Summit Opens with Rousing Debate on ICD-10

In the kickoff to AHIMA’s ICD-10-CM/PCS and Computer-Assisted Coding Summit, panelists at the “Early Riser” session jokingly referred to the code set’s recent implementation delay as “ICD When.”

IMAG1590During the Tuesday morning session “What Now? Industry Reaction to the Latest ICD-10 Delay,” payers and providers alike vented their frustrations and shared their strategies for dealing with legislation that, less than a month ago, pushed back the implementation date of ICD-10-CM/PCS until at least October 2015.

The morning’s keynote speaker, Dr. Steven Stack, MD, immediate past chair of the American Medical Association’s (AMA) board of trustees, presented immediately after the Early Riser session and offered a sharp contrast in perspective on the ICD-10 delay. Although the AMA was unhappy with the legislation that delayed ICD-10—the delay was bundled into a bill that provided a temporary patch to Medicare’s sustainable growth rate—the AMA, as Stack admitted, is ultimately seeking to permanently block ICD-10 implementation.

The two sessions opened the floor for discussion on both sides of ICD-10 debate, offering attendees a chance to express everything from frustration and disappointment to optimism and pragmatism.

 

Speaking Out in Support of ICD-10

Connie S. Tohara, RHIT, director of health information at the University of Utah Hospitals and Clinics, and an Early Riser session panelist, said cynicism from physicians and medical staff about the future of ICD-10 is worse than it has ever been. However, she said she thinks it will improve once the Centers for Medicare and Medicaid Services sets a final implementation date.

Tohara’s co-panelist, Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, national director of coding quality, education, systems and support, national revenue cycle at the Kaiser Foundation Health Plan Inc. & Hospitals, urged health information management (HIM) professionals to use this extra time before ICD-10 implementation to bring more HIM professionals into the coding fold.

“We need more analytics, opportunities for growth and advancement, [it is a] good time to bring them into training and grow,” Bryant said. “We’ve got a lot of good information.”

She also encouraged AHIMA members to step up their advocacy efforts to ensure no further delays of ICD-10. “It’s important that you make your voice heard, be more of an advocate to counter the apathy that exists,” Bryant said.

 

The Other Side of the Aisle

The AMA’s Stack started off his presentation with the acknowledgement that his organization’s stance on ICD-10 implementation is at odds with that of the majority of the summit audience. He noted that his presentation, “ICD-10, EHRs, and Other Mandates: An Evolving Landscape,” was not intended to persuade attendees, but merely to provide another perspective. He was quick to add, however, that he couldn’t start without mentioning the delay.

“We [the AMA] didn’t ask for this. Our policy is not to delay, it is to kill ICD-10,” Stack said. “Congress screwed up again. That legislation had nothing to do with ICD-10. A do-nothing Congress managed in six days to do something we didn’t ask it to do.”

Stack offered some context for why physicians are frustrated by ICD-10 and electronic health records (EHRs). Among other things, he says doctors’ collective frustration with health IT initiatives such as the “meaningful use” EHR Incentive Program and the ICD-10 implementation mandate stem from the fact that “the things we do uniquely are not coding, charting, collecting information for folks,” although, he added “there’s value in that.”

Stack also challenged ICD-10 trainers to keep their training programs relevant.

“What I did not like from my hospital’s training, there was a bias in the beginning. It was advocating for the value of ICD-10, and asserting that all these things were good,” Stack explained. “I wish they would just say ‘Here’s what we can do with this data.’”

 

3 Comments

  1. Dr. Stack is right. ICD-9-CM and ICD-10-CM is too hard for physicians. Its language is not natural to how physicians were trained or what we read in our literature. Heart failure with reduced systolic function should be coded as systolic heart failure, yet Coding Clinic 1st Quarter 2014 prohibits the use of the newer term. The ICD-10 Cooperating Parties, of which AHIMA is a member, appears to supports this difficulty. ICD-10 is a wonderful code set, yet coders should be given some leeway to assign clinically congruent codes that would withstand reasonable scrutiny. Until the Cooperating Parties makes ICD-10 easier for practicing physicians, how matter how wonderful ICD-10 is, I relate to why physicians want to kill it.

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  2. At least AMA admitted their kill ICD-10 wish. Maybe ICD-10 is a scheme for full employment for coders and MDs should stop worrying about coding.

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  3. I agree with Dr. Kennedy’s statement that “coders should be given some leeway to assign clinically congruent codes that would withstand reasonable scrutiny”. We had this in the past, it was taken away. Yet, we need to be viewed as professionals who know what they are doing. Also, many coding areas work with Clinical Data Specialist’s. Our CDS are RN’s and we consider ourselves a team, able to responsibly handle some “leeway” that would stand firm with review of documenation and clinical language.

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