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Since our last ICD-10-CM blog, I have successfully completed the two required AHIMA courses, attended an on-site Nashville, TN grueling three day session, and successfully wrote the final exam. I am now the proud recipient of the AHIMA Approved Instructor for ICD-10 CM/PCS and an AHIMA Coding Ambassador. This four month experience was an eye-opener to me professionally as an HIM administrator but also as a member of the health care team. Prior to initiating these studies, I had little familiarity as to how two code-based diagnostic and procedural systems would have the degree of monumental impact on the US health care industry as a whole.

From my background in Clinical Documentation Improvement Systems, I questioned which major health care leaders were engaged in the advancement of these coding systems. My research suggests that the principals were the Center for Medicare Services (CMS), National Center for Vital Statistics (NCVS) , American Hospital Association (AHA), and the American Health Information Management Association (AHIMA), all of whom have fully engaged this huge overhaul, a refit of an old and tiring code-based system which has been used for over thirty years.

Surprisingly the preliminary years, beginning in the early nineties, were spent in the design, testing, and restructuring of two new and completely unique code sets that could optimally meet the challenges of US health care practices. I suspect that these years did not go without many sleepless nights for the principals. Some say that a saving grace is that the diagnostic system, ICD-10-CM, did not require a complete overhaul since many of the coding guidelines and rules were compatible with the old ICD-9-CM diagnostic system.

As with the development of any new documentation system and more specifically where medical terminology, medical nomenclature and classification systems will affect the documentation of the medical practitioner, one key player, the American Medical Association (AMA) has rarely been mentioned. Through the evolution of DRG's in 1980-83, we recognize that not bringing the physicians into the new case mix system was a huge mistake and caused many hospital organizations to fail. We need to take heed from our past experiences if we have any chance for these coding systems to be successful from the onset. As we all know, these systems are predicated on capturing physician documentation and converting these diagnostic and procedural terms to ICD-10 alpha-numeric language.

To add insult to injury so near the implementation phase, the American Medical Association delegates, at their Annual Meeting in November, 2011, voted against the start date of October 1, 2013 for ICD-10-CM/PCS. Although they admit that their disagreement is not in the actual ICD-10-C/PCS code structures, they object to the timing, physician financial constraint and staff preparation. They questioned the efficacy of implementing systems that would require much more physician time in clarifying documentation while adding more financial woes for implementing required manual and computerized system changes into their practices.

The American Health Information Management Association has responded in full disagreement to the American Medical Association's position. They contend that the current ICD-9-CM system cannot meet the demands of the emerging knowledge and technology in American health care and can only survive through broader, more flexible systems that can keep up with the health care changes.

Who will win and who will lose in this recent dispute over classification systems and time frames? Stay tuned. 2012 will be an exciting year!

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