Let me ask you a question. Who is the most powerful person in the United States referable to medical terminology? Is it the most esteemed physician who edits the most prestigious medical textbook or journal? Is it a physician or group that actually writes criteria, such as the those invested in the 4th Universal Definition of Myocardial Infarction, the KDIGO and their work with acute kidney injury, or the group of 19 that wrote Sepsis-3? NO! It’s none of these.

The most powerful person is Donna Pickett, RHIA, Chief of the National Centers for Health Statistics, a HIM profession who has final say in how ICD-10-CM, a federally mandated HIPAA-mandated transaction set essential to physician and hospital billing, is constructed. Donna, and Donna alone, commands whether we use Sepsis-2 or Sepsis-3. She alone decides if we have a code for myocardial injury. Donna Pickett alone picks her consultants; while she will accept outside input, she is under no obligation to follow it. All meetings regarding ICD-10-CM are secret except for the twice a year Coordination and Maintenance committee meetings. No physician group is an ICD-10-CM Cooperating Party that even has a chance of governing the guidelines that govern ICD-10-CM code assignment.

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