August 20, 2012

WHO Official Calls Delay of ICD-10 Implementation “Fascinating and Inexplicable”


At the rate the federal government is moving, “2013 is an optimistic expectation” for the implementation of ICD-10, Dr. T.B. Üstün, team coordinator of classification, terminologies, and standards of the Department of Health Statistics and Informatics for the World Health Organization (WHO) in Geneva, Switzerland.  He finds our country’s continued delay “fascinating and inexplicable” not to mention “quite perplexing”—sentiments shared by the majority (62 percent) of listeners who responded to ICD-10 Monitor’s poll question during the August 14 Talk Ten Tuesday show: What’s your opinion on our continued delay and inability to implement ICD-10?


Üstün provided a historical perspective that makes the delay all the more puzzling for him. The United States adopted the ICD-9-CM system in 1979—just four years after the WHO released the final version. In the early 1990s, WHO released ICD-10, and because we implemented ICD-9 within a reasonable amount of time, he expected adoption sooner. “It has been more than 25 years since the release of ICD-9, and any system becomes obsolete in 25 years.”

He asks the question that many in the healthcare industry are asking: “Why has this delay taken place? The United States is one of the leading healthcare systems in the world” and has topnotch information systems as well.

Meanwhile, North of the Border

Like Australia, Palestine, and England, Canada also has adopted ICD-10. Another Talk Ten Tuesday guest Kerry Johnson, MAEd CHIM, a senior lecturer and HIM instructional coordinator who serves on the Health Sciences faculty at the University of Ontario’s Institute of Technology, explained that Canada’s transition was “very quick” and very different from how we are approaching the change.

They didn’t go federally as the United States is planning, but “province by province with more of a staggered orientation.” From the time providers got notification from their provincial government, they had six months to get ready. Knowing that this might occur, said Johnson, “We kept our preparation and training going even when we didn’t have a final ruling.”

The most difficult part of the progression was the fact that both ICD-9 and ICD-10 were operating simultaneously in Canada for four or five years.  Although this may seem chaotic to us, Johnson believes it was actually no more chaotic or burdensome than our current approach. In Johnson’s opinion, “suffering the pain of the big bang and everything happening all at once or suffering by prolonging it” probably doesn’t make a difference.

In spite of our varied implementation styles, we do share at least two common challenges: Physician documentation and staff training. About documentation, Johnson correctly notes that it was a problem with ICD-9, and it will continue to be a problem with ICD-10. However, he says, “There are different documentation needs for ICD-10, particularly on the intervention coding—details of how a procedure was done, equipment that was used, etc.”

Johnson also shared a best practice he encountered related to physician education. One organization made CDs that included service-specific sections addressing the documentation requirements for that specific specialty. Physicians could access the appropriate section of the CD anytime they wanted and train themselves on the ICD-10 requirements that applied to them.

Insights into ICD-11

In May, WHO released a Beta version of ICD-11 that will be field-tested for the next three years and final approval for this international standard is planned for 2015. During the next three years, WHO hopes to ensure “that 10 will be inside 11 to ensure a seamless transition,” Üstün said. “We want to make sure users of 10 won’t be left behind when 11 comes,” he explains.

Many in the healthcare industry are asking a question that Üstün readily answers: Why don’t we just skip over ICD-9 and go straight to ICD-11? Must we go to ICD-10? It’s “technically feasible and plausible to skip to ICD-11,” but for a seamless transition it will be better to “go to ICD-10—a luxury version of ICD-9—first and as soon as possible.”


Read 14 times Updated on March 16, 2016
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for and; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.