Just as the seceding South Carolinians firing on the Union Ship “Star of the West” became recognized as the first shot in the Civil War, the American Medical Association’s delegates voting to vigorously oppose ICD-10 may one day be seen as the salvo that set a conflict over coding sets in motion. 

The stage is set for a war over U.S. adoption of ICD-10. Indeed, such a fight could pit industry associations that stand to profit from the code set against those representing the providers who have to actually implement and pay for the ICD-10 conversion.

Less than a week after AMA revealed the voting results, in fact, AHIMA CEO Lynn Thomas Gordon struck back with a public statement maintaining that “there are countless benefits that will come from the use of a 21st century classification system."

Then, the AMA’s second shot, a late-January letter calling on U.S. House Speaker John Boehner to block ICD-10, again drew fire from AHIMA, in the form of a warning that healthcare entities should continue keep proceeding with ICD-10.

Following that, on Thursday AMA sent another letter, this time to someone who definitely knew prior to receiving it what ICD-10 is, HHS Secretary Kathleen Sebelius.

Opposing forces
And so the divide between sides is perhaps stating to take shape. In one camp are the associations representing medical coders and, of course, selling certification, educational resources, training, and memberships to coders and those who employ them. While none have publicly joined AHIMA’s cause yet, the American Academy of Professional Coders (AAPC) did not firmly rule out such a tactic when asked.

“We are full steam ahead with ICD-10 and don’t anticipate any delays,” a spokesperson explained, then added “when we decide to make an official comment though, I’ll let you know for sure.” And pressed to clarify whether that “when” was carefully-crafted rather than an “if”, the spokesperson responded “that would be my assumption, but its the powers that be’s call. Sorry to be so vague, but that’s the stance as of today.”

On the other side of the battlefield, the AMA is led by president Peter Carmel, MD, who said that ICD-10 offers “no direct benefit to individual patient’s care,” rather, the conversion and code sets will “create significant burden on the practice of medicine.”

Much like the AHIMA-led band, AMA is thus far riding alone. But the American Hospital Association (AHA) and the Medical Group Management Association (MGMA) are in a similar position in that their constituency of physician practices and providers are the ones who will ultimately carry the costs and work of implementing ICD-10.

It’s too early to tell whether these other associations will become brothers-in-arms. MGMA senior policy advisor Robert Tennant, no proponent of ICD-10, told Government Health IT that the MGMA is in the process of charting its own strategy for ICD-10.

“We have consistently raised concerns and offered recommendations,” Tennant explained. “We are in the process of determining the best course of action from an advocacy perspective.”