The ICD-10 emperor has no clothes – KevinMD.com

The howling about the delay of ICD-10 was loud and fierce. It seems the quality of health care in the United States depends on our ability to use 68,000 diagnosis codes. The rest of the world has switched to ICD-10, and we alone insist on using an outdated coding system. Here’s a secret. The World Health Organization’s version of ICD-10 has about 16,000 codes, equivalent to ICD-9-CM. The rest of the world is not using ICD-10-Clinical Modification set, which has 68,000 codes. Only we, in the US, are considering that. The Canadian version of ICD-10 has about 16,000 codes, but the physicians do not use those codes for billing and reimbursement. They use a more limited code set of about 600 three-digit codes. Let me repeat this: The WHO version of ICD-10 that the rest of the world uses about 16,000 codes. Our version, developed jointly by the CDC and the American Hospital Association has 68,000 codes.

ICD-10-CM is going is going to add significant cost and complexity to physician practices without any benefit to the patient or physician. Perhaps facilities or payers need this level of detail, but we on the medical practice side do not. Selecting an ICD-10 code in an electronic health record will add 1-3 minutes to each patient encounter. Is that a reasonable use of physician time? If your mother or child is in the exam room, wouldn’t you prefer that the doctor spent that time with your family member, or you?

For years, I listened to the experts say that we needed greater granularity and detail in our diagnosis coding. The transition from ICD-9-CM to ICD-10-CM increases the number of diagnosis codes from about 14,000 to 68,000. That is significant additional granularity. But, when I studied ICD-10-CM in order to teach it to physicians and coders, I realized the ICD-10 emperor has no clothes.

My objections to ICD-10-CM are that it includes needless specificity, absurd adherence to taxonomy, unnecessary detail about injuries and insufficient additional information about chronic illnesses to justify its use.

In ICD-9, there are about a dozen codes for acute or chronic conjunctivitis. There are about 50 in ICD-10. Here are four: unspecified chronic conjunctivitis, right eye, unspecified chronic conjunctivitis, left eye, unspecified chronic conjunctivitis bilateral eyes, unspecified chronic conjunctivitis, unspecified eye.

Coding for gout explodes from about a dozen codes in ICD-9 to over 150 codes for gout in ICD-10-CM, differentiating chronic gout, lead induced chronic gout, drug induced chronic gout, chronic gout due to renal failure, other secondary chronic gout, acute idiopathic gout, acute lead induced gout, drug induced chronic gout, chronic gout due to renal impairment, and other secondary chronic gout. Each is reported by joint and acute gout by with or without tophus. Idiopathic gout right knee, idiopathic gout left knee, idiopathic gout unspecified knee. Or, chronic gout, unspecified. You don’t believe me do you? Get out your ICD-10-CM book and compare the codes using the search function on the WHO website for ICD-10.

Of the 68,000 codes over half are for injuries and accidents. Is it a laceration with or without a foreign body, which side, initial or subsequent encounter? Is the fracture at the upper or lower end of the ulna? What type of fracture is it? The mainstream media focused on the external cause codes “struck by a parrot.” But, these external cause codes are the least of our worries as we attempt to use ICD-10-CM in medical practices. And, I assure you, “struck by a parrot” is not in the WHO ICD-10 code set.

Now I’m sure that in response to this post you will show me the chronic care codes that have increased specificity and provide additional information for physicians health systems and payers. I know they exist. Great, let’s use a version that includes those codes without all of the other detail.

If Stark was the full employment act for lawyers, and HIPAA was the full employment act for consultants, then ICD-10 is the full employment act for coders. Much of the outrage against ICD-10 came from my fellow coders and consultants. I am sure that some of them have a deep-seated belief that ICD-10 is better. And, coding is the job coders have selected to do, and coding in ICD-10-CM is a fun, interesting activity for coders. Not so much for physicians.

In the 1986 movie, “Star Trek IV the Voyage Home” Dr. McCoy says, “the bureaucratic mind set is the only constant of the universe.” You remember the scene don’t you? Our heroes are in a shuttle … well, maybe you don’t remember the scene. Dr. McCoy wasn’t talking about ICD-10-CM, but we can imagine his reaction to it.

“Dammit Jim, I’m a doctor not a coder.”

