Why is the International Statistical Classification of Diseases and Related Health Problems – 10th Revision (ICD-10) needed? It depends who you ask.
If you ask a coder or Health Informatics professional, the answer might be:
- International standards. The U.S. lags behind the rest of the world, which converted to ICD-10 years ago. The ICD-9 coding set is outdated and inadequate. With the adoption of ICD-10, the U.S. would be able to share its data with the rest of the world.
- Quality measurement and research. The greater detail offered by ICD-10 would provide the potential to collect better data and improve the quality of patient care.
- Reimbursement. The ICD-10 coding set is expected to lead to better justification of medical necessity and improved implementation of national and local coverage determinations. The result will be more accurate payments and fraud detection will be improved.
However, if you ask a practicing physician, you might hear the following:
- ICD codes are used for one reason alone — to file claims and get paid. The U.S. is the only country using ICD codes to pay physicians.
- The number of ICD codes will increase from 13,000 to over 70,000, introducing a plethora of subtle variations that, in the end, serve no real purpose. Migraine alone is designated by 64 separate codes. G43.809 is not the same as G43.619, at least if you are a coder or an insurance company. It is an understatement to say the codes are confusing.
- ICD-10 codes will likely result in more claim denials. In fact, the cost savings from the ICD-10 conversion is based on paying fewer dollars to providers. As physicians, we should expect to spend more time coding and to earn less money.
- The ICD-10 burden is placed on top of cuts in insurance payments and excessive administrative demands such as Meaningful Use, Physician Quality Reporting System (PQRS), and increasing insurance authorizations. For some physicians, it will be the final straw — forcing some to close their doors and abandon the practice of medicine, leaving thousands of patients without care.
- ICD-10 adds nothing to patient care, and in fact, the demands of ICD-10 implementation will hurt patient care. The motivation of the health informatics technology and coding industries seems self-serving, while the benefits of ICD-10 touted by these industries seem false and nonexistent.
Is there a practicing physician out there who believes we need to convert to ICD-10? I have yet to hear from one practicing physician without ties to industry that supports ICD-10. The informatics industry has taken advantage of medicine’s lack of effective organization and advocacy and will have its way with the implementation of ICD-10. Unless Congress acts, ICD-10 will go into effect October 1, 2015.
What Can You Do?
The four largest state medical associations have passed resolutions urging Congress to permanently abandon implementation of ICD-10. Let your county and state medical association know you want ICD-10 stopped. Representative Ted Poe (R-Texas) has introduced HR-2126, which would stop ICD-10 implementation. Call and ask your Congressman to support Rep. Poe’s bill.
You can also sign the Change.org petition and join organizations like Docs4PatientCare and the Association of American Physicians and Surgeons, which advocate a strong doctor-patient relationship. Finally, join the conversation on Sermo or Twitter. Let your voice be heard!
Steven M. Croft, MD, is a board certified neurologist in private practice in southwest Houston, Texas. He also serves as Neurology Consultant for Brenham, Richmond, and Austin State-Supported Living Centers for the developmentally disabled. He is a proud member of the Association of American Physicians and Surgeons, Docs4PatientCare, Texas Medical Association, and the American Academy of Neurology. Follow him on Twitter @smcroft.