Manchikanti Laxmaiah, Kaye Alan D, Singh Vijay, Boswell Mark V
Pain Management Center of Paducah, Paducah, KY, and University of Louisville, Louisville, KY; LSU Health Science Center, New Orleans, LA; Spine Pain Diagnostics Associates, Niagara, WI; and 4Department of Anesthesiology and Perioperative Medicine, Univers.
Pain Physician. 2015 Jul-Aug;18(4):E485-95.
The forced implementation of ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes that are specific to the United States, scheduled for implementation October 1, 2015, which is vastly different from ICD-10 (International Classification of Diseases, Tenth Revision), implemented worldwide, which has 14,400 codes, compared to ICD-10-CM with 144,000 codes to be implemented in the United States is a major concern to practicing U.S. physicians and a bonanza for health IT and hospital industry. This implementation is based on a liberal interpretation of the Health Insurance Portability and Accountability Act (HIPAA), which requires an update to ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) and says nothing about ICD-10 or beyond. On June 29, 2015, the Supreme Court ruled that the Environmental Protection Agency unreasonably interpreted the Clean Air Act when it decided to set limits on the emissions of toxic pollutants from power plants, without first considering the costs on the industry. Thus, to do so is applicable to the medical industry with the Centers for Medicare and Medicaid Services (CMS) unreasonably interpreting HIPAA and imposing existent extensive regulations without considering the cost. In the United States, ICD-10-CM with a 10-fold increase in the number of codes has resulted in a system which has become so complicated that it no longer compares with any other country. Moreover, most WHO members use the ICD-10 system (not ICD-10-CM) only to record mortality in 138 countries or morbidity in 99 countries. Currently, only 10 countries employ ICD-10 (not ICD-10-CM) in the reimbursement process, 6 of which have a single payer health care system. Development of ICD-10-CM is managed by 4 non-physician groups, known as cooperating parties. They include the Centers for Disease Control and Prevention (CDC), CMS, the American Hospital Association (AHA), and the American Health Information Management Association (AHIMA). The AHIMA has taken the lead with the AHA just behind, both with escalating profits and influence, essentially creating a statutory monopoly for their own benefit. Further, the ICD-10-CM coalition includes 3M which will boost its revenues and profits substantially with its implementation and Blue Cross Blue Shield which has its own agenda. Physician groups are not a party to these cooperating parties or coalitions, having only a peripheral involvement. ICD-10-CM creates numerous deficiencies with 500 codes that are more specific in ICD-9-CM than ICD-10-CM. The costs of an implementation are enormous, along with maintenance costs, productivity, and cash disruptions.
定于2015年10月1日强制实施的美国特定的ICD - 10 - CM（国际疾病分类第十次修订本，临床修订版）编码，与全球实施的ICD - 10（国际疾病分类第十次修订本）有很大不同，ICD - 10有14400个编码，而美国要实施的ICD - 10 - CM有144000个编码，这是美国执业医师主要关心的问题，却给健康信息技术和医院行业带来了巨大商机。此次实施基于对《健康保险流通与责任法案》（HIPAA）的宽泛解读，该法案要求更新ICD - 9 - CM（国际疾病分类第九次修订本，临床修订版），但未提及ICD - 10或更往后的版本。2015年6月29日，最高法院裁定，环境保护局在决定对发电厂有毒污染物排放设限时，不合理地解读了《清洁空气法》，且未首先考虑对行业的成本影响。因此，医疗保险和医疗补助服务中心（CMS）不合理地解读HIPAA并在不考虑成本的情况下实施现有的广泛规定，这同样适用于医疗行业。在美国，编码数量增加了10倍的ICD - 10 - CM导致系统变得极其复杂，已无法与其他任何国家相比。此外，大多数世界卫生组织成员仅在138个国家使用ICD - 10系统（而非ICD - 10 - CM）记录死亡率，在99个国家记录发病率。目前，只有10个国家在报销过程中采用ICD - 10（而非ICD - 10 - CM），其中6个国家拥有单一支付方的医疗保健系统。ICD - 10 - CM的开发由4个非医师团体管理，即合作方。它们包括疾病控制与预防中心（CDC）、CMS、美国医院协会（AHA）和美国健康信息管理协会（AHIMA）。AHIMA起了带头作用，AHA紧随其后，两者利润和影响力都在不断增加，本质上为自身利益创造了法定垄断。此外，ICD - 10 - CM联盟包括3M公司，其将因实施该编码大幅提高收入和利润，还有蓝十字蓝盾公司，其有自己的议程。医师团体并非这些合作方或联盟的成员，只是处于边缘参与状态。ICD - 10 - CM存在诸多缺陷，ICD - 9 - CM中有500个编码比ICD - 10 - CM更具体。实施成本巨大，还有维护成本、生产力影响和资金流中断问题。