But, in medical practices today, the physician typically selects the CPT code and the diagnosis codes that were the reason to provide the service and the diagnosis code that is the indication to order tests. ICD-10-CM will do little more than increase the bureaucratic side of physicians’ lives at the expense of their being doctors.

Betsy Nicoletti is president, Medical Practice Consulting and author of Auditing Physician Services. She blogs at Nicoletti Notes.

ICD-10 will accelerate the demise of private practice – KevinMD.com

You won’t read about the International Classification of Disease (ICD) on TMZ or hear it discussed on The View, but it has the potential to be an unpleasant October surprise in the healthcare world. It is a list of codes that physicians and hospitals use when billing insurance companies. These codes cover all manner of medical diagnoses for diseases, conditions, and injuries.

The first version of ICD appeared in 1946 with periodic revisions since. Six months from now, on October 1, the latest version, ICD-10 was supposed to be implemented in the US. We are late to the party, with other countries implementing this over the past 15 years.  ICD-10 has already been delayed for a year, but the administration promises no further delays. But similar to other promises, this may be another “never mind.” Congress voted for the 17th time to delay the April 1 SGR cuts, and attached a one year delay in ICD-10 implementation to their bill.

ICD-10 is not the fault of Obamacare nor is it Bush’s fault. Instead this classification even preceded Bill Clinton.  So this is not a partisan issue. Instead it is an issue of complexity, arriving in the wake of the largest healthcare overall in history with its attendant chaos and confusion. The current version, ICD-9 uses a 4 or 5 digit number to code for a particular disease, such as 540.9 for appendicitis. ICD-10 will have up to 7 alphanumeric characters to specify a condition such as S52.521A for “Torus fracture of lower end of right radius, initial encounter for closed fracture.” And there are now over five times as many codes for doctors and hospitals to choose from. But isn’t specificity better? Sure it is. Big data is the new frontier in medical research, making sense of the huge amount of generated healthcare data. But can this go to far?

In an effort to push specificity to the limit, some ICD-10 codes have gotten silly. Codes exist for being hurt at the opera (Y92253), walking into a lamppost (Y92253), walking into a second lamppost (W2202XD), getting sucked into a jet engine (V97.33XD), or being burned due to water skis on fire (V91.07XD). But this is not the Achilles’ heel of ICD-10.

First, medical practices and hospitals must know and have all of these 68,000 codes readily available to add to the medical record in order to bill correctly and hope to be paid. One more distraction for physicians, aside from all of the daily distractions of electronic records. When physicians pay more attention to their computer screen or tablet than to the patient, guess who suffers? This is the reason why texting and driving is illegal.

Second, electronic medical records (EMRs) must be able to incorporate these codes into the exam or procedure report. Are all EMR vendors up to speed on these codes? Will their system upgrades work as advertised? Or will they work as well as the Healthcare.gov website? And if the codes don’t work, physicians and their practices don’t get paid. Yet landlords, employees, and utility companies still want to be paid.

Third, will the insurance companies recognize each of these new 68,000 codes, correctly match them to billed procedures, and promptly pay the providers? If I treat a patient with macular degeneration with a monthly dose of a $2000 drug, I now bill a single code, which insures I will be paid. Under ICD-10, there will be 20 codes, specifying which eye(s) and severity, which allow payment. Will every insurance company have each of these codes in their computers? Will it recognize each code? Remember that these are the same insurance companies that don’t even know who has actually paid their insurance premiums.

The American Medical Association announced that ICD-10 implementation will cost three times as much as originally estimated. The  “costs of raining, vendor and software upgrades, testing and payment disruption” could be  $225,000 for a small medical practice and over $8 million for a large practice. How do medical practices of marginal profitability absorb these costs? With physician reimbursement rates set to grow at only 1/2 percent per year over the next five years, far below the true rate of inflation, of close to 10 percent, the financial writing is on the wall. This will accelerate the demise of private practice, already underway due to Obamacare. When ICD-10 is eventually implemented, “The doctor is in” may be a phrase of historical interest only.

Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor.

Medicare CPT Codes 2013 | Medicare About Health

Medicare CPT Codes 2013 (pdf download)

Medicare Screening Services 2013
Although Medicare does not cover comprehensive preventive visits such as
those reported with CPT-4 codes. 99381-99397, effective January 1, 2011,
Medicare …

2013 CPT Coding Update now available [.pdf] – American Society for …
New CPT and HCPCS codes for reporting preparation of fecal microbiota. …..
calendar year (CY) 2013, CMS has assigned CPT codes 99487, 99488 and
99489.

