EDI News

On March 27th, 2014, the House passed by voice vote a temporary fix to Medicare's sustainable growth rate formula (HR 4302) that includes a one-year delay to the ICD-10 compliance deadline, Modern Healthcare reports. The bill now heads to the Senate (Demko/Frank, Modern Healthcare, 3/27).


Background on ICD-10

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. The switch means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes. In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014, partially to look at the incremental changes needed in reforming health care (iHealthBeat, 3/19). Last month, CMS Administrator Marilyn Tavenner told an audience at the Healthcare Information and Management Systems Society's annual conference that there would be no more delays to the ICD-10 compliance deadline (iHealthBeat, 2/28).


Bill Details

The House-approved "doc fix" proposal, introduced by Rep. Joseph Pitts (R-Pa.), would push back the ICD-10 compliance date to 2015 (Sullivan, Healthcare IT News, 3/27). The measure states, "The Secretary of Health and Human Service may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets." It also cites sections in the Social Security Act and the Code of Federal Regulations, which contain the secretary's authority to mandate the new code sets (Conn, Modern Healthcare, 3/26). CMS estimates that a one-year delay of ICD-10 could cost between $1 billion and $6.6 billion, according to a blog post by the American Health Information Management Association, which opposes the bill.


Reaction

AHIMA said, "Without ICD-10, the return on investment in [electronic health records] and health data exchange will be greatly diminished" (Mace, HealthLeaders Media, 3/26). Russell Branzell, president and CEO of the College of Healthcare Information Management Executives, in the statement also criticized the proposal, saying, "Further delay of ICD-10 discredits the considerable investment made by stakeholders across the country to modernize health care delivery." He added, "Providers have already dedicated significant time and resources in financing, training and implementing the necessary changes to workflow and clinical documentation" (Bowman,FierceHealthIT, 3/26). However, Medical Group Management Association Senior Policy Adviser Robert Tennant said that the proposed delay is "recognition that the industry is simply not ready for the transition." He added that the delay would "really give practices the opportunity to upgrade their software and do internal testing so they'll know exactly what the impact of ICD-10 will mean" (Modern Healthcare, 3/26).

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