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Perception vs. Reality: Physicians and ICD-10

According to French abstract artist Robert Delaunay, “Our understanding is correlative to our perception.” Many in the healthcare community may have the perception that all physicians oppose the transition to ICD-10. That is simply not true. There is a long history of extensive involvement and support by physicians and physician groups throughout the lifecycle of ICD-10-CM development and the adoption process. In fact, much of the additional clinical detail in ICD-10 was recommended by physician groups.

Many physician organizations participated in the eight days of hearings the National Committee on Vital and Health Statistics (NCVHS) held in 2002 on the adoption of ICD-10-CM and ICD-10-PCS as a replacement for ICD-9-CM. All of the physician organizations that testified supported transitioning to ICD-10-CM and identified numerous benefits over ICD-9-CM, which are highlighted in excerpts from their testimony below. Keep in mind these statements about the serious limitations of ICD-9-CM and advantages of ICD-10-CM were made more than 10 years ago.

What about today? Many physician practices, like other providers, were not happy about the last delay in ICD-10 implementation and were ready for the transition. Beyer Medical Group, a small rural practice in Missouri, testified to this effect at both an ICD-10 Coalition Hill Briefing and an Energy and Commerce Committee Subcommittee on Health hearing in February 2015. They are ready for the transition and did not find preparation to be at all costly or burdensome. Atrius Health, the Northeast’s largest nonprofit independent multi-specialty medical group, indicated in a recent blog that they are well-positioned to go live with ICD-10. While many organizations had made significant progress at the time the last delay was announced and the delay only hindered their forward momentum, this medical group continued to move forward with preparation activities. According to Atrius Health, since organizations that were falling behind didn’t use the extra time presented by the last delay to get up to speed, additional time to prepare isn’t likely to motivate them any more than the first delay did.

As Atrius Health so aptly stated, “It’s not time for another delay; it’s time to get to work.”

Excerpts from the testimony of physician organizations at the 2002 NCVHS hearing:

American College of Obstetricians and Gynecologists (now the American College of Obstetricians and Gynecologists) (ACOG)

  • “Accurate diagnosis coding is critical to improving the quality of health care, informing decisions about public health policy, and facilitating smooth processing of health insurance claims. ACOG believes that ICD-10-CM represents a significant improvement over ICD-9-CM for these purposes.”
  • “Medical knowledge has expanded greatly [during the time since ICD-9-CM was introduced], as has the range of treatments offered. Obstetric care provides several examples of this rapid pace of change. Developments in sonography have revolutionized the examination of the fetus. Our understanding and clinical use of maternal and fetal physiology in the management of labor has improved significantly. Knowledge and classification of important maternal conditions such as diabetes mellitus and hypertensive diseases of pregnancy has also changed. ICD-9-CM is woefully inadequate to capture these changes. “
  • “ICD-10-CM offers greatly enhanced capabilities for identifying and tracking important obstetric conditions and interventions. These data are needed for high-priority public health efforts to reduce adverse pregnancy outcomes. “
  • [The addition of information about trimester of pregnancy] “…should prove valuable in efforts to monitor the provision of prenatal care and the occurrence of complications.”

American Academy of Neurology (AAN)

  • “Often regarded as mysterious, and previously regarded as having limited treatment, neurologic diseases are increasingly understood and treatable. The field of Neurology has expanded dramatically in the last ten years. At this point in time, ICD-9-CM no longer keeps up with the changes in neurologic classification.”
  • “ICD-10-CM not only contains more of our diagnoses, it would be a clean slate with which to work as new conditions are discovered or better understood.”
  • “ICD-9-CM is loosely based on older classifications of neurologic disease.”
  • “In our own extraction of neurologic codes, ICD-9-CM for Neurologists, the American Academy of Neurology has crosswalked an updated classification of stroke with existing ICD-9-CM codes. [AAN] chose the listing from ICD-10 for that updated classification because it is more familiar to today’s neurologists.”
  • “Hassle factor of ICD-9-CM – Imagine the busy practitioner already faced with increasing amounts of paperwork associated with each patient encounter. This practitioner has to first know older and now unused diagnostic classifications and ICD-9-CM idiosyncrasies in order to choose codes. It is very difficult to do this without much time and training. Many practitioners leave this chore to office staff who are not true coders. This results in less than accurate coding, a tendency to use nonspecific codes, and makes ICD-9-CM a less useful tool to use for research.”
  • “The transition should be easy and welcomed because the diagnostic codes are much more familiar to [neurologists].”
  • “Improved access of patients with certain diagnoses to neurologists is another anticipated benefit of ICD-10-CM.”

American Psychiatric Association

  • “We feel strongly that the time has now come to adopt ICD-10-CM as the official overall morbidity and mortality classification system in the United States, both in order to maintain international compatibility in health care reporting and to take advantage of the up-to-date conventions and terminology contained in ICD-10.”
  • “The ICD-10-CM classification system represents a significant advance over ICD-9-CM. Besides providing greater freedom for adding new categories and subtypes (due to the alphanumeric coding system), the ICD-10 reflects the most current usage of medical terminology, especially in the area of mental disorders.”
  • “Unfortunately, the United States has continued to lag behind much of the world in its adoption of ICD-10, and to hold back many other countries that look to the US for leadership in health care.”
  • “The continued use of archaic terminology [in ICD-9-CM] may carry negative connotations to the patient because of ongoing changes in the use of medical terminology over the past 25 years.
    ICD-9-CM includes a number of categories that are not recognized as mental disorders in the United States.”
  • “The continued use of archaic subtypes and wording in ICD-9-CM forces coders to make diagnostic distinctions that have no basis in current science.”
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