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A Better Understanding of ICD-10 Delays

Despite the United States being more than a decade behind Canada, even further behind European nations and the last industrialized nation to implement ICD-10, the deadline was delayed by another year when the “Protecting Access to Medicare Act of 2014” legislation (HR 4302) was signed by President Obama in April 2014. The new deadline for ICD-10 implementation is now October 1, 2015.

healthcare-reform-ICD-10-delaysThe Forty-third World Health Assembly endorsed the new diagnostic coding system in May 1990 and released it to World Health Organization member states in 1994. The United States is one of the last member states to replace ICD-9, which was developed in the 1970s.

Delays can be attributed to a few primary issues.

First are delays in replacing HIPAA 4010A1 with HIPAA 5010. This, although a much smaller undertaking, is seen by many as the foundation for ICD-10 medical coding standards, and delays in implementing it a symbol of the obstacles to converting to ICD-10.

The second issue is a “patch” enacted to postpone a 24% cut to doctors pay. The cuts are called for as part of the Sustainable Growth Rate system, created by Congress in 1997 to control Medicare spending, and would have taken effect the day after the “doc fix” legislation was signed if it hadn’t passed. The Bill, which did pass 64 – 35, was the 17th  time Congress has acted to postpone cuts in Medicare reimbursements to doctors since 2003, instead appropriating additional funds to Medicare to cover rising costs.

A third issue included in the “Protecting Access to Medicare Act of 2014” that further delayed ICD-10 enactment is the effort to tie Medicare reimbursements to Skilled Nursing Facilities  to the number of  patients they readmit to the hospital within their first 30 days at the facility. These “readmits” are seen as highly preventable and very costly to Medicaid and quality patient care.

For some, the Delay is Welcome

The adoption of ICD-10 coding is seen as coming at great expense. Costs for implementing ICD-10 are estimated at $84,000 for a three-doctor practice.

For many the transition from a choice of 14,000 codes to 69,000 codes is a daunting task. Not as much of an issue for specialists who will use only a small portion of the codes, but for hospitals and facilities that offer care to patients with a wide variety of conditions, the time can be well spent reviewing codes and developing a way to effectively use them.

For others the delay is welcome because the enactment of the Affordable Healthcare Act has created a sufficient amount of changes staff must adapt to without tossing ICD-10 into the mix.

For some, the Delay is Frustrating

Medical students have been educated in ICD-10 coding for several years now. They are graduating and entering the workforce unprepared to use ICD-9 coding.

The whole purpose of ICD-10 is to provide a more expansive and comprehensive coding tool. The expectations are that it will provide a more complete and detailed patient medical record that will reduce the need for “procedure code modifiers” that often lead to an increase in administrative costs and payment delays.

Making Use of the Delay

For those who haven’t prepared, the extra year can be used for purchasing updated technology, staff training and the development of a timeline for implementation.

For those who have already prepared, experts recommend they use the additional time to review codes relevant to their practice, continue training and work with vendors and others to ensure the transition to ICD-10 is a smooth one.

We can help you implement your conversion to ICD-10 so that you and your staff are prepared to make the transition smoothly when the deadline arrives. Contact General Medicine, The Post Hospitalist Company today, so you’re ready for tomorrow.

Tom Prose