2013 CPT® Code Sheet – ITC
System. 2013 CPT® Code Sheet. Coding and Billing. Product Description CLIA
Status. CPT. Code. Modifier. Codes. CPT Quantity for 85576. 2013 Medicare …

http://www.immunize.org/catg.d/p4072.pdf
Influenza Vaccine Products for the 2013–2014 Influenza Season
Product Code. CSL Limited. Afluria (IIV3). 0.5 mL (single-dose syringe). 0. 9
years & older2. 90656. 5.0 mL (multi-dose vial). 24.5. 90658. Q2035 (Medicare).

http://www.aafp.org/dam/AAFP/documents/practice_management/payment/TCMFAQ.pdf
Frequently Asked Questions about Transitional Care Management
A2: There are two CPT codes that may be used to report TCM, effective …. the
Webinar, “What’s new in Medicare and Medicaid payment in 2013” hosted on …

http://www.idsociety.org/uploadedFiles/IDSA/Manage_Your_Practice/Billing_and_Coding/Evaluation_and_Management_Coding_Resources/IDSA%20Billing%20Coding%20Updates%20Webinar%202013.pdf
BILLING AND CODING UPDATE 2013
CPT Coding Update 2013 … “Throughout the CPT code set the use of terms such
as ‘physician,’ ‘qualified … Still awaiting further instructions from Medicare.

http://www.ngsmedicare.com/ngs/wcm/connect/6614a4804f73c1eeb417f64914797481/MMR_May_2013-05_Final.pdf?MOD=AJPERES&CACHEID=6614a4804f73c1eeb417f64914797481
May 2013 Medicare Monthly Review – National Government Services
May 5, 2013 … April Update to the CY 2013 Medicare Physician Fee Schedule …. Article
published May 2013: CPT codes 64553 and 64585 removed from the …

http://www.upmc.com/healthcare-professionals/physicians/Documents/2013-fee-schedule.pdf
2013 Medicare Clinical Laboratory Fee Schedule – UPMC.com
2013 Medicare Clinical Laboratory Fee Schedule. HCPCS Code Modifier
National Limit. Mid Point. Floor. PA. Description. 36415. $0.00. $3.00. $0.00.
$3.00.

http://www.peacehealthlabs.org/publications/Medicare%20Coverage%20Policies/Medicare%20Coverage%20Policies%20-%20COMPLETE%20MANUAL.pdf
Medicare Coverage Policies May 2013 update – PeaceHealth …
determine whether it is necessary to have Medicare patients sign an … For each
policy, you will see its CPT code(s) listed below the heading area and the ICD-9.

http://cdn.freedomoutpost.com/wp-content/uploads/2013/11/2013-ARHPC_ICD-9-CM.pdf
2013 CPT®, HCPCS II and ICD-9-CM Coding … – Freedom Outpost
CPT definitions versus Medicare and various 3rd party payers. •. “Separate
procedures” and unlisted procedures. Pertinent Surgical Coding Concepts.

http://www.carefusion.com/pdf/Interventional_Specialties/Vertebral_Augmentation_Reimbursement_Guide_IS1316.pdf
2013 coding and payment information – CareFusion
… are Medicare national payments for 2013 and do not reflect actual …. CPT®
code. Description. APC. 2013 national payment. Status indicator. Vertebroplasty.

http://www.ethicon.com/sites/default/files/13-0030-Upper-GI-Reimbursement-Fact-Sheet.pdf
2013 Upper GI / ColonoscopyReimbursement Fact Sheet – Ethicon
NATIONAL AVERAGE MEDICARE … Level II Upper GI Procedures (CPT codes:
43250, 43251, 43255, 43258, 43259). $927 … 2013 Ethicon All rights reserved.

http://www.practicemax.com/wp-content/themes/PracticeMax/resources/newsletters/November%20news%20112012.pdf
2013 CPT® Code Changes Cod ing & Billin g Anno u … – PracticeMax
PracticeMax can help your practice transition to the 2013 CPT codes. Following
are just some of … ment (99495-99496, as an alternative to a Medicare G- code).

