April 9, 2012 — Physicians would have until October 1, 2014 — an
extra year — to begin using a new and expanded set of diagnostic codes,
called ICD-10, under proposed regulations announced today by the US
Department of Health and Human Services (HHS).
The news was expected. In February, HHS Secretary Kathleen Sebelius had promised that her department would extend the deadline
in response to physician complaints about the administrative burden of
converting to ICD-10 by October 1, 2013, as originally planned. The
American Medical Association (AMA) said the switch to the more
voluminous and complex set of diagnostic codes could both cost medical
practices tens of thousands of dollars apiece and interfere with their
adoption of electronic health records and electronic prescribing.
ICD-10 stands for International Statistical Classification of Diseases and Related Health Problems, 10th Revision.
In 2009, the Centers for Medicare and Medicaid Services (CMS) ordered
the change from the ICD-9 code set, which is now in use, to ICD-10, as
part of implementing the Health Insurance Portability and Accountability
Act.
"The proposed change in the compliance date for ICD-10 would give
providers and other covered entities more time to prepare and fully test
their systems to ensure a smooth and coordinated transition to these
new code sets," HHS said in a press release. The department warned that
if everyone does not change over to ICD-10 at the same time, providers
could see their claims rejected or their payments delayed.
The AMA wants HHS to develop a more physician-friendly replacement
for ICD-9, but HHS today once again affirmed the value of ICD-10. The
new code set, the department said, will improve the quality of care and
"lead to improved accuracy for reimbursement for medical services, fraud
detection, and historical claims and diagnosis analysis."
HHS noted that physician protests about ICD-10 dovetail with those about a new set of standards for electronic claims called Version 5010.
CMS pushed back its deadline for enforcing the use of the new standards
to March 31, 2012, and then to June 30, 2012, after some physicians
complained that Medicare bills submitted under Version 5010 were not
getting paid. Healthcare providers cannot use the new ICD-10 codes until
they have updated their billing software to the Version 5010 standards.
The plan to delay implementation of the ICD-10 codes appears in proposed HHS regulations
that also would introduce a standardized identifier code for health
plans. This new identifier would replace a mishmash of health plan
identifier codes that vary in length and format, and that create billing
problems for physicians and other providers.
HHS will accept comments from the public about the proposed regulations for 30 days after their publication in the Federal Register. The proposed regulations set forth several ways to send those comments to HHS.
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