Argument against ICD-10 delay doesn't focus on right points

To be honest, I think we're beyond arguing the merits of ICD-10-CM/PCS implementation. It's inevitable.

The American Medical Association took a vigorous shot at it, and the Department of Health and Human Services (HHS) delayed implementation for one year.

I don't think the AMA really is trying to kill it. There is a bigger goal, and ICD-10 coding is just a talking point in a larger debate.

Besides, most of the arguments have been made and aren't going to change anyone's mind. They haven't yet.

So it's interesting to see that Richard Averill and Susan Bowman make the case “There Are Critical Reasons for Not Further Delaying the Implementation of the New ICD-10 Coding System” in the latest Journal of AHIMA. Actually it seeks to refute a March 2012 paper that argues for a delay of ICD-10 implementation for Health Affairs. It's written by Christopher Chute, MD, professor of biomedical informatics at Rochester, Minn.-based Mayo Clinic; Stanley Huff, MD, CMIO of Murray, Utah-based Intermountain Healthcare; James Ferguson, vice president of health information technology strategy and policy for Oakland, Calif.-based Kaiser Permanente; James Walker, MD, chief health information officer of Danville, Pa.-based Geisinger Health System; and John Halamka, MD, CIO of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston. It's a strong argument.

Averill and Bowman make a strong case against the Health Affairs paper when they counter assertions that ICD-10 coding is not better than ICD-9. The earlier paper is based upon a study they take apart.

But Averill and Bowman go off the rails when they accuse the ICD-10 detractors of seeming to advocate skipping ICD-10 implementation for ICD-11 implementation. Which is not true. The authors are big fans of ICD-11 coding but don't at any point advocate leapfrogging. They argue for managing the ICD-10 to ICD-11 transition better and quicker than it's taken to get to ICD-10. In fact, Chute is in charge of developing the ICD-11 code set, and he's not advocating leapfrogging ICD-10 implementation.

Averill and Bowman wasted a lot of time and credibility with this counter-argument.

I shouldn't try to referee this battle. People are going to believe what they want to believe. But I would like to see some fresh arguments.

For example, Averill and Bowman write, "The Health Affairs authors do not acknowledge the value of health statistics and administrative data, both of which rely on the International Classification of Diseases and are the basis for much of health policy."

We need to talk more about what is that value and give specific examples. How has policy changed for the better as a result of this kind of data?

There has to be some examples. Remember, the United States and Italy are the last industrialized nations to adopt ICD-10 coding. That means there is plenty of diagnosis data to study. Hey, the United States has even been using ICD-10 (straight up World Health Organization (WHO) version without any clinical modification) to report cause of death since 1999. Surely someone has done something worthwhile by now.

Also, we need to look at history. According to Averill and Bowman:

"The clinical detail incorporated into ICD-10-CM was not added arbitrarily, but at the request of the medical community and other users of health information because it was felt to be clinically relevant and meaningful  for a variety of  secondary uses of coded data."

Who asked for what? We can end a lot of debates if we can find out why lamppost injuries are important to track.

Let's find out some of these answers. Maybe they won't change the debate but they might give us some useful information about how to implement ICD-11 coding. After we get through ICD-10 implementation of course.