http://tools.medicine.yale.edu/billingcompliance/files/Medicare%20Monthly/Medicare%20Monthly%202013.08.pdf
Medicare Monthly Review (MMR) August 2013-08 – Yale School of …
Oct 1, 2013 … Add-on HCPCS/CPT Codes Without Primary Codes (SE1320) … 2013 Medicare
Physician Fee Schedule Database (MPFSDB)” and Transmittal …

http://www.doh.wa.gov/portals/1/Documents/Pubs/681018.pdf
CLIA Waived Tests and CPT Codes
Sep 16, 2013 … DOH 681-018 January 2013 ….. *Drug Screen CPT Code Update: 80101QW has
been replaced by code Q0434QW. …… Medicare carrier.

https://www.ubhonline.com/html/pdf/cptChangesDeckDec2012.pdf
2013 CPT Code Changes – Provider Express
Dec 3, 2012 … CPT Code Development. • CPT … Current coding structure doesn’t allow for
accurate description of … APA Current CPT Code Changes 2013.

http://www.kchealthcare.com/media/11116865/h0009_1201_pain_rates.pdf
2013 MEDICARE PAYMENTS foR PAIN MANAGEMENT …
2013 MEDICARE PAYMENTS foR PAIN MANAGEMENT PRoCEDURES1. (
Effective 1/7/13). CPT CODE. DESCRIPTION. PHYSICIAN. IN-OFFICE.
PHYSICIAN.

http://www.healthandwelfare.idaho.gov/Portals/0/Providers/Medicaid/MA13-01%20.pdf
MA13-01 – Health and Welfare
Jan 29, 2013 … This updated release contains the 2013 CPT code and rate changes for … for non
-primary care services at 90 percent of the Medicare rate.

http://www.clslaboratory.com/Files/BillingHandbook/Billing_Guide_CLS.pdf
2013 Billing Guide – CLS
Apr 1, 2013 … 29-30. Medicare NCD & LCD Listings . 31-105. Common ICD-9 Codes … . 106-
108. CLS 2013 BILLING GUIDE: TABLE OF CONTENTS …

http://www.magellanprovider.com/MHS/MGL/getpaid/HIPAA/cptcodechanges-FAQ.pdf
2013 CPT® Codes Changes Background and Frequently Asked …
Apr 19, 2013 … the Centers for Medicare and Medicaid Services (CMS) on an annual basis … on
or after January 1, 2013 that includes the old CPT codes will.

Medicare CPT 82947 | Medicare About Health

Medicare CPT 82947 (pdf download)

Medicare Preventive Services Quick Reference Chart – American …
This educational tool provides information on Medicare preventive services. …
provided includes Healthcare Common Procedure Coding System (HCPCS)/
Current Procedural Terminology (CPT) codes; … 82947 – Glucose, quantitative,
blood.

CPT Codes – CLIAwaived.com
Jun 1, 2010 … Medicare and Medicaid Services or any other public or government organization
or agency. National … CPT Code … 82947-QW. $ 5.62.

LCD for Metabolic Laboratory Panels (L1136)
LCD for Metabolic Laboratory Panels (L1136). All ICD-9 Codes (diagnosis codes
) must be carried to their highest level of specification. CPT/HCPCS Codes.

https://www.medica.com/~/media/Documents/Provider/Laboratory%20Rebundling.pdf
Policy Name Laboratory Rebundling Summary This policy … – Medica
Medica uses the codes indicated in the Centers for Medicare and. Medicaid
Services … Note: For the purpose of this policy, CPT codes 82947 and 82948 are
not.

http://labs.unchealthcare.org/medical-necessity-checking/icd-9-codes/Blood%20Glucose.pdf
Blood Glucose Testing
Medicare National Coverage Determinations (NCD). Coding Policy Manual and
… HCPCS Codes (Alphanumeric, CPT. ©. AMA). Code … ICD-9-CM Codes
Covered by Medicare Program. The individual …. code 82947 only. Special
screening …

http://www.ucdmc.ucdavis.edu/pathology/resource/pdf/annual_notice_for_physicians.pdf
Annual notice for physicians – UC Davis Health System – the …
Human Services, and the Center for Medicare and Medicaid Services (CMS) 63
Federal. Register 45076, 45079 (August … CPT 82947. Glucose; blood, reagent …

