# HHS Press Release:  Just announced



## Pam Brooks

*HHS Press Release: HHS Announces Intent to Delay ICD-10 Compliance Date*

In a new press release from HHS, Secretary Kathleen Sebelius announced that HHS will initiate a process to postpone the compliance date by which certain health entities have to comply with ICD-10. The press release can be found below.
*Press Release: HHS Announces Intent to Delay ICD-10 Compliance Date*
As part of President Obama's commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).
The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.
“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”
ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.
*Keep Up to Date on Version 5010 and ICD-10.*
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!


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## ollielooya

Well, this indeed is big news, but I'm guessing a lot of will not be surprised by this announcement! ---Suzanne E. Byrum CPC


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## mhanson1

I'm curious to hear everyone's thoughts on this news.  Relieved?  Frustrated?  No feelings one way or the other?  

Where I work, we are diligently preparing for the transition, so a significant delay for us is very frustrating.  

Michelle Hanson, CPC


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## MnTwins29

*My $0.02*

First one is mock surprise - gee, it's an election year and one of the biggest specialty groups is putting up a fight over a regulation.   Better make sure they are happy and will vote and continue to contribute to our campaigns!

Second one and a little more serious - I want to find out what the certain types of providers are that will be provided the extension.   Is this going to be played out where smaller practices get a delay while bigger ones don't, much like HIPAA implementation?   Is it a matter of only a few days or weeks (such as a 60 or 90 day delay) or a more significant time frame?   

As I am in a transition phase and am currently not up to speed yet on my new employer's ICD-10 progress, I don't know if this will be a positive or negative for them, but I do feel for all those providers of all sizes who have invested millions of dollars and man-hours to be ready, only to see it all for naught because of a few whiners.


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## scorrado

I can't say that I am surprised by this either.  It seems like there is always delays with anything to do with the government.


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## cheermom68

Lance,
I agree with your questions of who it will affect and for how long.  Also, how long before they let us know?  Many have paid for and signed contracts for educational products and consultants which they will still have to pay for and if it is extended too long will be absolutely useless.  And what about those that have quit jobs to take consulting positions and/or education/training positions?  Many unanswered questions and they need to give everyone a hint of when we will know and what we should do in the meantime.
LeeAnn


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## Pam Brooks

Note the reference to President Obama. I bet he doesn't even know what ICD-10 is, and someone thinks it might be fun to indirectly involve him with the AMA's arm-wrestling with CMS's decision.  Never saw that one coming. Sorry, I'm disgusted with election year mudfights, so thought I'd join in. Just an observation-- so hold your fire, please .

Lance, I also noted the verbiage "certain healthcare entities". I wait with bated breath........


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## MnTwins29

*No worry*



Pam Brooks said:


> Note the reference to President Obama. I bet he doesn't even know what ICD-10 is, and someone thinks it might be fun to indirectly involve him with the AMA's arm-wrestling with CMS's decision.  Never saw that one coming. Sorry, I'm disgusted with election year mudfights, so thought I'd join in. Just an observation-- so hold your fire, please .
> 
> Lance, I also noted the verbiage "certain healthcare entities". I wait with bated breath........



Pam, I am with you 100% on the political mudslinging and the reference to President Obama on practically every issue.   No firing from here!


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## alincoln

I'm also very interested in the who/when of this decision, as in like you all have said, who is "certain covered entities" and how much of a delay.  This leaves a lot of us and our practices in limbo at the moment... oh politics!


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## scorrado

I like the "certain entities" statement also.  The government is going to complicate it even more if they pick and choose who does ICD -10 for awhile. Not to mention the cost involved. Much easier to let us all go at once.  But what do I know - lol!


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## dcraven

*Delay ICD-10*

It states "Intent" and "initiate a process".  Absolutely sounds like Washington!  Many of us have stressed to our Providers that this will not be delayed...now we have to pass this on to them.....?
Our Health Care Network has worked diligently to be ready and need I say spent a lot of $ to assure we are ready.  It is quite frustrating.


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## JMeggett

All I can say is, Wow.   Amazing that all this hype & hoopla is pushed…”Prepare! For it is coming!”….just to later be told, “Wellllll…maybe not”.    I've been trying to prepare my Providers and Administrator and have been hearing back, “Oh it probably won't happen”.  They'll love this.

Jenna


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## ruthan

*wow*

I am hoping they make a decision very soon.  This is ridiculous what they are pulling at this point.  They have had 5 years why not do something then instead of now when from what I am reading and hearing a majority of the Medical community is behind this change.  Like myself I have put alot of time and money in my education for this for CEU requirements, that if they end up getting there way...it is basically money out the door that could have been invested in other things right now.

