Why every American should care about the ICD-10 delay
March 13, 2015 in Medical Technology
To the average person, ICD-10 might sound like the cataloging number one uses to locate a piece of furniture in an IKEA warehouse. And with each passing delay, it is positioned more and more as a government versus healthcare provider debate. While these organizations and facilities are certainly impacted, we, as patients, are as well – only most don’t realize it.
All care is not equal
The ICD or “International Classification of Diseases” system is a standardized way of documenting diagnosis and procedure codes throughout the world. They are a way for physicians, hospitals, and other providers to exchange information with health plans to describe a patient’s condition and the services that were provided to treat those conditions.
As we shift from a volume-based payment system, i.e., how many patients go through the door and how many tests are issued, to a value-based system, one that measures patient outcomes and the level of quality care as evidenced by such things as hospital-acquired infections and readmission rates, accurate clinical documentation and medical coding play an even more vital role in ensuring organizations are appropriately reimbursed for the care they are providing.
For instance, a patient who received a heart transplant will have very different needs than a patient admitted to the hospital with a kidney infection. The severity of each patient’s case, and the associated level of care, are not the same and require different resources. Hospitals are reimbursed for the type of care they are providing to their patient populations, and therefore diagnosis codes are an important piece of information that describes patients’ conditions, justifies the services and treatments, and demonstrates medical necessity.
A worldly matter: why the ICD-10 delay matters
The challenge is that while every other industrialized nation across the globe is documenting their diagnoses using ICD-10, the United States is still relying on the antiquated code sets of ICD-9, which is nearly 40 years old. And, in an industry where new discoveries are made every day, this is not only unacceptable, it is dangerous.
This means that when a health crisis arises, we are not able to track it the same way our colleagues in Canada or France can by documenting a patient’s specific condition using an ICD-10 code. Although our clinicians know what the patient has-and treat him or her accordingly-it is not documented in the system.
The disparity between the ICD-9 and ICD-10 code sets can have dire consequences when it comes to a public health threat such as the recent Ebola outbreak. The lack of a designated ICD-9 code for Ebola posed some challenges for global agencies, such as the World Health Organizations (WHO), that document and track such diseases in order to ensure better public health response measures and reduce the risk of contagion.
As Americans and global citizens, we must understand the important role ICD-10 plays in our healthcare system and communicate this to our leaders in Washington. All of these delays send a strong negative message and dilute the value of these codes.
So each time Washington politics throw a roadblock in front of this piece of legislation, it not only impacts an important component in our healthcare industry’s shift to value-based care, it prevents our valuable participation in global health monitoring, and slows our ability to help identify public health threats and ensure we have the right resources in place to deal with them readily and appropriately.