http://www.peacehealthlabs.org/publications/Medicare%20Coverage%20Policies/Medicare%20Coverage%20Policies%20-%20COMPLETE%20MANUAL.pdf
Medicare Coverage Policies – PeaceHealth Laboratories
determine whether it is necessary to have Medicare patients sign an Advance
Beneficiary … For each policy, you will see its CPT code(s) listed below the
heading area and the ICD-9. (diagnosis) codes that ….. 82947, 82948, 82962.
Glycated …

http://www.bcbsms.com/assets/docs/HYCodes.pdf
Healthy You! codes
Immunizations are set to pay at any age, unless specified by the CPT code. •
82947: Glucose, quantitative. 82948: Glucose, blood, reagent strip. 82962:
Glucose …

http://www.clslaboratory.com/Files/BillingHandbook/Billing_Guide_CLS.pdf
2013 Billing Guide – CLS
Although it may be obvious that the patient is on medication, Medicare does not
allow ….. CPT 87340 Infectious agent antigen detection by enzyme immunoassay
….. 82947. 1 per year. V77.1 Special screening for endocrine, nutritional …

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/preventive_care_services_coding_guideline_summary.pdf
Preventive Coding Summary – UnitedHealthcareOnline.com
Jan 1, 2014 … CPT® is a registered trademark of the American Medical …. Procedure Code(s):
82947, 82948, 82950, 82951, 82952, 83036, 36415,. 36416.

http://www.acllaboratories.com/site_media/documents/forms/ACL_NCD_Booklet.pdf
ACL Medicare Policy (NCD & LCD) Summary … – ACL Laboratories
Apr 1, 2013 … 82947, 82962 …………………….. 18 – 21 …. Table of Contents. 3. ACL Medicare
Policy Disclaimer and Direct Sources of Coverage Information.

http://www.emhreflab.org/downloads/pdf/medicare-guidebook.pdf
Medicare Coverage Guidebook – Elmhurst Memorial Reference …
Medicare Limited Tests – Estimate of Costs if Not Covered. CPT. TEST NAME …
Glucose Tolerance Test, 2hour. 227.00. 82947. Glucose, quantitative blood.

https://www.codemap.com/abbott/autoreim.pdf
6. What are automated tests and how do they affect … – CodeMap
Medicare’s rules for “automated tests” reimbursement are one of the most
confusing parts … Basic metabolic panel (CPT 80053) 8 automated tests …
individually as 82040, 82947, and 82465 respectively at $15.00 each, the total
Medicare.

http://www.munsonhealthcare.org/upload/docs/cms%20limitations%20guide/cms_limitations_guide_laboratory_services.pdf
CMS Limitations Guide – Laboratory Services – Munson Healthcare
Jan 1, 2013 … Medicare National Coverage Determinations (NCD) ….. Use CPT 87088 where a
commercial kit uses manufacturer defined media for isolation …

http://www.thenationalcouncil.org/wp-content/uploads/2013/10/Ohio-HH-HSAG-Overview-of-HH-Indicators.pdf
Health Homes Presentation_D1 – National Council
The Centers for Medicare & Medicaid Services (CMS). – National …. This
measure is a CMS Health Home Core Quality measure. … CPT: 82947, 82948,
82951,.

https://medicare.fcso.com/Publications_B/1997/138549.pdf
July-Aug 1997 Medicare Part B Update! Publication
(HCFA) has advised Medicare carriers to begin denying claims for diagnostic …..
CPT-CODE(S): 82947QW, 82950QW,82951QW, 82952QW(effective 10/1/96) …

http://www.keepingyouwell.com/Portals/3/docs/ALPS%20files/Estimated%20MC%20Cost,%20Ref%20Lab%2005202013.pdf
TEST CPT CODE * ESTIMATED COST **
May 20, 2013 … (ICD-( codes that DO NOT support Medicare medical necessity) … 82947. 36.46.
Glycosylated Hemoglobin/Glycated Protein 83036. 69.00.

https://www.caresource.com/documents/oh-p-215-codeeditguideprofclaims-pdf/
Code Editing Guidelines on Professional Claims – CareSource
Medicare & Medicaid (CMS) and the American Medical Association, CPT.
Professional and … 82374, 82435, 82565, 82947, 84132, 84295 and/or 84520.

