Trouble with timelines (1) DSM-5, ICD-10-CM, ICD-11 and ICD-11-CM

Trouble with timelines (1): DSM-5, ICD-10-CM, ICD-11 and ICD-11-CM

Post #198 Shortlink: http://wp.me/pKrrB-2qr

Update at March 7, 2014: ICD-11 has been postponed by two years. It is now scheduled for presentation for World Health Assembly approval in 2017.

Update at August 15, 2012: On Page 3, I stated that Steven Hyman, MD, is a DSM-5 Task Force Member and that Dr Hyman chairs the meetings of the  International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. According to the DSM-5 Development site, Dr Hyman is no longer a member of the DSM-5 Task Force, having served from 2007-2012. I cannot confirm whether Dr Hyman continues involvement with the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders though his name remains listed on the WHO site page, or on what date or for what reason Dr Hyman stood down from the DSM-5 Task Force.

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While the US health care industry, professional bodies and clinical practices sweat on the announcement of a final rule for ICD-10-CM compliance and speculation continues over the feasibility of leapfrogging from ICD-9-CM to ICD-11, I thought I’d run through the timelines.

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DSM-5: ETA: May 18-22, 2013

Originally slated for publication in May 2012.

In December 2009, the American Psychiatric Association shifted release of DSM-5 to May 2013, in response to slipping targets. With no changes to the published Timeline and no intimation of further delays, I’m assuming DSM-5 remains on target.

The final manual is scheduled for submission to American Psychiatric Publishing by December 31, 2012, for official release, next May, during APA’s 2013 Annual Meeting in San Francisco.

Following closure of the third and final public review on June 15, 2012, draft proposals for disorder descriptions and criteria sets as published on the DSM-5 Development website were frozen. The DSM-5 website will not be updated with any further revisions made by the work groups between June 15 and going to print. Final criteria sets and manual content are under strict embargo until publication [1].

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ICD-10-CM: ETA: Compliance mandatory by October 1, 2013; Final Rule to be announced on CMS’s proposal to delay compliance date to October 1, 2014

The development process for ICD-10-CM is as old as God’s dog.

WHO published ICD-10 in 1992. Twenty years on, while the rest of the world has long since migrated to ICD-10, the US is still waiting to transition from ICD-9-CM to a US specific clinical modification of ICD-10. The US is still using a modification based on WHO’s long since retired, ICD-9, and a code set that is now over 35 years old.

The Tabular List and preliminary crosswalk between ICD-9-CM and ICD-10-CM were posted on the NCHS website for public comment in December 1997. Field testing took place nearly ten years ago, in the summer of 2003.

The proposed rule for the adoption of ICD-10-CM/PCS was published in August 2008 with a proposed compliance date of October 1, 2011. In January 2009, the Department of Health and Human Services (HHS) published a final rule adopting ICD-10-CM/PCS to replace ICD-9-CM in HIPAA transactions, with an effective compliance date of October 1, 2013.

On February 16, 2012, HHS Secretary Kathleen Sibelius announced intent to postpone the compliance date for adoption of ICD-10-CM/PCS codes sets for a further year, to October 1, 2014 to allow more time for providers, payers and vendors to prepare for transition.

Public comment on the proposed rule closed in June. An imminent decision on a final compliance rule is anticipated but no date by which a decision would be announced has been issued.

Annual updated releases of ICD-10-CM and associated documentation have been posted on the CDC website for public viewing since January 2009.

CMS has issued the 2013 release of ICD-10-CM and General Equivalence Mappings (GEMs) which replace the December 2011 release. Until an implementation date is reached, codes in the 2013 release of ICD-10-CM are not currently valid for any purpose or use but are available for public viewing on the CDC website.

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Partial Code freeze for ICD-9-CM and ICD-10-CM

At the September 15, 2010 public ICD-9-CM Coordination and Maintenance Committee Meeting it was announced that the committee had finalized its recommendation to impose a partial code freeze for ICD-9-CM and ICD-10-CM/PCS codes prior to implementation of ICD-10-CM. Partial Code Freeze Announcement [PDF]

October 1, 2011 was the last major update of ICD-10-CM/PCS until October 1, 2014. Between October 1, 2011 and October 1, 2014 proposals for revisions to ICD-10-CM/PCS will be considered only for new diseases/new technology procedures and minor revisions to correct reported errors. Regular (at least annual) updates to ICD-10-CM/PCS will resume on October 1, 2014.

These Partial Code Freeze dates are based on the original compliance date of October 1, 2013. It’s reported that postponement of the requirement for compliance until October 1, 2014 would also push back scheduled ICD-10-CM coding updates.

