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It’s difficult to argue with the logic that you can’t build a modern skyscraper (or, really, any structure of significance) on a crumbling foundation. 

Unfortunately, that logic does not apply to the modernization of America’s healthcare system, much of which continues to use an antiquated coding system called ICD-9 that fails to adequately reflect nearly 30 years of advances in medical treatments and technology. While the nation’s many voices of authority increasingly are calling for modernizing all aspects of healthcare, meaningful progress will be inhibited by relics such as ICD-9 unless the new system, ICD-10, is implemented.

While often misunderstood, coding systems for medical diagnoses and inpatient procedures fulfill important roles, but to date the benefits of capturing health-related data through coding has not been fully realized. 

ICD-9 is primarily a reimbursement system that provides minimal (if any) tracking data on what procedures, devices, and treatments are effective against illnesses and injuries. ICD-9 also cannot be used to track the cost implications of chronic conditions and their treatments, nor can it track the severity of repeat injuries. This latter shortcoming limits physicians’ ability to analyze trends, such as those associated with head trauma in young athletes.

Fortunately, ICD-10 is expected to be implemented industry-wide later this year. ICD-10 is a more precise coding system that will enable the tracking of diagnoses for diseases, signs and symptoms, and external causes of injury or diseases. Specialty doctors and clinicians requested the additional specificity provided by ICD-10.

With its ability to capture comprehensive data, ICD-10 will improve medical performance, help find new and more effective cures, and identify areas for creating efficiencies. Said another way, ICD-10 is a necessary foundation for critical healthcare modernization initiatives, including the 21st-Century Cures Initiative being driven by the Energy and Commerce Committee of the U.S. House of Representatives. 

What’s not to like?

ICD-10 should have been implemented more than three years ago, but concerns from a small but vocal group of physicians convinced some in Congress to delay the implementation. Meanwhile, the nation’s healthcare industry has moved forward, diligently preparing and making investments for ICD-10, with many physicians taking advantage of free preparation resources from the Centers for Medicare & Medicaid Services (CMS).

Another potential hurdle for ICD-10 (and arguably, whether America’s healthcare modernization efforts will rest on a strong or weak foundation) is coming up at the end of March. Congress must vote on the sustainable growth rate (SGR) for Medicare physician payment rates, which has been the means for passing legislative language to delay ICD-10 in the past.

Certain segments of the healthcare industry will yet again lobby Congress on this obscure but important issue with those who have taken steps to prepare for ICD-10, pitting the prepared against the diminishing few set upon maintaining a nearly 30-year status quo. The stakes are high, as the U.S. Department of Health and Human Services (HHS) estimates that the cost to delay the implementation yet again could potentially reach $6.8 billion. 

Perhaps more important than the monetary assessment is the lost opportunity that will result when an antiquated, 20th-century coding scheme hobbles America’s ability to build a 21st-century healthcare system.

About the Author

Chris Powell is the chief executive for Precyse.

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