http://www.tmhp.com/tmppm/2009/26_TMPPM09_Independent_Laboratory.pdf
Independent Laboratory – TMHP.com
CPT only copyright 2008 American Medical Association. All rights reserved. ….
The CLIA rules and regulations are available on the CMS website at … 82947-
QW. 82950-QW. 82951- … laboratory services cannot exceed the Medicare
payment.

http://www.upmc.com/healthcare-professionals/physicians/Documents/2013-fee-schedule.pdf
2013 Medicare Clinical Laboratory Fee Schedule – UPMC.com
2013 Medicare Clinical Laboratory Fee Schedule. HCPCS Code …… 82947.
$5.39. $7.29. $0.00. $5.39. Assay glucose blood quant. 82947. QW. $5.39. $7.29.

Alabama doctor excoriates EMR damage to patient health care.

Dear Congressman Brooks,

As a practicing family physician, I plead for help against what I can best characterize as Washington’s war against doctors.

The medical profession has never before remotely approached today’s stress, work hours, wasted costs, decreased efficiency, and declining ability to focus on patient care.

In our community alone, at least 6 doctors have left patient care for administrative positions, to start a concierge practice, or retire altogether.

Doctors are smothered by destructive regulations that add costs, raise our overhead and ‘gum up the works,’ making patient treatment slower and less efficient, thus forcing doctors to focus on things other than patient care and reduce the number of patients we can help each day.

I spend more time at work than at any time in my 27 years of practice and more of that time is spent on administrative tasks and entering useless data into a computer rather than helping sick patients.

Doctors have been forced by ill-informed bureaucrats to implement electronic medical records (“EMR”) that, in our four doctor practice, costs well over $100,000 plus continuing yearly operational costs . . . all of which does not help take care of one patient while driving up the cost of every patient’s health care.

Washington’s electronic medical records requirement makes our medical practice much slower and less efficient, forcing our doctors to treat fewer patients per day than we did before the EMR mandate.

To make matters worse, Washington forces doctors to demonstrate ‘meaningful use’ of EMR or risk not being fully paid for the help we give.

In addition to the electronic medical records burden, we face a mandate to use the ICD-10 coding system, a new set of reimbursement diagnosis codes.

The current ICD-9 coding system uses roughly 13,000 codes. The new ICD-10 coding system uses a staggering 70,000 new and completely different codes, thus dramatically slowing doctors down due to the unnecessary complexity and sheer numbers of codes that must be learned.

The cost of this new ICD-10 coding system for our small practice is roughly $80,000, again driving up health care costs without one iota of improvement in health care quality.

Finally, doctors face nonpayment by patients with ObamaCare. These patients may or may not be paying their premiums and we have no way of verifying this. No business can operate with that much uncertainty.

On behalf of the medical profession, I ask that Washington stop the implementation of the ICD-10 coding system, repeal the Affordable Care Act, and replace it with a better law written with the input of real doctors who will actually treat patients covered by it.

America has enjoyed the best health care the world has ever known. That health care is in jeopardy because physicians cannot survive Washington’s ‘war on doctors’ without relief.

Eventually the problems for doctors will become problems for patients, and we are all patients at some point.

Sincerely yours, Dr. Marlin Gill of Decatur, Alabama

House Postpones ICD-10 Delay Vote, AHIMA Calls for Continued …

The US House of Representatives has postponed their vote on a bill that would delay the implementation of ICD-10-CM/PCS. 

After 40 minutes of debate on the bill and a call for a vote, House officials decided that a quorum was not present, and therefore a vote would not be conducted. Further proceedings on the motion were postponed, and the bill has not yet been slated for another vote. However, another vote could take place later today or in the coming days.

AHIMA has again called on proponents of ICD-10 to contact their congressional representatives and ask that they not delay ICD-10.

The House bill, H.R. 4302 – Protecting Access to Medicare, mainly adjusts the Sustainable Growth Rate (SGR) for Medicare payments, which dictates how much physicians get paid for services. But bill section 212, a seven line section inserted into the SGR patch bill, also states that the Department of Health and Human Services (HHS) cannot implement the ICD-10 code set until October 1, 2015, a year later than the current date of October 1, 2014.

The bill introduced by Representative Joe Pitts (R-PA) states: “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.”

