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ICD-10: Time's Up; No More Excuses

Scott Mace, for HealthLeaders Media, September 11, 2012

"ICD-11 is in the beta phase right now," Jacobs says. "So we really don't know what it is going to look like when it is finally released in 2015. To say that we'll just forego ICD-10 and go to ICD-11 when we don't even know what the final product is going to look like is really frivolous, I think."

According to another consultant I spoke with who prefers to remain unnamed, the AMA has a hidden agenda when it comes to slowing down adoption of ICD-10.

This consultant says the AMA derives significant revenue from providing codes for a somewhat competitive diagnosis system known as Current Procedural Technology, or CPT.

"The AMA licenses CPT to the federal government and agrees to use it exclusively for characterizing physician work," the consultant says. "That's why in the ICD-10 uptake, doctors didn't have to characterize their work with ICD-10 PCS procedure codes. They only had to do diagnosis codes. They were going to continue to use CPT."

Each year, companies pay the AMA license fees for the current version of CPT to embed in the practice management software piece of electronic health records, the consultant says. "CPT owned by the AMA is the AMA's major source of income, because the AMA updates CPT every year," says the consultant.

AMA critics on this CPT issue have been pushed to the margins, and my raising this concern may place me on the margins as well. But it does provide one plausible theory of why the AMA wants to continue to throw a spanner in the ICD-10 works, ostensibly in favor of ICD-11.

And Janice Jacobs' words of concern about the infeasibility of crosswalk technology from any coding system to any other coding system still echo. For sanity's sake, our industry's implementation of the government's ICD-10 mandate needs to hurtle forward, and now.

Shameless plug: If you're ready to roll up your sleeves and get started, or even if you're already under way, a perfect place to start or continue would be my upcoming HealthLeaders Webcast, "Reboot for ICD-10: Lessons from UnitedHealth Group & North Shore-LIJ," scheduled for Monday, October 22 from 1:00 to 2:30 p.m. Eastern time.


Scott Mace is senior technology editor at HealthLeaders Media.
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4 comments on "ICD-10: Time's Up; No More Excuses"


Dr Jeremy A Lazarus (9/14/2012 at 3:44 PM)
The article's theory regarding the AMA's opposition to ICD-10 implementation is unfounded and unsubstantiated. The true basis of the AMA's policy has already been accurately reported by HealthLeaders (http://www.healthleadersmedia.com/page-1/NRS-273412/ICD10-Cost-Timing-Concerns-Explain-AMA-Vote) and other publications when physicians passed a directive instructing the AMA to intervene on their behalf. The timing of the ICD-10 transition could not be worse. Physicians are spending significant financial and administrative resources to cope with overlapping regulatory requirements and multiple government programs that include penalties for noncompliance. At the same time, physicians face a continued threat of drastic Medicare payments cuts year after year. The mounting burdens take time away from patient care. Burdens on physician practices need to be reduced - not created - as we work to get the best value possible for the health care dollar and the nation undertakes significant payment and delivery reforms. The AMA will continue to urge the government to make good on its commitment to improve the regulatory climate for physicians. In the meantime, physicians need to understand the impact ICD-10 will have on their practices, and the AMA has devoted considerable effort to educational programs and resources to get them ready (http://www.ama-assn.org/go/ICD-10). Jeremy A. Lazarus, M.D. President, American Medical Association

Mimi Hart (9/14/2012 at 9:46 AM)
I must have missed a step..what happens under ICD-10 to the CPT system that the AMA would not be happy with?

usausa (9/12/2012 at 5:32 PM)
In the past 20 years I have headed up the coding section at 3 large hospitals, one for profit, one not for profit and now a University setting. In none of these hospitals were Physicians ready (or willing) to document to the extent ICD-10 will require and coders are NOT prepared to code to the level ICD-10 will require. It will be the unprepared leading the recalcitrant and revenues will drop like a rock. With electronic health records, Obamacare, and RACs already devastating what little revenues hospitals and physician's offices have, the smartest thing done to date was to postpone ICD-10,and that needs to be for TWO years not one. The commentators in favor of ICD-10, in my opinion, unanmously appear to benefit from the implementation in some way. Those of us who will be on the front lines can see what is going to happen, and it is our opinion that the entire medical profession(and the patients we serve) need to "Be afraid - be very afraid!"