I say get over it and get with the times United States, times are going to get any better for awhile.


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## jmcpolin

I believe I saw someone post why not just wait until ICD-11 comes out at this point, I agree with that if they are going to push the ICD-10 out any further.


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## ked12387

dcraven said:


> It states "Intent" and "initiate a process".  Absolutely sounds like Washington!  Many of us have stressed to our Providers that this will not be delayed...now we have to pass this on to them.....?
> Our Health Care Network has worked diligently to be ready and need I say spent a lot of $ to assure we are ready.  It is quite frustrating.



As with any government process, by the time they get around to putting a process in place to not use ICD-10, it will already be 2016.


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## mitchellde

I am furious and disappointed over this.  It is rediculous to continue putting this off especially after so much money has been spent to ready ourselves. I have been ready and looking forward to this conversion for so long....... it is like waiting for Christmas!!!!!!!!!


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## theresa.dix@tennova.com

scorrado said:


> I like the "certain entities" statement also.  The government is going to complicate it even more if they pick and choose who does ICD -10 for awhile. Not to mention the cost involved. Much easier to let us all go at once.  But what do I know - lol!




Pam,
 My exacts thought too. How in the world would Obama know what ICD 10 is and im sure someone tried to explain it. but you know how confusing it is to understand coding. haha


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## mmorningstarcpc

Pam, I agree, I doubt very much the President has a clue what ICD-10 is!!

Having attended the Coordination and Maintenance Meetings at CMS twice a year for the last four years, I will be SHOCKED if it is actually pushed back.  I believe they will offer a grace period instead.  I would like to be a mouse at CMS as I believe there are several people there who are livid at the mention of even contemplating push back.  Pat Brooks has stated many times "there will be no extension, 10/1/13 is FIRM!!!  Also, if it goes thru rule-making it may takes months for a new date to be given.  So will they really wait until 12 or so months ahead of time to annouce a new date?  I really don't think so!! 

I don't believe it is fair to the entities that have already spent lots of money, provided or are planning to provide training to staff, organizations that are "ready" now or in the process of getting to the ready point!!  Those entities would then assume more costs to retrain people if ICD-10 is pushed back.

Physicians, coders and facilities need to continue to work towards the original date.   I don't think its a panic situation.

I too am annoyed that they are even thinking about this, I have worked with ICD-10 in different capacities for many years and its time to GO LIVE!!


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## bridgettemartin

Note the article refers to _compliance dates_.  Perhaps it is similar to what they did regarding 5010 implementation.  The implementation date didn't really change.  The date in which _certain entities_ had to be compliant changed.  It seems to me that we are way beyond the point of no return with ICD-10.  Too much has already been invested to throw it all away.


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## mitchellde

bridgettemartin said:


> Note the article refers to _compliance dates_.  Perhaps it is similar to what they did regarding 5010 implementation.  The implementation date didn't really change.  The date in which _certain entities_ had to be compliant changed.  It seems to me that we are way beyond the point of no return with ICD-10.  Too much has already been invested to throw it all away.



I agree!  Also I read another piece from a different CMS entity which stated to continue to prepare for ICD-10 CM with the same implementation date in mind.  Also I find it interesting that the article and the CMS person was careful to word the transition as ICD-10.  In the US we will use ICD-10 CM.  This is what is in the HIPAA regulation and the Federal Register not ICD-10.  Accident?  or purposeful?


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## paynemedbill

Good afternoon everyone.  In response to Michelle Hanson's reply, I guess I am feeling a little relieved AND frustrated.  It will be interesting to discover which "covered entities" the Secretary of Health was referring to.  One blog mentioned that in Canada ICD-10 is only used by hospitals.  Hopefully we will be given some clarification in the not-too-distant future.


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## mmorningstarcpc

jmcpolin said:


> I believe I saw someone post why not just wait until ICD-11 comes out at this point, I agree with that if they are going to push the ICD-10 out any further.



They can not wait until ICD-11.  First of all, that is just in the very beginning stages of development, so will be several years away.  Then it will have to go thru rule making processes in the US before it can be implemented.  Second, and more important, it is based on the principles of ICD-10.  Delaying until ICD-11 is not an option.  There is more about this in the proposed and final rules for ICD-10.  Third, they have to implement ICD-10as it is the code set of HIPAA.

If they would wait until ICD-11, it would be way more to implement than ICD-10 is.


