At a House subcommittee hearing on Wednesday, lawmakers and stakeholders generally agreed that the implementation of ICD-10 code sets should not be delayed beyond the Oct. 1 deadline, Modern Healthcare reports (Demko, Modern Healthcare, 2/11).
U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1.
In April 2014, President Obama signed into law legislation (HR 4302) that pushed back the ICD-10 compliance date until at least October 2015.
Seven health care officials testified at the hearing before the House Energy and Commerce Committee’s Subcommittee on Health:
- Rich Averill, 3M Health Information Systems’ director of public policy;
- Carmella Bocchino, representing America’s Health Insurance Plans;
- Sue Bowman, the American Health Information Management Association’s senior director of coding policy and compliance (Perna, Healthcare Informatics , 2/11);
- Edwin Burke, a Missouri-based internist (Modern Healthcare, 2/11);
- John Hughes, a Yale School of Medicine professor of medicine (Healthcare Informatics, 2/11);
- Kristi Matus, athenahealth’s chief financial and administrative officer (Modern Healthcare, 2/11); and
- William Jefferson Terry, an Alabama-based urologist representing the American Urological Association (Healthcare Informatics, 2/11).
Testimony in Opposition of Further Delays
According to Modern Healthcare, six of the seven witnesses said that there should not be any further delays to the ICD-10 compliance date.
Matus said, “It is decision time. Maintain the current date for ICD-10 implementation, or cancel it once and for all. Do not allow another delay” (Modern Healthcare, 2/11).
Meanwhile, Bowman argued that further delay would add additional costs for providers. She cited an HHS report that estimated a one-year delay in the ICD-10 compliance date would increase providers’ costs by 10% to 30% relative to what they have already budgeted or spent for the transition, equaling a range of $1.1 billion to $6.8 billion for each additional one-year delay (Slabodkin, Health Data Management, 2/12).
In addition, several hearing participants said that the ICD-9 code set is out of date. Averill said, “The reality is with ICD-9 we often don’t know what really is wrong with the patient or what procedures were performed. ICD-9 codes like a repair of an unspecified artery by an unspecified technique are virtually useless for establishing fair payment levels or evaluating outcomes.”
Similarly, Hughes expressed frustration with the ICD-9 code sets, which he says have often not allowed him “to specify the exact nature of a complication, its extent, its location, and how it was treated” (Healthcare Informatics, 2/11).
Meanwhile, the American Hospital Association in a statement submitted to the committee also expressed opposition to any further delay. AHA said, “Hospitals are actively preparing their information systems, affiliated physicians and coders to make the transition possible” (AHA News Now, 2/11). According to AHA, 93% of 362 hospitals surveyed in January and February by the group said that they are either moderately confident or very confident in their ability to transition to ICD-10 code sets (Gold et al., “Morning eHealth,” Politico, 2/12).
Further, most members of the subcommittee expressed support for keeping the current Oct. 1 deadline.
Subcommittee Chair Joe Pitts (R-Pa.) said, “We need to end the uncertainty in my opinion and move forward to full implementation of ICD-10.”
Meanwhile, Rep. Kathy Castor (D-Fla.) specifically called on congressional “leadership not to include [ICD-10] delays in must-pass bills,” such as legislation to address Medicare’s sustainable growth rate formula.
Concerns About ICD-10 Implementation
However, Terry expressed several concerns about transitioning to the new code sets and urged Congress to delay the ICD-10 compliance date (Health Data Management, 2/12).
He said “[t]he vast majority of America’s physicians in private practice are not prepared.” He called ICD-10 a “costly unfunded mandate” and said it would result in physicians closing down their practices (Modern Healthcare, 2/11).
In addition, Terry said the ICD-10 code sets are too specific, noting that there are more than 200 ICD-10 codes for diabetes. He said that such specificity would result in physicians being less productive (Healthcare Informatics, 2/11).
Terry urged lawmakers to delay the ICD-10 deadline and create a committee to study the “risks and benefits” of a code set transition (Health Data Management, 2/12). He said that ICD-10 implementation could instead be carried out over a two- to three- year period (Healthcare Informatics, 2/11).
Terry added, “If a delay is not possible, I urge you to consider legislating a dual ICD-9/ICD-10 option so that physicians will have time to transition to the new coding system especially those nearing retirement or those with a demonstrable hardship that limits their ability to adopt ICD-10 by the deadline” (Health Data Management, 2/11).
Meanwhile, Rep. Larry Bucshon (R-Ind.), a physician and subcommittee member, also spoke out against the ICD-10 transition. He said that the administrative costs of transitioning to ICD-10 had resulted in his own practice being sold to a hospital (Healthcare Informatics, 2/11).
Rep. Michael Burgess (R-Texas), a physician and subcommittee member, expressed concern about CMS’ readiness for the deadline. He said that he has “a great deal of faith” in the ability of Medicare contractors and insurers to process claims and “move data” but that CMS seems to be the “weak link in the chain.” Specifically, he cited “systems fail[ures]” by the agency when it launched the federal insurance exchange and Sunshine Act reporting websites. Burgess said stakeholders need to develop a contingency plan for any potential problems that could arise on Oct. 1, such as small physician practices being unable to “meet their fiscal obligations that they are required to meet to stay in business” or possible disruptions in patient care (Health Data Management, 2/12).