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Hell freezes over: ICD-10 becomes a reality

Two-decade saga ends as US implements healthcare codes

ICD-10 is here. No, really.

That's the reality for thousands of healthcare practices, hospitals, laboratories, specialists and doc-in-the-box walk-up clinics. After years of planning, software upgrades, complaints, varying degrees of panic and numerous delays, the new generation of U.S. healthcare codes goes into effect today.

Getting here has been a very, very long journey.

The World Health Organization adopted ICD-10 more than 20 years ago. That is not a typo: Ace of Base ruled the airwaves in 1994 when WHO approved the update. Sweden was on board by 1997. Canada adopted its version in 2000. China picked up ICD-10 in 2002.

And then there's the U.S. A host of issues contributed to a grinding slog toward ICD-10 implementation, including cost concerns, technical worries and raw politics.

The road to ICD-10

From a practical standpoint, the U.S. endgame began in 2008. That's when the Bush administration announced ICD-10 would be implemented by Oct. 1, 2011.

The American Medical Association had other plans. The group saw ICD-10 as a bureaucratic mess that would burden healthcare providers with unnecessary expenses and massive complexity.

"If it was a droid, ICD-10 would serve Darth Vader," Dr. Robert M. Wah, then the president of the AMA, said in a November 2014 speech to the group's House of Delegates. "For more than a decade, the AMA kept ICD-10 at bay -- and we want to freeze it in carbonite."

The group was far from alone in its opposition. ICD-10 cut across a number of powerful interests that pushed for changes for both pragmatic or political reasons. Some opposing politicians feared ICD-10 was a step in the march toward nationalized healthcare. Doctors and healthcare administrators saw a massive implementation cost and hassle.

"We’d see 13,000 diagnosis codes balloon into...a five-fold increase. Sucked into a jet engine? Burned by flaming water skis? Yes, there are codes for that," Wah said. He wasn't kidding, as Healthcare Dive noted in a feature more than a year ago.

Delays followed the Bush announcement. The Obama administration decided in 2009 to put off ICD-10 until 2013, then until 2014. In February 2014, CMS's then-administrator Marilyn Tavenner made an unquestionably direct promise in a speech to the Healthcare Information and Management Systems Society: "There are no more delays and the system will go live on Oct. 1, 2014."

Only there were, and it didn't.

Congress stepped in and slipped ICD-10 language into routine must-pass Medicare legislation. It mandated a new delay of at least a year.

Finally, on July 31, 2014, HHS issued a rule that set the compliance date: Oct. 1, 2015. The options for additional delay appeared to be drying up, but there were plenty of attempts.

Last November, Wah made his "carbonite" pledge. And as late as May, the AMA was still publicly opposed to implementation, saying costs of making the ICD-10 changeover had skyrocketed and suggesting it would be better to wait for ICD-11 -- the next iteration.

The group backed a bill introduced April 30 by Rep. Ted Poe, R-TX, that would prohibit the federal government from implementing ICD-10. "Instead of hiring one more doctor or nurse to help patients, medical practices are having to spend tens of thousands just to hire a specialist who understands the new codes," Poe said.

But Poe's bill was the equivalent of a football Hail Mary -- a last-second, long-odds play that had little chance. 

The positions of the AMA and CMS still seemed intractable into the summer, while legislation was introduced to create an ICD-10 "testing period" after Oct. 1. Opponents claimed that action was just a delay by another name. And the deadline clock kept ticking.

The situation finally thawed in July. CMS announced a one-year no-penalty grace period for incorrect ICD-10 claims, easing some concerns the changeover would immediately pound medical practices in the pocketbook.

The AMA had earned a significant concession. The winds shifted.

"The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible,” Dr. Steven J. Stack, the current AMA president, said in response to the CMS move. In short, ICD-10 had moved from "frozen in carbonite" to "as smooth as possible" in about eight months.

In the end, the AMA simply recognized there would be no more delays, Dr. Robert Wergin, president of the American Academy of Family Physicians, said in a Healthcare Dive interview earlier this year. The group "appropriately chose to move forward in the best interest of their members with resources to prepare them," he said.

A late scramble

Almost immediately, the AMA and CMS began offering joint resources to help prepare health professionals for ICD-10 -- a process many professionals already had begun. Insurance companies and consulting/training firms already were heavily involved in preparation, and the push toward October gained momentum.

"Many agencies were gearing up for the transition first set for Oct. 1, 2014. However, when the delay was announced in 2014...many agencies put their implementation training on the back burner and didn't continue to prepare for ICD-10-CM implementation," Jennifer Gibson, a RN and ICD-10 coding trainer for healthcare technology company Axxess, told Healthcare Dive.

The company has been conducting coding seminars across the country and has seen a broad spread in preparation for the change -- or lack thereof, Gibson said.

"The majority of attendees in my classes over the last two years did not have a transition team in place, and did little or no training before coming to coding boot camp," she said. "These agencies will now be dealing with a knowledge deficit, a higher hit on the productivity decline and may not be able to find available certified coders to assist them."

The issues are not limited to providers. Four states do not have ICD-10 fully coded for their Medicaid programs and are temporarily going to use ICD-10-to-ICD-9 conversion techniques to reimburse providers for now. How well that will work is yet to be seen.

Still, here we are. A change this massive will cause pain, and it will be months before the implications of the changeover become clearer. But after a fight that took decades, ICD-10 is really, really in place.

Want more coverage of ICD-10? Here's a look at some preparations for the changeover. And if you need a smile while battling the new system, be sure to check out our gif guide to the most important animal ICD-10 codes or our look at the 16 most absurd codes.

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Filed Under: Health IT Payer Policy & Regulation
Top image credit: Wikimedia Commons