization, the Medical Group Management Association, said it considers the provision enough of a reason to cause them to reject the whole bill.
The debate for this year may be moot. As of early October, it appeared unlikely that the Health IT bill would be enacted this year. The House bill needs to be reconciled with a Senate version, and both sides of Congress will face many pressing issues as they return for a "lame duck" session beginning November 13.
There's been some discussion about a compromise on the ICD-10 transition, said David Roberts, vice president for government relations for the Healthcare Information and Management Systems Society. One possible solution, he said, would be to push the deadline back one year, to 2011.
Still, ICD-10 remains a polarizing issue in the industry. MGMA has offered a number of reasons for delaying implementation. It contends that the next generation of ANSI X12 codes must be implemented first, and that could take two years. It estimates that implementing ICD-10 could take three years after that.
ICD-10 contains more than 200,000 codes, compared with the 24,000 codes in ICD-9, said Robert Tennant, senior policy advisor for MGMA. The government doesn't know for sure whether the more granular results available with ICD-10 will pay off.
"We've called for the government to implement pilots to see what the impact will be on clearinghouses, clinics and payers," Tennant said.
Proponents note that other countries have implemented ICD-10, and the U.S. remains one of the lone holdouts still using ICD-9. However, other countries don't use it to record clinical events or for reimbursement, as would be the case in the U.S., said Merit Smith of the Robert E. Nolan Co., a Dallas-based firm that has researched the shift to the new code set.
Using the new code set will require significant training, particularly in physician offices, Smith said. Last year his firm estimated that making the shift to ICD-10 could cost from $6 billion to $14 billion.
However, industry groups in favor of the rapid shift to ICD-10 call it vital to modernizing Medicare. Groups such as the American Hospital Association note that the National Committee on Vital and Health Statistics in 2003 called for rapid adoption of ICD-10.
ICD-10 is needed, they said, to appropriately reimburse for new technology and to provide accurate data to assess the effectiveness of treatments.
Groups favoring quick adoption of ICD-10 include the AHA, the Advanced Medical Technology Association and the Federation of American Hospitals.