Health Information Management

Congress foregoes all logic with latest ICD-10 bill proposal

APCs Insider, June 12, 2015

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By Steven Andrews
 
ICD-10 implementation is 110 days away. Coders, HIM professionals, and providers have spent massive amounts of time and money to prepare, and the switch is all but inevitable.
 
That hasn't stopped members of Congress from introducing increasingly illogical bills to delay or defer ICD-10, apparently in a desperate attempt to appease certain constituents.
 
Rep. Ted Poe's, R-Texas, bid to permanently shelve ICD-10 was a predictable rehash of his 2013 bill. So far, it's gathered less than a quarter of the cosponsors of his original version, and every day we get closer to October 1 decreases its likelihood of even getting out of committee.
 
Perhaps sensing the inevitability of ICD-10, Rep. Diane Black, R-Tennessee, introduced a bill that wouldn't delay the code set—but it would turn the 18 months after implementation into a free-for-all in which no claims could be denied due to unspecified codes or "inaccurate subcodes." It's not clear how Black thought delaying the inevitable would suddenly encourage lagging providers to train for ICD-10, which they've known was coming since 2009. The bill is currently languishing with a mere seven cosponsors, all Republicans.
 
Rep. Gary Palmer, R-Alabama, apparently doesn't think Black's bill goes far enough. Last week, he introduced H.R. 2652, with the scaremongering title of the "Protecting Patients and Physicians Against Coding Act of 2015." The bill proposes a two-year grace period, during which "physicians and other health care providers submitting claims and other documents using ICD–10 are not penalized for errors, mistakes, and malfunctions relating to the transition to such code set."
 
That seems awfully broad and written by someone who does not understand coding at all. For example, according to the ICD-10 NCDs, providers reporting intracranial percutaneous transluminal angioplasty with stenting using CPT® code 37799 (unlisted procedure, vascular surgery) need to also report ICD-10-CM code I67.2 (cerebral atherosclerosis).
 
If Palmer's bill passes, that claim wouldn't be denied if the provider reported I68.2 (cerebral arteritis in other diseases classified elsewhere). Or J67.2 (bird fancier's lung). Or even S91.009S (unspecified open wound, unspecified ankle, sequela). All of those are simply errors Palmer doesn't think providers should worry about. This bill would inspire no one to learn more about coding accurately, would not allow providers to accurately track patient diagnoses, and could open the door to potentially massive fraud.
 
Here's the kicker: Palmer's bill calls for the Government Accountability Office (GAO) to report on how ICD-10 impacts providers by April 1, 2016. Imagine how useless a couple months of data potentially full of errors would look. ICD-10 opponents would simply point to the massive amount of errors and say that providers shouldn't have to use a system they can't figure out.
 
Where would Palmer even come up with such a bill? Look no further than a resolution passed by the AMA at its annual meeting this week. Clearly, Palmer and the AMA worked together on this, though the AMA's resolution only calls for physicians to be protected from these errors. Palmer expands that to all "health care providers," so does that mean hospitals as well?
 
According to CMS' definition of "provider," yes. Is that what Palmer meant? It's tough to say. These are the same people who can let a handful of inadvertent words unravel what they consider to be one of their landmark accomplishments. Let's just be glad their job isn't something as precise as medical coding.

 



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