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## MnTwins29

mitchellde said:


> I agree!  Also I read another piece from a different CMS entity which stated to continue to prepare for ICD-10 CM with the same implementation date in mind.  Also I find it interesting that the article and the CMS person was careful to word the transition as ICD-10.  In the US we will use ICD-10 CM.  This is what is in the HIPAA regulation and the Federal Register not ICD-10.  Accident?  or purposeful?



Just like the Obama comments in this thread earlier, I am not sure if the person realizes the difference between ICD-10 and ICD-10-CM.   Even if that person is from CMS - I am sure anyone here who has had the pleasure of talking to CMS reps know that they are not all knowledgable on this topic.


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## cansas

*for what it's worth*

I am not completely suprised by the decision to delay.  My frustration is that they haven't announced a new implementation date.  I think "certain entities" going forward while others aren't would be horrible.  Can you imagine an insurance trying to handle both ICD-10 and ICD-9 with no uniform stop start date?  That would be a heavy burden for all insurance carriers.

I am honestly slightly revlieved because of the delay.  (I think I am the only coder in my organization who is)  I work for an organization that employes 100+ providers (multi specialty).  We are currently trying to get our EHR off the ground for our providers and new software for our hospital departments.  The providers are expected to learn our EHR for their clinic duties and another new software for their hospital duties.  It is going to be an extremely stressful time for the providers.  If the delay is only a few months, then I welcome the extra time to examine each of our providers current documenatation, so the providers have the opportunity to be educated on the importance of their documentation and how it will be affected with the implemination of ICD-10.  

I have talked with several of our providers and they are releived as well.  e-prescribing, new EHR, new organization structure...  They are a little over-whelmed.  

I am not hoping for a lengthy delay, but I plan on using any and all extra time to further educate myself, my staff, and my providers.  ICD-10 is inevitable, we know, so I don't see that any money we have already spent is wasted.  So instead of being negative about the delay, I will use it as extra "study time" so that hopefully when the new implementation date rolls around, I will be better prepared.  

So for now, I say continue on training and educating...  and waiting for the new implementation date before altering your education plan.  

Cansas Riggenbach, CPC


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## mmorningstarcpc

I'm not sure what your providers are relieved about, as nothing has changed yet, and it may not change at all.  It may just be a grace period.  CMS is looking at this idea, but nothing has been set in stone yet.  Right now, there is no delay!  CMS is taking a look at possibly delaying implementation, but I think they are going to get way more push back on delaying it now, than comments in favor of a delay.  CMS has even stated "proceed as if the date is 10/1/13" for now!!!  

I will say, some organizations are really using this "potential" situation to their advantange.  I got an email yesterday stating "as I-10 is delayed" and they were pushing their I-10 training.  I got another one this morning that says "CMS confirms I-10 delay" but when you read the article, it clearing states CMS is reviewing the possibility of a push back.

The only thing for sure right now is CMS is taking a look at the implementation date.  IF and WHEN a change is made, they will publish that information.  Also, everyone wants the "delay" date today.  With the rule-making process, there may not be an announcement for several months.  

People need to not get caught up in waiting to train, as it may come back that CMS says there will be no delay.  Then those people are even further behind than they might be now.


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## Pam Brooks

There has been (to my knowledge) no absolute formal decision to delay, postpone or otherwise move the I-10 date. All I've read is that CMS is considering a delay, and at best will possibly implement a grace period for certain entities. The AMA is still leaning heavily on CMS, but other groups (like AHIMA) and large healthcare facilities that have already invested thousands (if not millions)of dollars in ICD-10 preparation are encouraging CMS to not cave in. 

As professionals, we are trained to read and research carefully and not make decisions based on anything other than regulatory guidance. I know that this is a hot topic, but we must be extremely particular with what and how we communicate this recent development to our providers and each other, in order that we don't further perpetuate chaos. The conversion is going to be challenging enough, I expect. 

I think that those of us who are responsible for ICD-10 implementation should stay on the course that we've set forth. Worst case scenario will be that we have a brief delay, which might provide a bit of breathing room. If there is no delay (or a delay only for some), then we'll be glad we didn't hold off on our implementation plans.


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## mitchellde

well stated Pam!  Also it occurred to me that There are 2 official dates for implementation of ICD code changes, they wrote into the HIPAA regulation several years back that codes changes could officially occur on Oct 1 and April 1 of each year.  The fact that they have never used the April 1 date does not mean they will not start now!  So they could in fact either delay until April 1 2014, or implement Oct 1 2013 with a phase in thur April 1.  And still get this thing off the ground in fiscal 2014.