If the proposed compliance date of October 1, 2014 is instituted, adoption of ICD-10-CM would become mandatory around 18 months after publication of DSM-5. The first regular updates to ICD-10-CM would resume one year post compliance date, that is, from October 1, 2015.

Continued on Page 2

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Reminder: Comment period on ICD-10-CM proposed delay ends May 17

Reminder: Comment period on ICD-10-CM proposed delay ends May 17

Post #159 Shortlink: http://wp.me/pKrrB-23H

On April 9, the US Department of Health and Human Services issued a proposed rule calling for a one year delay in the ICD-10-CM/PCS compliance deadline.

The proposed rule would postpone the compliance date by which providers and industry have to adopt ICD-10-CM by one year, from October 1, 2013 to October 1, 2014. 

The proposed rule was published in the Federal Register on April 17, followed by a 30 day period during which CMS will take comments.

Comments should be submitted to HHS no later than 5:00 pm ET on May 17, 2012.

 

Proposed Rule

The Proposed Rule documentation can be found on this page in PDF and HTML formats:

http://www.regulations.gov/#!documentDetail;D=CMS-2012-0043-0001

Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets

Document ID: CMS-2012-0043-0001 Document Type: Proposed Rule
Docket ID: CMS-2012-0043 RIN:

More information on the proposed rule is available from this CMS fact sheet

HHS PROPOSES ONE-YEAR DELAY OF ICD-10 COMPLIANCE DATE (CMS-0040-P)

Submitting comment

Submitting comment by post:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–0040–P
P.O. Box 8013
Baltimore, MD 21244–8013

Submitting comment online:

Go to the Federal Regulations website, here:

http://www.regulations.gov/#!documentDetail;D=CMS-2012-0043-0001

Hit the Submit a Comment button, top right of web page

http://www.regulations.gov/#!submitComment;D=CMS-2012-0043-0001

For delivery by hand see the Alternate Ways to Comment pop up, top right of Submit a Comment page.

Related material

Press release: April 9, 2012

Summary Proposal Rule

This proposed rule would implement section 1104 of the Patient Protection and Affordable Care Act (hereinafter referred to as the Affordable Care Act) by establishing new requirements for administrative transactions that would improve the utility of the existing Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions and reduce administrative burden and costs. It proposes the adoption of the standard for a national unique health plan identifier (HPID) and requirements or provisions for the implementation of the HPID. This rule also proposes the adoption of a data element that will serve as an other entity identifier (OEID), an identifier for entities that are not health plans, health care providers, or “individuals,” that need to be identified in standard transactions. This proposed rule would also specify the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose an NPI. Finally, this rule proposes to change the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014. 

Update on timelines: DSM-5, ICD-11, ICD-10-CM

Update on timelines: DSM-5, ICD-11, ICD-10-CM

Post #155 Shortlink: http://wp.me/pKrrB-21N

Update @ April 10, 2012: CMS issues press release – proposes one year delay for ICD-10-CM compliance

See: http://wp.me/pKrrB-22q for press release and full Proposal document

I will update as more information becomes available.

DSM-5

The DSM-5 clinical settings field trials, scheduled to complete by December, last year, but extended in order that more participants might be recruited, were expected to conclude this March. (Source: DSM-5 Disorganization, Disarray, and Delays, Dr Dayle Jones, American Counseling Association, January 3, 2012)

In November, DSM-5 Task Force Vice-chair, Darrel Regier, MD, predicted the pushing back of the final public review and comment period for revised draft diagnostic criteria from January-February to “no later than May 2012,” in response to DSM-5 timeline slippage and delays in completion of the field trials. (Source: APA Answers DSM-5 Critics, Deborah Brauser, November 9, 2011)

The timeline on the DSM-5 Development site was updated to reflect a “Spring” posting of draft diagnostic criteria but thus far, APA has released no firm date for a final public review and feedback exercise in May.

The second release of draft proposals was posted on May 4, last year, with no prior announcement or news release by APA and caught professional bodies, patient organizations and advocates unprepared.

It is hoped that APA will give reasonable notice before releasing their third and final draft – though how much influence professional and public feedback might have at this late stage in the DSM-5 development process is moot.

DSM-5 is slated for publication in May 2013.

Extract from revised Timeline

Spring 2012: Revised draft diagnostic criteria will be posted on http://www.dsm5.org and open to a third public feedback period for 2 months. Feedback will be shared directly with work group members, and further edits to proposals will be made as needed.

The full DSM-5 Timeline (as it stands at April 8, 2012) can be found here.