House Speaker John Boehner (R-OH) and Senate Leader Harry Reid (D-NV) announced they were working in cooperation on the SGR “patch” bill late Tuesday night. The bill passes a temporary one year patch to prevent a 24 percent reduction in physician Medicare payments that would go into effect March 31. The development of the bill, and insertion of the ICD-10 delay, was negotiated at the leadership level in the House and Senate. 

During the debate, several House representatives mentioned that H.R. 4302 included provisions unrelated to SGR that likely many members of Congress were unaware were included in the bill.

Similar Delay Bill Proposed in the Senate

A Senate bill, S. 2157, features similar language to delay ICD-10 for one year. Senators were expected to vote on that bill next Friday, April 4, though that timeline may change due to the delay in the House.

AHIMA and other proponents of ICD-10 have been rallying members and stakeholders to contact their representatives and senators and tell them to not delay the new code set. On Wednesday thousands of AHIMA members contacted their representatives and called for no further delays of ICD-10.

Further requests to contact senators have been made by AHIMA and the Coalition for ICD-10, an advocacy group of healthcare associations, vendors, and insurers that support the implementation of ICD-10, to stop further delay of the code set.

ICD-10 Proponents Warn of Harmful Implications of Another Delay

AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

In a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner, members of the Coalition for ICD-10 said that CMS and other government officials should move forward with the current ICD-10 deadline of October 1, 2014. Coalition representatives include the American Hospital Association (AMA), the American Medical Informatics Association (AMIA), BlueCross BlueShield Association, the College of Healthcare Information Management Executives (CHIME), and vendors like 3M Health Information Systems and Siemens Health Services.

“Although many of the signatories to this letter were at odds over the timing of implementation when the National Committee on Vital and Health Statistics (NCVHS) and HHS embraced ICD-10—which has already been adopted outside the U.S. worldwide—we are now in agreement that any further delay or deviation from the October 1, 2014 compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending,” the letter reads. “By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing,” the letter stated.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients,” the letter continued. “Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

The impact of another delay in ICD-10 would be far reaching across the healthcare industry, AHIMA officials said. Many healthcare education programs have been teaching ICD-10 exclusively to students in preparation for the October implementation, while healthcare organizations have invested time and money into preparing staff and systems for the switch.

Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

The call for a delay likely came as a surprise to CMS. On February 27, Tavenner announced at the Health Information and Management Systems Society Annual Conference that ICD-10 would not be delayed any further, stating “we have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. There will be no change in the deadline for ICD-10.”

AHIMA Calls on Members to Request Removal of Delay Provision

AHIMA has put out a call to members and other stakeholders to contact their representatives in Congress and ask them to take the ICD-10 provision out of the SGR bill.

When contacting congressional members, AHIMA has instructed callers to state that their representatives/senators:

  • Oppose the specific language in the SGR patch legislation
  • Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ”This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,” AHIMA wrote in a statement, which it encouraged its members to use when contacting Congressional representatives. ”Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished…  Let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district.”

Contacting Your Congressional Representatives

For more information on contacting your representatives and senators in Congress, visit AHIMA’s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/.

For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy.

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DIY ICD-10 conversion – Part 11 | 3M Health Information Systems

At the end of Part 9, we were translating a list of ICD-9 codes – a policy – into ICD-10. We used the 10-to-9 single GEMs with reverse lookup to find ICD-10 codes that should be in your ICD-10 version of the policy. We had some ICD-9 codes left over that no ICD-10 code translated to. You tried to look them up in the 9-to-10 single GEMs. You found some translated to ICD-10 codes already in your ICD-10 policy list, so you could feel assured that their meaning was taken care of. A few may have translated to single ICD-10 codes not already on your list. Those ICD-10 codes (“pink” in CTT) might be appropriate for your policy, but a clinical review of them was recommended.