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## tpontillo

Just got this emailed to me from CMS.  I guess they are doing a survey from the physicians and facility's to see how far they have gotten with the ICD-10 implementation.  

The link to the survey is:

http://www.surveymonkey.com/s/WEDIFeb12ICD10

News Updates | February 24, 2012


WEDI's Survey on ICD-10 Industry Progress Now Open
The Workgroup for Electronic Data Interchange (WEDI) is conducting its latest Industry Progress Survey on ICD-10. Information from this survey will be used to inform WEDI, CMS, and other organizations on the progress of ICD-10 implementation. This brief survey will also assist in planning necessary programs and actions to assist the industry in transitioning to ICD-10.
To gather the most complete picture of progress within the industry, this survey is open to all organizations affected by ICD-10 such as vendors, health plans, providers, and payers. The survey is open to both WEDI members and non-members.
Responses to this survey will be gathered online.  WEDI asks that participants only submit one survey per organization. The survey will close on Wednesday, February 29, 2012. Please direct any questions to Ann Marie Railing at WEDI at 703-391-2718 or amrailing@wedi.org. 
Keep Up to Date on Version 5010 and ICD-10.
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!


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## cansas

They are releived that there is a possibility they will get more time to learn their new softwares and ICD-10.  Nothing has changed for them, but it is coming.  Sorry I was not more specific in saying the possibility of delay.  However, in the press release it states "HHS will announce a new compliance date moving forward."  That statement may be what is confusing many people.  CMS is saying they are reviewing the possibility, and the HHS is saying they will announce a new compliance date.  The scretchy details from several people and organizations are confusing.

Again, I stand by my statement.  A little more breathing room would give us more time to train and get further educated.


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## SherryMiller

I would doubt that an April, 2014 date would be announced.  Because of federal budgeting and fiscal planning, I would hedge that the implementation date will be pushed back a year or two.  Then interestingly enough, could we go straight to ICD-11?  There is a release date of 2015 or 2016 slated for the soon to be new version.


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## mmorningstarcpc

The US can not go directly to ICD-11.  First, it is just in the beginning stages of development by WHO.  Second, ICD-11 is based on the principles of ICD-10.  The short story is if the US waits for ICD-11, it will be way more complicated than going from ICD-9 to ICD-10, and would cost tons more money to do as well.  Third, there are future programs that are contingent on ICD-10 being in place and implemented.  All those programs would have to be put on hold, and it would continue to create a major backlog.  Think of the physician fee schedule every year, look how much bigger the issue becomes because Congress can't/won't fix the problem.  Waiting on ICD-11 would be that type of situation, only about 1000 times more!!


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## laurenkrass

mmorningstarcpc said:


> The US can not go directly to ICD-11.  First, it is just in the beginning stages of development by WHO.  Second, ICD-11 is based on the principles of ICD-10.  The short story is if the US waits for ICD-11, it will be way more complicated than going from ICD-9 to ICD-10, and would cost tons more money to do as well.  Third, there are future programs that are contingent on ICD-10 being in place and implemented.  All those programs would have to be put on hold, and it would continue to create a major backlog.  Think of the physician fee schedule every year, look how much bigger the issue becomes because Congress can't/won't fix the problem.  Waiting on ICD-11 would be that type of situation, only about 1000 times more!!



Why does it matter if ICD-11 is based on the principles of ICD-10? ICD-10 is a whole new coding language, so if we have to learn a whole new language, why not go straight to the one that is up to date? So what if it is a little more complicated? We will have several more years to prepare. 

The ICD-10 transition at this point in time is extremely inefficient and useless since it will be outdated as soon as it is functional in the US. The only ones that are up in arms about any type of postponing are those that have some type of financial interest in ICD-10. Those that are against it are those that are unprepared for any transition. 

I am on schedule with ICD-10 compliance if need be, but I think it's a day late, dollar short no matter when it will be implemented. Why not be ahead of the game and prepare for implementing the most current ICD available?


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## jpspencer

*ICD-10 At This Stage Makes No Sense*

I left a comment back in 2008 during the Proposed Rule period for ICD-10 stating that we should skip ICD-10 completely and go to ICD-11. Now that ICD-10 compliance is being delayed, I vehemently stand by that original opinion.

The Final Rule for ICD-10 from January of 2009 stated that a clinical modification for ICD-11 could not be put into place until the years 2020. This was a half-truth, as ICD-11 is going to be the first classification system with a clinical modification built in. What CMS was referring to was an American, insurance-friendly clinical modification designed to more easily deny claims. 