 

ICD-11

The current timeline schedules presentation of the ICD-11 to the World Health Assembly in May 2015 – a year later than the 2009 timeline.

According to a paper published by Christopher Chute, MD, (Chair, ICD-11 Revision Steering Group) et al, implementation of ICD-11 is now expected around 2016. (Source: Chute CG, Huff SM, Ferguson JA, Walker JM, Halamka JD. There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System. Health Aff March 2012 DOI: 10.1377/hlthaff.2011.1258) 

The ICD-11 Beta drafting platform is scheduled to be launched and open to the public this May for comment and interaction. It will be a work in progress – not a final Beta draft. The final Beta draft isn’t scheduled until 2014.

No announcement that the Beta platform remains on target for a May release has been issued by WHO or ICD-11 Revision Steering Group and no date is given on the ICD Revision website for the launch.

The publicly viewable version of the Alpha drafting platform (the ICD-11 Alpha Browser) can be accessed here. The various ICD-11 Revision Topic Advisory Groups work on a separate, more layered multi-author drafting platform.

NB: The Alpha drafting platform is a work in progress. It is incomplete, in a state of flux, updated daily and subject to WHO Caveats.

ICD-11 Alpha Browser User Guide here.

Foundation view here.

Linearization view here.

PDFs of Draft Print versions of the Linearization are available from the Linearization tab to logged in users.

The ICD-11 timeline (as it stands at April 8, 2012) can be found on the WHO website here.

 

ICD-10-CM

Note: ICD-10-CM is the forthcoming US specific “Clinical Modification” of the WHO’s ICD-10. Following implementation of ICD-10-CM, the US is not anticipated to move on to ICD-11, or a Clinical Modification of ICD-11, for a number of years after global transition to ICD-11.

On February 16, Health and Human Services Secretary, Kathleen G. Sebelius, announced HHS’s intent to initiate a process to postpone the date by which certain health care entities have to comply with ICD-10-CM diagnosis and procedure codes. (Source: CMS Public Affairs/HHS Press Release, February 16, 2012)

The final rule adopting ICD-10-CM as a standard was published in January 2009, when a compliance date of October 1, 2013 had been set – a delay of two years from the compliance date initially specified in the 2008 proposed rule.

CMS plans to announce a new ICD-10 implementation date sometime this April, according to CMS Regional Office, Boston. (Source: Healthcare News: CMS targets April for release of new ICD-10-CM/PCS implementation date, March 20, 2012)

It is anticipated that CMS will make an announcement in the Federal Register, take public comment for 60 days, consider feedback on its proposed ruling, then issue a final rule.

For developments on the new ICD-10-CM compliance date, watch the CMS site or sign up for CMS email alerts: http://www.cms.hhs.gov/Medicare/Coding/ICD10/Latest_News.html

 

Related information:

DSM-5 Development

ICD-11 Revision

ICD10 Watch

Federal Register

CMS Latest News

DHHS Newsroom

ICD-10-CM CDC Site

CMS expected to announce proposal for new ICD-10 implementation date sometime in April

CMS expected to announce proposal for new ICD-10 implementation date sometime in April

Post #153 Shortlink: http://wp.me/pKrrB-218

In a press release on February 16, Health and Human Services Secretary, Kathleen G. Sebelius, announced HHS’s intent to initiate a process to postpone the date by which certain health care entities have to comply with ICD-10-CM diagnosis and procedure codes.

The final rule adopting ICD-10-CM as a standard was published in January 2009, when a compliance date of October 1, 2013 had been set – a delay of two years from the compliance date initially specified in the 2008 proposed rule.

Several sites covering CMS’s intention to delay implementation are citing April as the month in which a new timeline for ICD-10-CM is expected to be announced:

HC Pro

New ICD-10 implementation date expected in April

ICD-10 Trainer | March 21, 2012

CMS plans to announce a new ICD-10 implementation date sometime in April, according to representatives of CMS and MassHealth, a public health insurance program for low and medium-income residents in Massachusetts.

Renee Washington, director of customer system integration at MassHealth, revealed the time frame for the much anticipated announcement during the Massachusetts Health Data Consortium’s March 9 conference call. Renee Richard from the CMS Regional Office in Boston confirmed this information during the call…

HC Pro Just Coding

Healthcare News: CMS targets April for release of new ICD-10-CM/PCS implementation date

March 20, 2012

CMS expects to release a new ICD-10-CM/PCS implementation date sometime in April. That date will be the same for payers and providers. (Excerpt from a member only article.)

