ICD-10 and SNOMED-CT: Better together?

ACP: Delay ICD-10 to investigate alternatives to controversial coding system
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A funny thing happened on the way to ICD-10: Suddenly, there's talk of using the Systemized Nomenclature of Medicine--Clinical Terms (SNOMED-CT) in place of or in conjunction with the controversial diagnostic coding set. The American College of Physicians (ACP) and the Texas Medical Association (TMA) have both taken this position, although in different ways.

In a May 17 letter, ACP told the Department of Health and Human Services that it supports the proposed implementation of ICD-10 by Oct. 1, 2014; a year later than the current deadline.

But if the government delays the ICD-10 deadline to 2014, ACP said, it should use the extra time to investigate whether ICD-10 codes can be automatically generated from SNOMED-CT terms. In addition, the ACP recommends that clinicians and health IT vendors be given incentives to use SNOMED-CT for coding clinical information.

In its proposed Meaningful Use Stage 2 and EHR certification regulations, the Centers for Medicare and Medicaid Services (CMS) already provides such an incentive. CMS would require all certified EHRs to use SNOMED-CT for problem lists, along with other standard terminologies for medications, lab data and immunizations. This underlines the fact that ACP's proposal would benefit only providers who use EHRs certified for Meaningful Use.

The ACP prefers SNOMED-CT to ICD-10 because of its clinical usefulness. "While it is clear that coding with a classification system such as ICD-10 has benefits when it comes to compiling data for secondary purposes, it is generally acknowledged that a reference terminology such as SNOMED-CT is much more effective for accurately capturing the nuances of health conditions and clinical care," the ACP letter notes.

The American Health Information Management Association (AHIMA), a leading proponent of ICD-10, agrees that SNOMED-CT "should be used to document the course of care," according to ACP. Moreover, the Health IT Standards Committee, a private body that advises the government, supports ACP's suggestion that a "crosswalk" be developed between SNOMED-CT and ICD-10, the letter says.

TMA says it wants to scrap ICD-10 entirely and replace it either with SNOMED-CT or ICD-11, which is scheduled to make its worldwide debut in 2011. A switch to SNOMED should include a "translator program" to an ICD code set, TMA says.

TMA's call for a further delay in changing to a new diagnostic code set echoes the position of the American Medical Association, which recently asked HHS to move the ICD-10 deadline back to 2015.

To learn more:
- read the ACP letter to HHS
- see the TMA letter

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