Health association calls for code updates

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The American Health Information Management Association is calling on the Department of Health and Human Services to update the set of codes that designate diagnoses and treatments for medical records and billing.

The association may have found some support in Congress.

Linda Kloss, executive vice president and chief executive officer of the association, told a House subcommittee yesterday that the United States is the only major industrialized nation still using the 30-year-old code set known as the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).

The old set, which HHS agencies developed, “is not meeting current health care data needs and cannot support the transition to an interoperable health data exchange in the U.S.,” Kloss said in her testimony before the House Ways and Means Committee's Health Subcommittee.

Congress included an endorsement of more up-to-date code sets, ICD-10, in the Medicare Modernization Act of 2003. That same year, the National Committee on Vital and Health Statistics recommended that HHS propose new rules for implementing the newer codes.

However, HHS has not done so, and adoption of the ICD-10 code sets is not high on the department’s priorities list, according to an HHS official. But that could change if Congress gets more forceful in its directions to the department.

Rep. Nancy Johnson (R-Conn.), the subcommittee's chairwoman, is expected to introduce a bill Thursday that would, among other provisions, direct HHS to issue rules making the new code sets the U.S. standard, with a three-year transition.

Kloss said the ICD-9-CM code set was developed before the arrival of laser surgery or magnetic resonance imaging, and before the discovery and definition of diseases such as AIDS.

Although new diagnoses and procedures have been added to the code set over the years, she said, ICD-9-CM is running out of numbers for that purpose. “There are about 70 remaining unassigned codes,” Kloss said.

HHS has licensed the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) for anyone to use as a reference terminology in electronic health records. The HHS official said that action indicated the direction HHS expected classification technology to take.

But Kloss said SNOMED-CT alone won’t do the job. She said it must be mapped to ICD-10 “so robust, computer-assisted coding applications will be available for adoption. Today, the National Library of Medicine is preparing mappings to ICD-9-CM because there is not yet a final rule for ICD-10. I liken this to putting a Model T engine in a Porsche.”