Health Information Management

Associate Director’s Note: AMA, CMS join in ICD-10 education initiative

CDI Strategies, July 9, 2015

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Those following the episodic turns of the ICD-10-CM/PCS implementation saga witnessed another dramatic plot twist in the narrative this week when the American Medical Association (AMA) and CMS made a joint announcement essentially prioritizing physician ICD-10 education and allowing some flexibility in claims auditing and quality reporting.

“ICD-10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD, in a joint statement with CMS Monday morning, July 6.

Stack’s statement not only marks a sea change in opinion from the AMA but also seems to resolve years of debate and back-room political attempts to delay ICD-10 implementation—including an attempt just last month to impose a two-year moratorium on payment penalties for physicians as a result of ICD-10 coding mistakes.

The author of the June resolution, W. Jeff Terry, MD, a Mobile, Alabama, urologist, sounded off on the problems of ICD-10-CM/PCS implementation in a HealthLeaders Media article, “AMA Delegate Blasts ICD-10 Implementation Requirements,” on Friday, July 1.

In it, Terry explains that expecting physicians to be ready for ICD-10-CM/PCS by the implementation deadline is “like telling someone they need to learn to fly a plane and they will be given books and computer stuff to learn from. On October 1, they will be put in the cockpit with 200 passengers onboard and told to take off without ever having a dry run or practice flight.”

Previous AMA leaders described ICD-10-CM/PCS’ detriments in Star Wars terms, Healthcare IT News pointed out this week, recalling that past-AMA President Robert Wah, MD, indicated the group wanted to essentially freeze the code set in carbonite.

Monday, however, the AMA and CMS said they will work “in parallel” to educate physicians and to “help physicians…learn about the updated codes and prepare for the transition.”

And Stack further iterated that the “[i]mplementation of the ICD-10 code set is just around the corner, with a hard deadline of [October] 1,” in an article published in AMA Viewpoints.

While the AMA seems to have conceded the “hard deadline,” CMS for its part said Medicare review contractors “will not deny physician… claims …based solely on the specificity of the ICD-10 diagnosis code as long as the physician used a valid code from the right family.”

While some industry experts equivocated this as allowing physicians to incorrectly code for a year, others point to the guidelines’ caveat—“as long as the physician uses a valid code from the right family.”

Physicians will also not need to worry about penalties for the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes, again, “as long as they use a code from the correct ICD-10 family of codes.”

If Medicare contractors cannot process claims due to ICD-10, CMS will authorize advance payments to physicians. (CMS’ end-to-end testing thus far points to successful processing, according to an article in the ICD-10 Trainer Blog.) For physicians, however, who are often told by contractors to have three to six months’ worth of operating income available to cover potential problems with implementation, this single step could do much to alleviate fears.

Finally, CMS agreed to establish an ICD-10 Ombudsman to help physicians during the transition—a wise, and easily accomplished gesture to ensure the AMA’s assistance in ensuring a smooth ICD-10 transition.

While those entrenched in ICD-10-CM/PCS drama may say that these concessions read more likesnip-its from the Official Guidelines for Coding and Reporting, getting the AMA to effectively bury its opposition is, for once, a welcome shift in the ICD-10-CM/PCS implementation storyline. 

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