ICD-10 deadline causing worry, even 3 years away

Washington -- The American Medical Association met last month with several other industry organizations and government agencies in an effort to ensure physicians are as ready as possible for the next mandated version of diagnostic codes.

Doctors, hospitals and payers need to adopt an updated version of the International Classification of Diseases code sets, ICD-10, by Oct. 1, 2013.

As a prerequisite to the ICD-10 move, entities by Jan. 1, 2012, need to adopt updated electronic transaction standards, known as 5010, under the Health Insurance Portability and Accountability Act. The original compliance dates were much sooner -- April 1, 2010, for HIPAA 5010 and Oct. 1, 2011, for ICD-10 -- but were moved back due to a regulation released last January by the Bush administration in its final days in office.

Despite having the additional time to get up to speed, the AMA is worried that physicians are still facing a costly and aggressive time line for implementing ICD-10.

"The AMA strongly supports upgraded HIPAA transactions to improve the efficiency and effectiveness of the health care system," said Nancy Spector, the AMA's director of electronic medical systems. But the move to ICD-10 "will impact many business processes within a physician's practice, including documentation of a patient's visit, research activities, public health reporting, quality reporting and administrative transactions."

Spector made the comments during a Dec. 10, 2009, meeting in Washington, D.C., held by the National Committee on Vital and Health Statistics, an advisory committee that makes recommendations to the Dept. of Health and Human Services. The AMA has also reached out to a handful of organizations that are necessary partners for ensuring a successful transition to ICD-10, hosting a stakeholder meeting on Dec. 4, 2009, with America's Health Insurance Plans, the BlueCross BlueShield Assn., the American Dental Assn., and the Healthcare Billing and Management Assn., among others.

At that meeting, the AMA outlined its plans for physician outreach in 2010 and discussed barriers to implementation, the most notable of which is cost. According to estimates by the Medical Group Management Assn., the average cost of upgrading to ICD-10 for a three-physician practice will be $84,000.

Spector said the AMA has concerns as to whether physicians will realize the projected return on investment for the initiative. "Because 50% of physician practices have fewer than five physicians, and yet account for 80% of outpatient visits, the AMA is very sensitive to issues that impact physicians' resources, costs and reimbursement," she said.

AHIP supports the code set upgrade but is also asking for more time, said association spokesman Robert Zirkelbach.

Throughout 2010, the AMA intends to develop an ICD-10 fact sheet series to give an overview of the process and to compare the new code sets to ICD-9. The document will also review concepts such as crosswalking, which involves transferring and applying some of the codes from the older system to the newer one. In addition, the Association will be developing an ICD-10 implementation tool kit, as well as a code set conversion tool.

The Centers for Medicare & Medicaid Services has developed a national standard system for crosswalking, called general equivalency mapping, that health care organizations can follow. But CMS has not mandated the use of that system, which could potentially cause problems, said Robert Tennant, a senior policy adviser with MGMA. Tennant was present at both of the December policy meetings discussing ICD-10 and 5010.

"The inevitability is that we will have to use these crosswalks," said Tennant. "But the health plans may say it's up to them to decide how to map these codes."

Zirkelbach said insurers are aware of those concerns and that AHIP will be trying "to bring more uniformity to the process."

Tennant did credit CMS with attempting to connect with stakeholders to maintain an open dialogue as it presses forward. He said the agency does not appear willing to commit to any contingency plans nor to extend the deadlines any further, meaning Medicare will be ready to start testing the 5010 transaction standards by Jan. 1, 2011.

Federal officials and other ICD-10 proponents say the upgrade must happen because the current system is nearly 30 years old, and its approximately 16,000 procedure and diagnosis codes are insufficient. ICD-10 has roughly 155,000 codes, including about 68,000 diagnostic codes.