AMA wants protection for doctors rolling out new medical coding system

The ICD-10 coding system affects dozens of core applications for healthcare providers and insurance payers

winn army community hospital pharmacy stays online during power outage 100564365 primary.idge
Creative Commons

The American Medical Association (AMA) today voted in favor of a two-year grace period to protect hospitals and physician practices that implement a new medical classification system.

The vote related to the federally mandated ICD-10 coding system is mostly symbolic, as the AMA doesn't make federal policy.

The AMA's House of Delegates, however, does represent U.S. doctors, medical students and residents and is working to create a national physician consensus on emerging issues in public health.

ICD-10, which is designed to better track diagnoses and treatments, affects dozens of core applications for healthcare providers and insurance payers. Currently, there's an Oct. 1, 2015 deadline for implementing the new medical coding system.

While the AMA has voted in favor of delays, conversely, healthcare CIOs and other senior IT leaders have expressed concerns about deadlines being extended.

The College of Healthcare Information Management Executives (CHIME) has stated that every day that passes without a concrete deadline "is another day that should have been spent planning and implementing this critical undertaking."

To date, ICD-10, a medical coding system developed and used by the World Health Organization (WHO), changes out about 15,000 codes used in ICD-9 for approximately 68,000 new ones.

For example, when ICD-9 was rolled out in 1978, there was no such procedure as arthroscopy, where an endoscope is used to perform minimally invasive surgery on a joint. ICD-10 codes also add whether a procedure is an initial one or a subsequent treatment.

The new codes are also vastly more descriptive.

If a physician is treating a broken ankle, the ICD-10 code needs to be selected for which leg the ankle is on, whether it's on the lateral or medial side and whether the injury is an open or closed fracture.

At times, the detail with which ICD-10's codes describe medical conditions can  wander into the bizarre. For example, if you were stabbed while crocheting, your doctor would use the code Y93D1. Sucked into a jet engine? That's a V97.33XD.

There's even a code for having been attacked by a squirrel.

The codes, however are serious business and will dictate how the more than $2.8 trillion that Americans spend each year on medical care is paid out.

The new coding system is so complex that the mandate requiring it has been delayed twice. As its current deadline approaches, there are industry rumblings that it may be delayed again.

"It is the largest and most challenging mandate we'd ever seen," said Ryan McDermitt, vice president of software products at Edifecs, a tier-one vendor of B2B data trading networks. "There'll be a real crush in the healthcare industry in the second half of the year."

Along with hospitals and physician practices, large insurers such as WellPoint and United have each spent more than $100 million in systems upgrades since ICD-10's rollout began.

The AMA said its latest vote was taken in the hopes of mitigating the potential problems by ensuring physicians will not be penalized for errors, mistakes and/or malfunctions of the ICD-10 system.

"The bottom line is that ICD-10 will significantly overwhelm physician practices with a 400% increase in the number of codes physicians must use for diagnosis, which will take time away from the valuable one-on-one patient-physician interface that is the hallmark of taking the best care of patients," AMA board member Dr. Russell Kridel, said in a statement.

Kridel said the AMA will continue to pressure Congress and the Obama Administration to take necessary steps to avoid widespread disruptions created by what it he called an "overly complex and burdensome mandate.

"Coding and billing protocols should never get in the way of patients receiving high quality care," Kridel said.

Copyright © 2015 IDG Communications, Inc.

7 inconvenient truths about the hybrid work trend
Shop Tech Products at Amazon