Back in March when the Ebola epidemic in West Africa was just beginning, and the mid-term elections were still in the distant future, Congress passed and President Obama signed the Protecting Access to Medicare Act of 2014. This bill was kind of sneaked onto the floor, because it was the 17th time a yearly extension was passed to increase the reimbursement to health care providers and maintain the fee for service reimbursement system Medicare was founded on rather than convert to a reimbursement system based on outcomes. In order to garner support for this bill, increases in the reimbursement rate for laboratory services and medical imaging was included in the bill, and as an extra bonus, this bill delayed the implementation of ICD-10, a medical coding system used world-wide for diagnoses, for a second year so that it would not be implemented until October of 2015.
Despite the efforts of thousands of health care professionals who called and e-mailed their senators and the President speaking of the dangers of continuing to use ICD-9, a 35 year old system, for medical coding when the rest of the world has been coding with ICD-10 for almost a decade, the Senate passed the bill and the President signed it. So we are stuck using a medical coding system we implemented in 1979 using technology that is 35 years old and is a decade behind the rest of the world.
Why is this important?
Because ICD-9 ran out of codes several years ago and has no code for EBOLA; EBOLA is coded as Other viral diseases. ICD-10 does have a code for Ebola and several other dangerous infectious diseases besides. With a current medical coding system and an electronic health record there would be no need for physicians to plow through nurse's notes to discover that a patient just arrived from a epidemic area. A simple code for possible diagnosis would literally light up the system like a holiday tree, and it wouldn't matter what EHR vendor developed your system. If ICD-10 had been implemented on October 1, 2013 the EHR at Texas Health Presbyterian would have lit up the first time Mr. Duncan walked in the door. Not only would every health care worker who dealt with him be aware of his possible diagnosis, the CDC could be automatically notified also. Even if ICD-10 had been implemented this year as scheduled on October 1, 2014 there would be a much better chance of catching his probable diagnosis the first time he came to the hospital, increasing his chances of survival and better preparing the health care workers who would be delivering his care.
This infographic from the Coalition for ICD-10 explains how an updated and current medical coding system is necessary to protect the US public from public health threats no matter what their origin.