Latest ICD-10 Delay Re-shuffles the Deck, Irritates Players

Another year-long delay in the deadline for implementation of the ICD-10 medical coding set spells frustration for vendors and providers. "This is bad," says CHIME president and CEO Russ Branzell.

CHIME president and CEO Russ Branzell's mood was one of irritation Monday evening in the wake of the Senate "doc fix" vote which postpones ICD-10 compliance requirements for another year.

"We'll continue to try to push to see with the executive branch and the White House staff [Tuesday] to see if there's any chance at all of doing some education of why this is bad. But at this point, we generally think it's going to go through," Branzell told me.

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"Essentially, ICD-10 was being held hostage with the SGR fix and at this point. It had to be voted on tonight and essentially it has to be signed tonight to have an SGR fix effective tomorrow, which is when the original SGR fix sunsets. I would be surprised if it isn't on its way over to the White House to be signed tonight anyway."

I asked Branzell if anybody had identified those groups that had gotten the ICD-10 language inserted.

"I asked the question around today and all I got was that it was predominantly from the specialty and subspecialty medical groups," he said. "We know the AMA wasn't for it, because they put something on their Web site… I would assume that it was more that the specialty groups were pushing for the SGR fix, and this got included in it."

I offered that groups such as the MGMA pretty much supported an ICD-10 delay, but I doubted whether a group like MGMA had sufficient clout to ram through a postponement.

"Most of the physicians now, well over 50 percent, are working within health systems, so you would think the health systems would carry their voice to try to get this where it needs to be. But in the end, if you had to balance payment reform and losing 25 percent of your income versus ICD-10, it sounds like payment is going to take precedence," Branzell says.

During our chat, I mentioned to Branzell that I had had a conversation earlier in the day with an EHR vendor who noted that large, well-capitalized healthcare systems are either continuing on with their ICD-10 plans or have actually gone live with ICD-10 already.

According to this vendor, who asked not to be identified, such large, prepared providers plan to simply "backcode" to ICD-9 for the next year. I wondered, however, if that is an indicator of a widening disparity between those who have the resources to do that and those who do not.

"If you look at the mapping of going from ICD-9 to ICD-10, that's much harder than going from ICD-10 back to ICD-9," Branzell says. "Actually I had a discussion with some people today about that. I'd be surprised if, with some exploration, that isn't part of the toolkits brought out for people and suggestions that come out, whether that be from other associations, or ours, or whatever, as a viable option to stay on track, keep your people trained, and just automate back.

"So, if there are, say, 27 codes for a sprained ankle in ICD-10, and there are only one or two in ICD-9, it's pretty easy to backtrack to ICD-9."

I suggested to Branzell that based on a story I wrote last month about CDI in HealthLeaders magazine, coding for ICD-10 now is also consistent with the kind of coding rigor that SNOMED is striving for. In other words, if you're going to stay on track with SNOMED, you're going to be doing better coding anyway.

But Branzell noted that the extra year of delay will raise the specter again of the entire industry waiting a few extra years to move to ICD-11, which is due to be published in 2015.

On listservs he monitors, which include "quite a few physicians," he's noticed comments like this: "If we're going to delay a year, and ICD-11 really isn't that far away and it's what the doctors want with SNOMED anyway, is this just one delay until the next delay, and then we jump from ICD-9 to ICD-11?"

"It may make sense to just combine it into one effort. I don't know what the wait [for ICD-11] would be and what the trickle effect of issues are. I don't even know if you can go from ICD-9 to ICD-11, [or] if you have to go from nine to 10 and then 10 to 11.

I told Branzell I had looked into this and it seemed like it was much easier to go to ICD-10 first.

"I think it has to do with the documentation requirements. It's much more intuitive for a physician to code and document into a SNOMED environment."

So while the industry fulminates about the underhanded way the newest ICD-10 delay has made its way into the law books, and the cost of delaying the transition are re-tallied, it would be prudent for us to take a moment to also look around and see just how another 12-month delay re-shuffles the deck in the complex game of healthcare IT and payments.

I'm certain that's what U.S. healthcare's CIOs will be doing for the next few days or weeks.