AMA calls on Congress to block ICD-10 mandate on doctors

Washington -- Citing high implementation costs and coinciding federal mandates, the American Medical Association has urged House Speaker John Boehner (R, Ohio) to stop the switch to the new diagnosis coding sets known as ICD-10.

Requiring doctors to use ICD-10 would offer no direct benefit to patient care, said AMA Executive Vice President and CEO James L. Madara, MD, in a Jan. 17 letter to Boehner. He said requiring all physician practices to use new diagnosis codes starting Oct. 1, 2013, also would interfere with concurrent efforts by doctors to implement electronic medical records and satisfy other Medicare quality improvement requirements. AMA delegates adopted policy opposing the switch to the enhanced code sets during the Association's Interim Meeting in November 2011, but Dr. Madara's letter is the next step toward effecting a legislative solution.

"Stopping the implementation of ICD-10, and calling on appropriate stakeholders including physicians, hospitals, payers, national and state medical and informatics associations, to assess an appropriate replacement for ICD-9 will help to keep adoption of EMRs and physician participation in quality and health IT programs on track and reduce costly burdens on physician practices," Dr. Madara wrote.

In January 2009, the Health and Human Services Dept. published rules requiring new standards under the Health Insurance Portability and Accountability Act and the transition to ICD-10. Physician practices must start using the new diagnosis codes by Oct. 1, 2013, or Medicare claims will not be paid. Practices will continue to use CPT codes to bill for services they provide based on the diagnosis.

ICD-10 contains about 68,000 codes, while the current ICD-9 standard has only about 13,000 codes. The AMA says the switch represents a significant administrative burden, as the costs of implementing ICD-10 range from about $83,000 to $2.7 million depending on the size of the physician practice.

However, health technology industry groups have defended the push to update ICD-9, which is more than 30 years old. They say the more expansive code sets would allow much more specificity in identifying diagnoses and lead to care improvements.

Implementation won't be as expensive as some have estimated, said Sue Bowman, director of coding policy and compliance at the American Health Information Management Assn. A physician practice implementing an EMR system that is ICD-10 ready now, for instance, would save the practice the expense of retrofitting the system in 2013.

The current ICD-9 codes do not support advancements in the medical industry, said Juliet Santos, a senior director with the Healthcare Information and Management Systems Society. The alphanumeric ICD-10 code sets leave more space for the future addition of new diagnostic procedures and other medical advances.

Using ICD-10 codes would allow physician offices to capture more detailed information about patients, and practices might find it easier to bill for services. "When a physician is negotiating payer contracts, they have a stronger case to support what they are billing," Santos said.

Physicians should not be shocked by the number of codes in ICD-10, she added. Right now, no doctor would use or need to know all ICD-9 codes.

Doctors and their office staff mainly focus on the codes that apply to the practice's specialty, and that wouldn't change.

But the timing of the transition could not be worse for physicians, Dr. Madara said. Practices are adopting EMR systems under Medicare incentives, and 2013 marks the first reporting year for which doctors face potential payment penalties under quality reporting and value-based purchasing requirements. In addition, Medicare payment rates have remained unstable as the sustainable growth rate formula continues to mandate across-the-board cuts.

The AMA has called on lawmakers to synchronize federal incentive programs. Electronic prescribing, EMR meaningful use and physician quality reporting programs have separate requirements, but they have overlapped and created situations where physicians can be penalized unfairly for choosing one program over the other, the Association has said.

By coming up with a better sequence for Medicare incentives and coordinating their requirements, Congress can ensure that the system is better prepared for health reform, Dr. Madara said. "The struggle to keep up with the various health IT use and reporting requirements leaves little time for physicians to get engaged in the practice redesign and payment and delivery reforms envisioned in the Affordable Care Act."