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CMS: No more delays with move to ICD-10

Physician practices must start using new diagnosis codes for billing patient services by Oct. 1, 2014.

By Charles Fiegl amednews staff — Posted March 4, 2013

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The mandated transition by billers throughout the health system to the more complex ICD-10 diagnosis codes will go forward without any further delays, the Centers for Medicare & Medicaid Services stated in a Feb. 6 letter to the American Medical Association.

Acting CMS Administrator Marilyn Tavenner made the case for moving forward with ICD-10 to modernize the health care system. Halting its implementation, which has been ongoing since 2009, would mean relying on outdated ICD-9 codes that soon will be incompatible with general health care needs and new technologies, she stated.

“Many in the health industry are under way with the necessary system changes to transition from ICD-9 to ICD-10,” Tavenner wrote. “Halting this progress midstream would be costly, burdensome, and would eliminate the impending benefits of these investments. Many private and public sector health plans, hospitals and hospital systems, and large physician practices are far along in their ICD-10 implementation and have devoted significant funds, resources and staff to the effort.”

In December 2012, the AMA and about 80 other organized medicine groups had requested that CMS stop ICD-10 implementation. The AMA House of Delegates had approved official policy to advocate for abandoning ICD-10. Costs related to training and infrastructure upgrades could be enough to force physicians out of business, the organizations said.

Practice administrators also have shared the AMA’s concerns. MGMA-ACMPE, the medical practice management association, projects that adopting ICD-10 would cost a 10-physician practice $285,000. The implementation price for smaller practices is about $83,000.

Overlapping federal regulations, such as those governing electronic health records and quality reporting under Medicare, also make the ICD-10 mandate especially burdensome, organized medicine groups have said.

“The American Medical Association harbors serious concerns with the significant burden of the ICD-10 mandate and will continue to convey these points to policymakers in Washington,” said AMA President Jeremy A. Lazarus, MD. “As the current compliance deadline grows closer, the AMA will continue educating members on how to best prepare for what will be a very disruptive change for physicians.”

Previous delay aimed to strike balance

The Obama administration had delayed the ICD-10 implementation deadline by one year, to Oct. 1, 2014, in a September 2012 regulation. Physicians must use ICD-10 codes on claims to payers for services starting Oct. 1, 2014, or else those claims will be rejected. Tavenner stated in the letter that the extension offered physicians and administrators time to train office staff, upgrade practice software and conduct appropriate testing.

“Many industry comments strongly favored a one-year extension, indicating it was a good balance that allowed additional time for those concerned about meeting the original Oct. 1, 2013, date, with minimal disruption to entities whose implementation efforts were already under way,” she wrote.

Furthermore, the agency believes ICD-10 is an important factor for several integrated programs that will modernize the health care system so it can provide better care, improve health and lower costs.

“Integrated programs such as version 5010, the ICD-10 code-set itself, the Medicare and Medicaid electronic health record incentive programs and the physician quality reporting system are all aimed at accomplishing these outcomes,” Tavenner said. “Together, they move America’s health care system towards better coordinated care through greater interoperability and ease of transmitting electronic data; better quality measurement and reporting of clinical outcomes data; and lower costs achieved through operational efficiencies.”

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Pain more complex under ICD-10

The transition to ICD-10 will require physician practices filing claims to select from a universe of diagnosis codes that are more specific. In 2013, the current ICD-9 set had 14,567 codes, while ICD-10 offered 69,832. For coding multiple injections provided to patients with pain, for example, ICD-9 has two codes — one for knee pain (719.46) and one for limb pain (729.5). The ICD-10 library would offer significantly more options, including:

M25.561: pain in right knee.

M25.562: pain in left knee.

M79.601: pain in right arm.

M79.602: pain in left arm.

M79.604: pain in right leg.

M79.605: pain in left leg.

Source: “Preparing Physicians for ICD-10 Implementation National Provider Call,” Centers for Medicare & Medicaid Services, Oct. 25, 2012 (link)

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