Jun 7, 2015

ICD-10: Stop This Freight Train ... Or At Least Install Seat Belts!

(CHICAGO) -- Staring down the muzzle of the Oct. 1 mandatory deadline to implement the ICD-10 coding system, the American Medical Association House of Delegates searched for multiple ways to help U.S. physicians dodge a dangerous bullet.

Thanks to strong lobbying from AMA, the Texas Medical Association, and other physician groups, the original Oct. 1, 2013, ICD-10 deadline has been pushed back twice.

Dr. Fuller testifies at AMA

Both TMA and AMA still formally oppose ICD-10. They've pointed out that many physicians, especially those in small practices, are still not ready to use the new coding language. Some cite the high cost of transition; others blame electronic health record vendors that have not yet made ICD-10-compliant software available. Those who aren't ready run the risk of having all or some of their Medicare, Medicaid, and commercial insurance claims going unpaid.

TMA supports H.R. 2126, the Cutting Costly Codes Act of 2015, by U.S. Rep. Ted Poe (R-Humble), which would prohibit the government from requiring physicians and health care providers to use ICD-10.

Texas physicians at the AMA meeting spoke out about the dangers they foresee, especially for primary care practices. Greg Fuller, MD, a family physician from Keller, said the wide array of medical problems primary care physicians treat is forcing them to try to learn thousands of new codes.

"We need to stop ICD-10," Dr. Fuller told the Reference Committee on Legislation. "Any delay in pay is going to kill these practices."

Dr. Villarreal at reference committee

E. Linda Villarreal, MD, an internist in the Rio Grande Valley, said she is concerned about the ramifications for access to care in South Texas, many parts of which already face a dire shortage of physicians. "I've taken three courses in ICD-10, and I still don't get it," Dr. Villarreal said.

But Washington watchers say Congress has no stomach for delaying the implementation date one more time. "The ICD-10 Coalition has done a better job than [medicine has] over the past four years," one delegate said.

That leaves organized medicine in a tough spot, said Fort Worth pediatrician Gary Floyd, MD, a member of the TMA Board of Trustees. Groups like AMA and TMA must continue to push for a last-minute reprieve and at the same time work to protect their members from the likely upheaval that will come with ICD-10, he explained.

"Our message is this," Dr. Floyd said, "don't give up the ship, but make sure the lifeboats are manned and at the ready."

Physicians line up to testify on ICD-10

One likely outcome of the House of Delegates meeting will be a directive for AMA to push the Centers for Medicare & Medicaid Services (CMS) for some leeway for physicians who can't master the intricacies of ICD-10 right away.

"We simply need to implement ICD-10 as planned and ask for a grace period where we are not held financially accountable for improper coding in order to protect our patients access to care and to protect physicians’ practices," said Alabama urologist Jeff Terry, MD, who has been an outspoken critic of ICD-10 for the past several years. He said a bill introduced last week in Congress by U.S. Rep. Gary Palmer (R-Alabama) would set up such a grace period.

In testimony before the reference committee today, Dr. Terry, Dr. Floyd, and others outlined a series of protections they want AMA request from CMS:

  • Two years with no penalties for incorrect coding;
  • Two years with no bounty-hunting auditors looking for coding errors;
  • A promise of no delay in payments to physicians; and
  • Acceptance of ICD-10 codes with less-than-optimal degrees of specificity.

Dr. Floyd describes the terms of

the ICD-10 grace period.

The reference committee's recommendations are expected early Monday, and the full House of Delegates will debate the issues before the meeting ends on Wednesday.

TMA offers extensive ICD-10 coding training materials, including specialty-specific online ICD-10 documentation training, on-demand webinars, and customized on-site ICD-10 training.

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