Health Information Management

Potential delay of ICD-10 and 2-midnight enforcement loom on the horizon

HIM-HIPAA Insider, March 31, 2014

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by Jaclyn Fitzgerald, Editor
 
On March 27, the House approved by voice vote H.R. 4302, legislation to prevent cuts to Medicare physician rates. The Senate is expected to vote on the bill Monday around 2 p.m. (Eastern). On the surface, this is a vote about the Sustainable Growth Rate (SGR), the amendment of the Social Security Act, and extension of Medicare payments to physicians. But dig a little bit deeper and you will find some text that is concerning.
 
Buried in the bill are a few lines that mention delaying ICD-10-CM/PCS so its earliest implementation date is October 2015. The bill reads:
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 Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.
 
Notice that the language in the bill says CMS may not require ICD-10 “prior to October 1, 2015.” That doesn’t mean October 1, 2015, would be the new implementation date. So the date could get pushed back to 2016 or 2017. It will also reignite the debate about whether we should just wait for ICD-11.
 
But that’s not all. The bill also mentions extending CMS’ reviews of the 2-midnight rule. CMS’ probe and educate period for this rule has already been extended twice, and a third extension would push the pre-payment status reviews out to March 31, 2015. This is not quite as earthshattering as the thought of once again delaying ICD-10, because the 2-midnight rule would still be in effect if the bill passes. However, if the review period is extended, it may allow facilities additional time to understand denials and implement policies related to the 2-midnight rule. 
 
It is unclear who introduced the ICD-10 delay language into the bill, which is a compromise bill worked out by House and Senate leadership. Some speculated that the AMA was behind it because the association has been quite vocal in its opposition to ICD-10. However, the AMA and numerous specialty societies sent a letter asking Congress NOT to pass this bill. The association is looking for a permanent fix to the SGR. They almost got one, too. The House passed a bill March 14 that would have fixed the SGR, but the Senate failed to pass it. Hence, the compromise with the additional language to delay ICD-10.
 
The potential delay is more than just a nuisance. It could have serious repercussions on finances and the industry’s ability to accurately code. In an article posted on the Journal of AHIMA website, the association—which urged its members to contact their senators and request removal of the ICD-10 delay provision from the bill—underscored the financial impact of a delay. The article stated that CMS estimated the delay would cost $1–6.6 billion. And don’t forget about all the time organizations spent preparing for the transition. Workforce members were trained, systems were modified, testing was performed—the list goes on.
 
The delay could also prolong the code freeze. The last regular update for ICD-9-CM was in 2011. If ICD-10 is delayed again, we’re looking at no new codes until at least October 2016. All around, a delay means bad news.



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