The U.S. implementation of the ICD-10 diagnosis coding system has been delayed several times, but members of a House subcommittee seemed to be leaning Wednesday toward making sure the current Oct. 1 deadline sticks.
“Many providers and payers, including the Centers for Medicare and Medicaid Services (CMS), have already made considerable investments in the ICD-10 transition, and any further delay will entail additional costs to keep ICD-9 systems current, to re-train employees, and to prepare, again, for the transition,” Rep. Joseph Pitts (R-Pa.), chairman of the House Energy and Commerce Health Subcommittee, said in his opening statement at a hearing on the issue.
“The United States currently lags behind most of the rest of the world, which already uses the updated ICD-10,” he added.
Rep. Kathy Castor (D-Fla.) agreed. “I’d like to join my colleagues in saying no more delays in the transition to ICD-10, and [urge them] not to include delays in ‘must-pass’ bills [such as] how we pay doctors,” she said. “Let’s stick with the Oct. 1 deadline.”
ICD-10 was originally set to take effect in October 2013 but was pushed back a year to October 2014, and then another year to this coming October.
Most witnesses at the hearing seemed to agree that no more delays were needed. Edward Burke, MD, an internist from rural Fredericktown, Mo., described how his small independent medical practice easily transitioned from ICD-9 to ICD-10 despite the delay by CMS. “All I was unprepared for was how seamless it was,” he said. “We do not have special training, we did not spend any money in preparation … and our practice did not suffer.”
Rich Averill, director of public policy at 3M Health Information Systems, an electronic health record vendor in Salt Lake City, noted that the last implementation delay cost the healthcare industry $6.5 billion. “It’s time to end that uncertainty and allow the healthcare industry to move forward in this transition,” he said. “We strongly oppose any further delay to ICD-10.”
There was one witness, however, who took an opposing view. “We are faced with the costly unfunded mandate of ICD-10 that will put some physicians out of business,” said William Terry, MD, a Mobile, Ala., urologist who testified on behalf of the American Urological Association. “Based on data from other countries, doctors will be forced to reduce the number of patients they see after ICD-10 is implemented.”
ICD-10, the 10th edition of the International Classification of Diseases, is the manual most commonly used for coding medical diagnoses on claims for Medicare, Medicaid, and private health insurers.
ICD-10 codes differ from current ICD-9 codes in several respects, including a different number of digits, but the biggest difference is the number of codes — 68,000 compared with 13,000.
Terry noted that although CMS is in the midst of end-to-end testing of the ICD-10 system, “it is primarily using volunteers who are well prepared,” who may not accurately represent the majority of providers, he said. “We would urge Congress to further delay ICD-10 and appoint a committee” to study the issue.
Terry got some support from committee member Rep. Billy Long (R-Mo.). “I know this is very disconcerting for a lot of doctors,” he said.
Another committee member, Rep. Larry Bucshon, MD (R-Ind.), a cardiac surgeon, was also sympathetic. “It’s pretty clear we’re going to need to move forward with ICD-10 and we should, but I do have concerns” about the impact on physicians in the near term, he said. “I encourage all of us to look [at this] and make sure we’re able to implement ICD-10 in a way that doesn’t cause problems for our entire healthcare system.”
Bucshon also disputed Burke’s contention that transitioning his practice to ICD-10 didn’t cost anything. “You made a statement that the cost is zero and that’s just false,” he said. “This is extremely expensive for medical practices. It may not be that converting from one day to the next is going to cost you anything, but it is costly.”
Terry suggested that maybe doctors could transition to ICD-10 at a slower pace, while continuing to also use ICD-9. “There needs to be some kind of transition we have to figure out,” Terry said. He added that he’d heard that CMS said running a “dual system” wasn’t possible, and yet some health plans, such as Florida Blue Cross, were already doing it.
“It’s interesting that you bring that up,” said committee member Rep. Michael Burgess, MD (R-Texas), an ob/gyn. Burgess said he had gone on the CMS website and looked at the “frequently asked questions” on ICD-10, where there is a question on the subject of dual coding. “The answer is that the practice management system must be able to accommodate both ICD-9 and ICD-10 codes,” he said, adding wryly, “Maybe the problem is solved.”
Burgess had another concern about ICD-10. In terms of the transition, “all roads lead to CMS and, if you’ll pardon me, that does appear to be the weak link in the chain,” he said. “From healthcare.gov to the Sunshine Act, when CMS flips a switch, something breaks. So it begs the question, is flipping a switch on Oct. 1 the right move? If it is, what is the contingency plan for any problems that might develop?”
No witnesses from CMS were at the hearing, but Averill pointed out that claims processing — as opposed to helping people sign up for health insurance — was CMS’ strength. “This is a relatively routine update to their claims processing system,” he said. “They have had difficulty with consumer-facing websites but this is their core competency.”