The worldwide relsease date for ICD-11 (WITH clinical modification) is May of 2015, which means that four years from now, without ICD-11, we'll be _exactly_ where we are today, which is to be doomed to be behind the rest of the world in disease, symptom and morphology reporting for the next decade because a lobbyist who writes a check is worried about "costs".


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## mmorningstarcpc

laurenkrass said:


> Why does it matter if ICD-11 is based on the principles of ICD-10? ICD-10 is a whole new coding language, so if we have to learn a whole new language, why not go straight to the one that is up to date? So what if it is a little more complicated? We will have several more years to prepare.
> 
> The ICD-10 transition at this point in time is extremely inefficient and useless since it will be outdated as soon as it is functional in the US. The only ones that are up in arms about any type of postponing are those that have some type of financial interest in ICD-10. Those that are against it are those that are unprepared for any transition.
> 
> I am on schedule with ICD-10 compliance if need be, but I think it's a day late, dollar short no matter when it will be implemented. Why not be ahead of the game and prepare for implementing the most current ICD available?



To understand why it matters that ICD-11 is based on ICD-10, I respectfully suggest you dial into the Coordination and Maintenance Meetings at CMS, help in March and Sept each year.  They give very detailed information.  You can go to meetings at cms.gov 30 days prior to a schedule meeting and register.

Also, you are totally incorrect about the only people being up in arms about delaying the transition.  I strongly object to the delay, and I have no monetary gain from implementation, other than being employed!!!  Many, many, many coders are in favor of the implementation  as is on 10/1/13.  Many have worked very hard to get to the point we are at now and are not in favor of waiting any longer.


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## Kristin Ledbetter

mmorningstarcpc said:


> They can not wait until ICD-11.  First of all, that is just in the very beginning stages of development, so will be several years away.  Then it will have to go thru rule making processes in the US before it can be implemented.  Second, and more important, it is based on the principles of ICD-10.  Delaying until ICD-11 is not an option.  There is more about this in the proposed and final rules for ICD-10.  Third, they have to implement ICD-10as it is the code set of HIPAA.
> 
> If they would wait until ICD-11, it would be way more to implement than ICD-10 is.



Could someone clarify how ICD-11 is based on ICD-10 and what specifically about ICD-10 must be implemented to make ICD-11 implementation work?  Just the facts, please.


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## mhanson1

Kristin Ledbetter said:


> Could someone clarify how ICD-11 is based on ICD-10 and what specifically about ICD-10 must be implemented to make ICD-11 implementation work?  Just the facts, please.



I have been reading up on several options proposed regarding the delay.  Regarding ICD-11 uses the concepts of ICD-10 and expands upon them.  Without ICD-10 knowledge already in place, the utilization of ICD-11 would be far more cumbersome.  I found a list of known problems in the BETA version of ICD-11 on the WHO website, and item #7 says this:


> It is premature to plan to go to ICD-11 when major applications for ICD-10 are not implemented.
> Currently there is a gap in the ICD-10 implementation world. Only 117 countries out of 194 report mortality data using one form of ICD to WHO despite the fact that there is an international health regulation since 1967. Some countries still prefer to use ICD9 and its modifications. For example, the transition from ICD-9 to ICD-10 for morbidity use is planned for October 2014 in the USA.
> These implementation issues are context specific. For example, global implementation is dependent upon the existence of “vital registration systems” and country specific examples depend on their unique health information infrastructure.
> WHO is managing a revision process to enable a scientific update of the classification scheme on the one hand (ICD10 was constructed between 1982-89 and was approved in 1990. In a sense we are using a 20-25 year old medical information standard). On the other hand, the emergence of information technology requires ICD to “interoperate” with electronic health applications – to be compatible with the Systematized Nomenclature of Medicine (SNOMED CT) and other terminology and ontologies.


http://www.who.int/classifications/icd/revision/icd11betaknownconcerns.pdf

In other articles that I have read, it states that in order for the US to convert ICD-11 to a clinical modification we could use, it would not be ready for implementation until 2021.  Frankly, ICD-9 is out of room and we can't wait that long for a replacement.  

I am still researching ICD-11.  I don't agree with waiting for ICD-11 based upon what I have been reading.  I hope the delay is not extended for more than 1 year, but as time passes quickly, I am grateful for the extra time to work on the conversion.  I have been working on the conversion for almost a year now, and with the differences between ICD-9 and ICD-10, mappings are sometimes very difficult and cumbersome. This reply has gotten very long, so I won't go into details, but feel free to ask me any questions about what I have learned in the conversion process.

Michelle Hanson, CPC


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