ICD-10 Watch (no connection with this site which was formerly known as “DSM-5 and ICD-11 Watch”)

It’s about time for an ICD-10 delay announcement

Carl Natale | March 30, 2012

It looks like next week is when the Centers for Medicare and Medicaid (CMS) will announce their proposals for a new ICD-10 timeline.

Which should mean they will publish it in the Federal Register and take public comment for 60 days. Then they will consider the feedback and issue a final rule. Who knows when that will be…

Read full round up by Carl Natale

 

Christopher Chute, MD, (Chair, ICD-11 Revision Steering Group) et al set out the case for delaying implementation, in this paper published at Health Affairs:

Health Affairs

At the Intersection of Health, Health Care, and Policy

There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System

Abstract: http://content.healthaffairs.org/content/early/2012/03/21/hlthaff.2011.1258.abstract

Full free text: http://content.healthaffairs.org/content/early/2012/03/21/hlthaff.2011.1258.full

PDF: http://content.healthaffairs.org/content/early/2012/03/21/hlthaff.2011.1258.full.pdf+html

Published online before print March 2012, doi: Health Aff March 2012 10.1377/hlthaff.2011.1258

There Are Important Reasons For Delaying Implementation Of The New ICD-10 Coding System

Christopher G. Chute 1,*, Stanley M. Huff 2, James A. Ferguson 3, James M. Walker 4 and John D. Halamka 5

Author Affiliations

1 Christopher G. Chute (chute@mayo.edu) is a professor of biomedical informatics at Mayo Clinic, in Rochester, Minnesota.
2 Stanley M. Huff is a professor of biomedical informatics at the University of Utah, in [please provide city], and chief medical informatics officer at Intermountain Healthcare, in Murray, Utah.
3 James A. Ferguson is a fellow at the Kaiser Permanente Institute for Health Policy and vice president of health information technology strategy and policy for Kaiser Permanente, in Oakland, California.
4 James M. Walker is chief health information officer of Geisinger Health System, in Danville, Pennsylvania.
5 John D. Halamka is a professor of medicine at Harvard Medical School, chief information officer at Beth Israel Deaconess Medical Center, and chief information officer at Harvard Medical School, in Boston, Massachusetts.
*Corresponding author

Abstract

Federal authorities have recently signaled that they would consider delaying some aspects of implementation of the newest version of the International Classification of Diseases, known as ICD-10-CM, a coding system used to define health care charges and diagnoses. Some industry groups have reacted with dismay, and many providers with relief. We are concerned that adopting this new classification system for reimbursement will be disruptive and costly and will offer no material improvement over the current system. Because the health care community is also working to integrate health information technology and federal meaningful-use specifications that require the adoption of other complex coding standardization systems (such as the system called SNOMED CT), we recommend that the Centers for Medicare and Medicaid Services consider delaying the adoption of ICD-10-CM. Policy makers should also begin planning now for ways to make the coming transition to ICD-11 as tolerable as possible for the health care and payment community.

Full free text

Tom Sullivan, for Health Care IT News, asks Chute, “Why not just skip right to ICD-11?”

Why not just skip right to ICD-11?

Tom Sullivan, Government Health IT| March 13, 2012

…While industry associations battle over the code set’s future, and HHS figures out when the new compliance deadline will be, the World Health Organization (WHO) is already moving toward ICD-11, promising a beta in 2014 to be followed by the final version in 2015. Should that slip until 2016, U.S. health entities will still be settling into ICD-10 when ICD-11 arrives – meaning that shortly thereafter, we will be right back where we are now: Behind the times, on the previous ICD incarnation.

Are we repeating our own faulty history?

“That almost assuredly will be the case,” said Chris Chute, MD, DrPH, who spearheads the Mayo Clinic’s bioinformatics division and chairs the WHO’s ICD-11 Revision Steering Group…

Read full article by Tom Sullivan

Rhonda Butler argues why US health care providers and industry can’t just ditch ICD-10-CM and wait for ICD-11 in 2015/16:

3M Health Information

We Can’t Skip ICD-10 and Go Straight to ICD-11

Rhonda Butler | March 26, 2012

Since the recent announcement by CMS that ICD-10 implementation will be delayed for certain healthcare entities, some industry pundits have argued, “Let’s just skip ICD-10 and go straight to ICD-11.”

Skipping ICD-10 assumes that we haven’t started implementing ICD-10. Well, the U.S. did start—19 years ago.

