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Stop the Fight! ICD-10 is Comin’

July 2, 2015
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Another month has come and gone, which means that we’re just a little bit closer to Oct. 1, 2015, the deadline to transition to the ICD-10 coding set. In fact, now that the calendar reads July, we are 90 days away from ICD-10 happening despite certain people in Congress doing everything possible to push some aspect of it back.

It’s honestly been too difficult to keep track of the bills that have been introduced into Congress regarding ICD-10, but I’ll give it a whirl anyway. One piece of legislation, the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act) introduced in May, would “require the Secretary of Health and Human Services (HHS) to provide for transparent testing to assess the transition under the Medicare fee-for-service claims processing system from the ICD-9 to the ICD-10 standard, and for other purposes,” according to the bill, which was presented by Rep. Diane Black (R-TN).

Another bill, the Protecting Patients and Physicians Against Coding Act of 2015, was introduced by Representative Gary Palmer (R-AL-6) on June 4. This bill, H.R.2652, backed by the American Medical Association (AMA), would create a two-year grace period where healthcare providers’ ICD-10-based claims submitted to Medicare and Medicaid would not be denied due to coding errors. Implementing this grace period would ensure physicians are not negatively impacted while ICD-10 is “fully implemented within the healthcare system,” according to a letter sent by Palmer to fellow Congressmen asking for their support of the bill. Before both of those bills was H.R. 2126, which would “prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code set.”

I’ve blogged about this before, but with 90 days to go, I think it’s time to touch on it again—more delays would only set the industry back even more and would continue this cycle of uncertainty until who knows when. As Piper Su, vice president of The Advisory Board Company’s health policy division, recently told me in regards to the proposed bills, “While a few members of Congress continue to voice concerns about the health system’s readiness for ICD-10, what we see this year is more widespread consensus amongst policymakers that the time has come to move forward.  The previous delays, combined with early results from end-to-end testing, alleviated some concerns that providers have not been given enough time to comply and are not ready to meet the deadline,” Su said. “Lawmakers are now coming to conclude that no amount of time will yield a perfect transition, so Oct. 1, 2015 may be a fair date for moving forward.  However, we expect concerns about the transition to continue, so we also anticipate that there will continue to be close scrutiny as we get closer to that date,” she added.

Indeed, twice this year, the Centers for Medicare & Medicaid Services (CMS) has announced successful ICD-10 end-to-end testing acceptance rates from participating healthcare providers, clearinghouses, and billing agencies. On June 2, the agency revealed that of the 23,138 test claims received between April 27 and May 1, 20,306 were accepted—an acceptance rate of 88 percent. During the first ICD-10 end-to-end testing week, which took place from January 26 until February 3, 81 percent of claims were accepted. About 875 participants took part in the second round of testing, including returning testers from the first round in January. Nonetheless, an exclusive survey done by Healthcare Informatics, in conjunction with QuantiaMD, a Waltham, Mass.-based social network for physicians, found that doctors—many of whom have come out against ICD-10—are not backing down in their distaste for the mandate.

To me, that’s something we as an industry might just have to accept. In the aforementioned Advisory Board interview, I also spoke with Ed Hock, managing director at the organization who said that just like with most mandates, there will be some physicians who like it and others who don’t. “There is a huge spectrum regarding ICD-10; people are all over the place,” he said. He continued, “From a policy perspective, ICD-10 is not getting the credit that it deserves. If you think about where healthcare is going, it’s about understanding the value that’s been provided in the service that’s been rendered, and understanding the tradeoffs between higher value and higher cost. The fact that our current coding system doesn’t capture the approach in common procedures is a real fallback for organizations that are trying to make decisions on providing the best care at the lowest cost. It serves a valuable cause, and I think people do miss that.”

Hock added that providers need to stop focusing so much on the silly ICD-10 codes, and prepare themselves for the future. “Providers are missing arguably the most important part, the post-ICD-10 transition,” he said. “At a certain point in the next couple weeks, the plans that have been made are all we can do. You have to execute on those.”