Finding all the ICD-10 codes that might be on a patient’s record, and that might imply the patient satisfies the policy, is the objective of our process. Have we now found them all? Consider this case from Part 10:

One ICD-10-PCS procedure

037K34Z, Dilation of Right Internal Carotid Artery with Drug-eluting Intraluminal Device, Percutaneous Approach

is the result of translation from a cluster of four ICD-9 procedure codes

00.61, Percutaneous angioplasty of extracranial vessel(s)

00.40, Procedure on single vessel

00.55, Insertion of drug-eluting stent(s) of other peripheral vessel(s)

00.45, Insertion of one vascular stent

Suppose you have 00.55 in a policy designed to pay differently for procedures where a drug-eluting stent is inserted. The policy may also contain 00.60 and 36.07. When you try to translate 00.55, you do not find it in the 10-to-9 singles, and all you find in the 9-to-10 singles is NOPCS.

I picked 00.55 because it is an extreme (though not isolated) example. 00.55 is an ICD-9 adjunct code – a “code” that is never supposed to be coded on its own, but rather included to modify the meaning of another code (in this case the PTCA, 00.61). ICD-10-PCS does not use adjunct codes. Every meaningful combination of 00.61 and its adjunct codes is represented by one ICD-10-PCS code.

Adjunct procedure code 00.55 is just one example of an ICD-9 code that requires other ICD-9 codes to be on the record with it in order to specify the same patients as can be specified with just one ICD-10 combination code. This happens with diagnoses, too, such as:

I25.110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris

requiring two ICD-9 codes to convey the same meaning

414.01, Coronary atherosclerosis of native coronary artery

411.1, Intermediate coronary syndrome

Let us pursue this second example a little further. Suppose you had a policy for finding all patients with coronary atherosclerosis. 414.01 would be on it. When you translated 414.01 using the 10-to-9 singles GEM table, you would have found I25.10, Atherosclerotic heart disease of native coronary artery without angina pectoris. Good enough? What about those people who also had angina? Assuming you want them too, you would have wanted I25.110 (and several other similar codes) in your ICD-10 policy. But you would not have found them with the process as outlined so far.

So here is where we add the third phase to the process – look up each ICD-9 code in your policy in the 10-to-9 clusters GEM table.

When I recommended dividing the GEMs files into four tables back in Part 6, I suggested making a reverse index for the 10-to-9 singles GEM, but I forgot to suggest that you also do so for the 10-to-9 clusters GEM table. I apologize. With any ICD-9 code in your policy, you will want to see what ICD-9 clusters it is a part of, and that is only practical if you’ve resorted (or re-indexed) the 10-to-9 clusters GEM by ICD-9. CTT and suchlike tools do this for you.

What do you do when you find one of your policy’s ICD-9 codes in a 10-to-9 cluster, and the ICD-10 code you find with it isn’t already on your ICD-10 policy list? In theory, you do not have the whole story – you don’t know what other ICD-9 codes are expected to also be on the record to equal the precise meaning of the ICD-10 combination code you’ve found. We could go through all the rigmarole of using the scenario and choices columns of the table to find them (which we will unfortunately have to get to later) but you really don’t have to know them. (Another benefit of CTT and similar tools is that they will show all that to you with just a few clicks.) No, all you need to do is review the ICD-10 code to see if it deserves to be in your policy. Its code title (or failing that, its Tabular entry) should give you all you need to know.

Going back to our example, I25.110, Atherosclerotic heart disease of native coronary artery with unstable angina pectoris, tells you that the code selects patients not only with coronary atherosclerosis, but also unstable angina. What is the policy about? Everyone with coronary atherosclerosis? Then you want it. Only patients without angina? Then you don’t. You don’t have to know what ICD-9 codes the GEMs equated I25.110 to.

Now let’s look at the adjunct code example. When you looked up 00.55 in the 10-to-9 GEM with reverse index, you didn’t find anything. When you looked up 00.55 in the 9-to-10 singles GEM, you only found NOPCS. There is no PCS code that just means “insertion of drug-eluting stent.” But when you look up 00.55 in the 10-to-9 cluster GEM, you see 202 ICD-10-PCS codes that are expressed in ICD-9 as clusters, where the cluster contains 00.55. According to the GEMs, these are all ICD-10 codes that say, among other things, that a drug-eluting stent was inserted into a peripheral vessel. If your policy applies to all patients where a drug-eluting stent was inserted into a peripheral vessel, then you can safely add all 202 codes to your ICD-10 policy list. If not, you should look at all 202 and pick the ones that satisfy the intent of the policy.

 

Ron Mills is a Software Developer for the Clinical & Economic Research department of 3M Health Information Systems.

You can find the complete DIY ICD-10 series here.