Time Warp: Why You Should Care About the ICD-10 Delay

Published on
April 21, 2014

To read the second of two posts in this series, click here.

About once a week, my laptop or smartphone tells me they want to make some updates. A software company has found a bug it wants to kill. A location on a map has changed. Or my computer’s security system has developed a new way to protect me (and everyone else) from bad things.

What if those updates only occurred once every 30 years? Can you imagine using technology from 1975 for your job today?

In a way, this is what health care professionals in the United States do. They have had at their disposal a more comprehensive system for identifying, tracking, and billing for diseases and injuries, and they have allowed it to sit on the shelf. The United Kingdom, Canada, Australia and other countries have taken advantage of the latest revision of the International Classification of Diseases and Related Health Problems (ICD-10). The United States has not.

The U.S. was scheduled to make the change in October 2014, but after a move by the U.S. Senate this month, it will delay implementation for at least another year. To understand the urgency of the matter, look at how Sue Bowman with the American Health Information Management Association described the differences:

Replacing ICD-9-CM with ICD-10-CM and ICD-10-PCS will provide higher-quality information for measuring healthcare service quality, safety, and efficacy. This will in turn provide better data for:

  • Quality measurement and medical error reduction (patient safety)
  • Outcomes measurement
  • Clinical research
  • Clinical, financial, and administrative performance measurement
  • Health policy planning
  • Operational and strategic planning and healthcare delivery systems design
  • Payment systems design and claims processing
  • Reporting on use and effects of new medical technology
  • Provider profiling
  • Refinements to current reimbursement systems, such as severity-adjusted DRG systems
  • Pay-for-performance programs
  • Public health and bioterrorism monitoring
  • Managing care and disease processes
  • Educating consumers on costs and outcomes of treatment options

Upgrading technology is something most of us do all the time with just a few taps of our thumb. Updating to ICD-10 is understandably more involved, as the history of disease classification shows. 

Coding deaths and diseases dates to at least the 1700s. The first major attempt to create an international standard was born in 1893 in Chicago. A gathering of the then young International Statistical Institute heard about an innovative way to track diseases based on where they occurred in the body. The innovator was Dr. Jacques Bertillon from France, and the new system was called the Bertillon Classification of Causes of Death. It went through many name changes and revisions since then — about once a decade for comprehensive overhauls with tweaks along the way.

The system currently in use in the United States was created in 1975 by the World Health Organization. At the time, it was a major step forward. It expanded the list of diseases and injuries that could be tracked, allowing for about 17,000 different codes.

In 1983, with new diseases arising – HIV/AIDS for example – and medical technology allowing for an even finer-grained analysis of what makes people sick, WHO started working to expand the coding system further. The revision was endorsed by the Forty-third World Health Assembly – an annual gathering of all WHO member states – in May 1990. It was put into practice by WHO in 1994.

It creates 155,000 different coding possibilities, and countries like Australia, Canada, and New Zealand started using it right away, making adaptations to fit their countries’ needs.

The United States appeared to be an early adopter, too. Even before Canada got on board, in December 1997, the U.S. National Center for Health Statistics posted a comparison of ICD-9 and ICD-10 codes on its website for public comment.

But then the slowdown began. It wasn’t until January 2009 that the Centers for Medicare and Medicaid Services announced that health care entities wanting to receive federal health dollars would have to start following the new system. The deadline? October 2013.

That deadline was bumped back a year in August 2012. And now it has been bumped back again until October 2015.

The delay isn’t just theoretical. Health care providers have invested millions in making the switch. They have trained their staffs to use ICD-10 coding. They have created entire systems based on the more extensive code list.

A poll by Deloitte LLP of 1,250 health professionals found that 58 percent were disappointed by the delay, although the same poll also showed that 39% of those polled thought that the new October 2015 deadline was the optimal scenario.

Next: How further delays could make this code change dead on arrival.

Image by Stéfan via Flickr.