What have we been doing for the last 19 years…

Read full article

Letter from Justine M. Carr, MD, Chairperson, National Committee on Vital and Health Statistics to The Honorable Kathleen Sebelius, Secretary, Department of Health and Human Services, March 2, 2012

Contains ICD-10-CM timeline

    Re: Possible Delay of Deadline for Implementation of ICD-10 Code Sets

James Phillips asks Michael First (Editor of DSM-IV-TR, Consultant to WHO ICD-11 Revision) how DSM-5 relates to ICD:

Psychiatric Times

DSM-5 In the Homestretch—1. Integrating the Coding Systems

James Phillips, MD | 07 March 2012

With DSM-5 scheduled for publication a little more than a year from now, we may safely assume that, barring unannounced surprises from, say, the APA Scientific Review Committee, what we will see on the DSM-5 Web site is what we will get. With that in mind it’s time to review what we will indeed get. But before moving to significant changes in the major disorder categories, we should remind ourselves where DSM-5 fits into the larger picture of coding mental illnesses.

There are, in case you have forgotten, two classificatory systems of mental disorders—the International Classification of Diseases (ICD), produced by the World Health Organization (WHO), and the Diagnostic and Statistical Manual (DSM), produced by the American Psychiatric Association. How are they related? It is a question that has confused me, and I assume, some of my psychiatric colleagues as well as others—other mental health professionals, and still others. For an answer to this question I asked Michael First, MD, Editor of DSM-IV-TR, Consultant on the WHO ICD-11 revision…

Read full commentary

 

Related posts:

HHS Secretary Sebelius announces intent to delay ICD-10-CM compliance date  February 16, 2012

AHIMA: Ten Reasons to Not Delay ICD-10 (ICD-10-CM)  February 23, 2012

HHS Secretary Sebelius announces intent to delay ICD-10-CM compliance date

HHS Secretary Sebelius announces intent to delay ICD-10-CM compliance date

Post #142 Shortlink: http://wp.me/pKrrB-1Ux

Coverage today of the announcement by Health and Human Services (HHS) Secretary Kathleen G. Sebelius of intent to delay ICD-10-CM compliance date.

Will American Psychiatric Association Board of Trustees take this opportunity to delay its DSM-5 timeline, take a breathing space, and reconsider its controversial proposals for DSM-5, or submit them to independent scientific scrutiny?

Link to report at end of post also quotes Chris Chute, Chair, ICD-11 Revision Steering Group, on possible delay for completion of ICD-11 from 2015 to 2016 – no surprise that ICD Revision may be considering another shift of timeline given the technical ambitiousness of the revision project, the lack of resources and slipping targets for the Alpha and Beta drafts.

Tom Sullivan reports:

Should the U.S. delay the ICD-10 compliance deadline just one year, until 2014, then the WHO will have a beta of ICD-11 ready. And if Sisko’s gut is correct, and the new ICD-10 deadline flows into 2015, well, then a final version of ICD-11 will be fast-approaching.

When it arrives, currently slated for 2015 (but Chute said it could be 2016), the underlying structure of ICD-11 will be profoundly different than any anterior ICD.

“ICD-11 will be significantly more sophisticated, both from a computer science perspective and from a medical content and description perspective,” Chute explains. “Each rubric in ICD-11 will have a fairly rich information space and metadata around it. It will have an English language definition, it will have logical linkages with attributes to SNOMED, it will have applicable genomic information and underpinnings linked to HUGO, human genome standard representations.”

ICD-10, as a point of contrast, provides a title, a string, a number, inclusion terms and an index. No definitions. No linkages because it was created before the Internet, let alone the semantic web. No rich information space.”

 

HHS Secretary Kathleen Sebelius announces intent to delay ICD-10 compliance date

February 16, 2012 | Carl Natale, Editor, ICD10Watch

Health and Human Services (HHS) Secretary Kathleen G. Sebelius confirmed Wednesday that they will change the ICD-10 timeline.

A HHS press release stated they “will initiate the rulemaking process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).”

On Tuesday, Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services (CMS), said the agency will examine the ICD-10-CM/PCS timeline. Tavenner made the statement at a conference of the American Medical Association (AMA) National Advocacy Conference. The AMA has declared vigorous opposition to the medical coding system citing the cost, complexity and lack of perceived benefit to patients… Read on

 

CMS Public Affairs Press Release:

http://www.dhhs.gov/news/press/2012pres/02/20120216a.html

News Release
Contact: CMS Public Affairs
(202) 690-6145

FOR IMMEDIATE RELEASE
February 16, 2012

HHS announces intent to delay ICD-10 compliance date

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

Report:

http://www.healthcarefinancenews.com/news/could-us-skip-icd-10-and-leapfrog-directly-icd-11

Could the U.S skip ICD-10 and leapfrog directly to ICD-11?

February 16, 2012 | Tom Sullivan, Government Health IT

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