AMA calls for 2-year delay of ICD-10 enforcement

The government must gauge the full impact of the massive code sets before requiring doctors to use them for billing services, the Association says.

By Charles Fiegl — Posted May 21, 2012

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Federal officials should delay a deadline to switch to the ICD-10 diagnosis code sets for billing physician services by at least two years instead of one, the American Medical Association said in a May 10 letter to the Centers for Medicare & Medicaid Services.

The agency overseeing the transition to the new codes has proposed a one-year delay from Oct. 1, 2013, to Oct. 1, 2014. But the AMA wants CMS to take more time to evaluate whether an alternative diagnosis code set is more appropriate than a full transition to the roughly 68,000 ICD-10 codes. A full cost-benefit analysis on the administrative and financial impact of the switch is needed, wrote AMA Executive Vice President and CEO James L. Madara, MD, in a letter commenting on the proposed one-year delay.

“While a number of other countries have implemented ICD-10, they have done so with a modified version of the code set and often with substantial government support,” Dr. Madara said. “CMS needs to give full consideration to all the issues. A year’s delay does not provide CMS with adequate time to fully examine the appropriate scope of ICD-10 and true costs to physician practices.”

The transition will require new training for physicians and office staff. Many medical practices also would need to upgrade their health information technology systems. Implementation of ICD-10 is estimated to cost between $83,290 and $2.7 million per practice depending on its size, the AMA letter said.

Some international physician and health IT organizations have questioned whether ICD-10 is an appropriate replacement for the current ICD-9 standard. “Moreover, experiences in Canada and studies on the transition to ICD-10 show a severe risk for claims processing and payment disruptions,” Dr. Madara said.

The American Health Information Management Assn. has opposed any delay of the transition to ICD-10. In an April 24 letter to CMS, AHIMA said the nation must remain on an established time line for moving toward implementation of the new code sets. ICD-10 would improve quality of care through more use of detailed claims data, improved public health reporting and enhanced research.

“Until [ICD-10] code sets are implemented, U.S. health data will continue to deteriorate at a time when there is an increasing number of data-dependent health care initiatives aimed at improving value,” AHIMA stated.

But CMS is leading several programs to improve quality of care and value, and physicians are overwhelmed with the amount of simultaneous federal programs, including electronic prescribing and electronic health record incentive initiatives, Dr. Madara said. CMS soon will start levying penalties on doctors who do not meet requirements for these programs.

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