A new report from the American Medical Association Board of Trustees concludes that the advantages of skipping implementation of the ICD-10 code sets and waiting until ICD-11 are outweighed by the disadvantages.

“Our AMA harbors serious concerns and reservations with the significant burden of the ICD-10 mandate and will continue to convey these points to policymakers in Washington,” the report states. “However, given the even greater complexities and uncertainties with moving directly from ICD-9 to ICD-11, the Board of Trustees believes skipping ICD-10 and moving directly to ICD-11 is fraught with its own pitfalls and therefore, based on current information available, is not recommended.”

The report follows a directive last year from the AMA House of Delegates to evaluate the feasibility of moving from ICD-9 to ICD-11 as an alternative to adopting ICD-10. The AMA in November 2011 launched a fight against ICD-10, which at the time had a compliance date of Oct. 1, 2013. Under pressure from the association and other stakeholders, the Centers for Medicare and Medicaid Services in August 2012 announced a one-year delay, to Oct. 1, 2014, for the compliance date. At the HIMSS13 Conference in March, CMS Administrator Marilyn Tavenner made it clear that the new compliance date would not change.

The AMA report evaluates work being done through the World Health Organization on ICD-11, which could be approved in mid-2015, with at least several years of additional work needed to create a version for the United States before implementation.

Advantages of skipping ICD-10 include eliminating costs for implementing ICD-10 that may have to be repeated only a few years later for ICD-11, giving providers only one implementation period to go through, and giving providers more time to implement electronic health record and health information exchange technologies without resources being so stretched.

Disadvantages of waiting for ICD-11 include continued use of outdated ICD-9 codes, impeding the building of knowledge and experience from ICD-10 to implement ICD-11, missing out on expected lower reliance by payers on claims attachments under ICD-10, and an unknown timetable for ICD-11 adoption that could range from several years to two decades.

The ICD-11 report is available here. The AMA also recently issued a report with tips on how to integrate electronic health records into the examination room without the technology becoming a disruption to workflow and physician-patient communication.

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