Hurry Up and Wait

John Marcille

The collective sigh heard earlier this month came from frazzled physicians and medical groups relieved that the Centers for Medicare & Medicaid Services issued a new deadline for implementing ICD-10, pushing it back to Oct. 1, 2014. Implementing the codes — about 155,000 of them, as opposed to the approximately 17,000 for ICD-9 — has been giving providers nightmares.

The ICD codes are actually two separate groups: ICD-10-CM (clinical modification) is a set of diagnosis codes to be used, for the most part, by health plans, hospitals, providers, and PBMs. ICD-10-PCS (procedure coding system) puts an additional burden on hospitals — and to some extent payers — because they will be used to describe inpatient procedures. There are approximately 13,000 ICD-9-CM codes; ICD-10-CM will have 68,000. There are approximately 3,000 ICD-9-PCS codes; ICD-10-PCS will have 87,000.

The codes add “granularity,” a vogue term for more detail, to the diagnosing process.

CMS’s notice of proposed rulemaking (NPRM) in the Federal Register notes that “ICD–9–CM has a single diagnosis code for fracture of the wrist. If a patient is treated for two successive wrist fractures, the ICD–9–CM code does not provide enough detail to determine if the second fracture is a repeat fracture of the same wrist, a fracture of the other wrist, incorrect billing for delayed healing, or non-union or mal-union of the original fracture.” Health plans should appreciate the finer level of detail for billing and care management purposes, although the billing part might recede in importance a bit as various episode payment schemes work their way into the system.

The problem with ICD-10 is that it was published in the Aug. 22, 2008 issue of the Federal Register. Everybody has been warned for four years (more really, since the the notice of rulemaking was late in the game) that the changeover is coming, and yet the deadline gets pushed back anyway.

The best-selling biography of Apple founder Steve Jobs by Walter Isaacson quotes Jobs as saying: “I think Henry Ford once said, ‘If I’d asked customers what they wanted, they would have told me, A faster horse!’ People don’t know what they want until you show it to them. That’s why I never rely on market research. Our task is to read things that are not yet on the page.” It is uncertain whether Ford actually said the “faster horse” thing, but Jobs believed he did.

Jobs was a difficult man to work for. But I’ll bet that if he were in charge of implementing ICD-10, we’d be talking about implementing ICD-12 by now.

John Marcille is the editor of Managed Care.