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Physicians ponder logistics, costs of adopting ICD-10 codes
The American Medical Association calls for a 2-year delay of the adoption deadline to allow detailed exam of administrative burdens facing physicians.
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The Centers for Medicare and Medicaid Services intends to delay by 1 year the deadline for physicians to implement a new code set. Citing concerns about costs and administrative burdens, the American Medical Association wants the agency to defer the deadline by 2 years.
In April, CMS published a proposed rule that would delay the deadline for implementation of International Classification of Diseases, 10th Edition (ICD-10), from Oct. 1, 2013, to Oct. 1, 2014. The AMA has requested that the deadline be extended to Oct. 1, 2015.
The delay will be beneficial for ophthalmologists participating in federal programs such as the implementation of electronic health records, Michael X. Repka, MD, American Academy of Ophthalmology medical director for governmental affairs, told Ocular Surgery News.
Michael X. Repka
“We’re not in a hurry to see ophthalmologists spend additional effort at the same time they’re adopting EHR with a more difficult diagnosis reporting program, for which practicing clinicians don’t see a benefit,” Dr. Repka said.
Currently, medical practices in the U.S. use ICD-9 codes, which have been updated annually.
“There are a lot of things that could be done better. ICD-9, though, is a bit of a misnomer because it is updated every year,” he said. “It’s a clinical modification in the U.S., so there is a process for adding new codes. … In ophthalmology, we’ve been adding codes annually for the last decade that I’ve been involved.”
ICD-10 has been used in World Health Organization member states since 1994, according to a WHO fact sheet.
AMA concerns
In May, AMA executive vice president and chief executive officer James L. Madara, MD, wrote a letter to Marilyn B. Tavenner, acting CMS administrator, asking for a longer deadline extension to allow time for a thorough cost-benefit analysis of how the transition to ICD-10 would affect physicians.
“A 2-year delay of the compliance deadline for ICD-10 is a necessary first step,” Dr. Madara wrote. “A year’s delay does not provide CMS with adequate time to fully examine the appropriate scope of ICD-10 and true costs to physician practices. If stakeholders cannot reach consensus on this matter during this 2-year delay period, then the move to ICD-10 should be postponed indefinitely.”
Dr. Madara voiced concerns about the logistics and cost of adopting ICD-10, which ranges from $83,290 to more than $2.7 million, depending on the size of a practice. ICD-10 includes 68,000 codes, five times the 13,000 included in ICD-9, he said.
“This is a massive administrative and financial undertaking for physicians, requiring education, software, coder training and testing with players,” he wrote.
Dr. Madara noted that many physicians are already burdened with the implementation of EHRs and face a possible 31% Medicare physician payment cut in January 2013.
“Physicians are also overwhelmed with the simultaneous implementation of multiple health IT programs and are being forced to prioritize which initiatives they are able to meet based on the potential incentives and penalties and their impacts on their reimbursement,” Dr. Madara wrote.
Better coordination between federal programs would ease administrative burdens and enhance participation, Dr. Repka said.
“The more CMS can make it feasible for practicing physicians to participate, the better the program will be and therefore more effective,” Dr. Repka said. “The problem is that when you have disparate programs, it’s hard for practicing physicians to keep a handle on each of the programs and how they’re participating or not participating. [Better coordination] would lead to better participation.”
Materials designed to help members make the transition to ICD-10 are posted on the AAO website. – by Matt Hasson
References:
- American Academy of Ophthalmology. Ophthalmology ICD-10 readiness for ophthalmology. www.aao.org/aaoesite/promo/coding/icd10.cfm.
- American Medical Association. ICD-10 code set to replace ICD-9. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page. Accessed May 23, 2012.
- Department of Health and Human Services. Proposed rule: Administrative simplification: Adoption of a standard for a unique health plan identifier; addition to the National Provider Identifier Requirements; and a change to the compliance date for ICD-10-CM and ICD-10-PCS medical data code sets. http://www.gpo.gov/fdsys/pkg/FR-2012-04-17/pdf/2012-8718.pdf. Accessed May 23, 2012.
- HHS announces intent to delay ICD-10 compliance date [new release]. U.S. Department of Health and Human Services; February 16, 2012. http://www.hhs.gov/news/press/2012pres/02/20120216a.html. Accessed May 23, 2012.
- World Health Organization. International Class-ification of Diseases (ICD). http://www.who.int/classifications/icd/en/. Accessed May 23, 2012.
For more information:
- Michael X. Repka, MD, can be reached at American Academy of Ophthalmology, 20 F Street NW, Suite 400, Washington, DC 20001; 202-737-6662; email: mrepka@jhmi.edu.
- Disclosure: Dr. Repka has no relevant financial disclosures.
Perspective
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Laurie K. Brown, COMT, COE, OSA, OCS, CPSS
The deadline push-back for a mandated change from ICD-9 to ICD-10 was a wise move. With the diagnosis code increase from approximately 15,000 to 70,000, ICD-10 represents a huge change in the way physician practices will be coding their work for reimbursement. I have heard the rest of the world has been using ICD-10 for years and we are behind. On the other hand, outside the U.S. they are not using ICD-10 directly for reimbursement due to their very different health care systems.
For practices without EHR, it seems utterly unmanageable to choose from such a vast list and code to the highest degree of specificity possible, as has always been our directive. EHRs will accommodate the code increase better but, in addition to just having more codes available, there is also the matter of the complete revamp of the logic of code organization and convention with which to deal. As is our culture in ophthalmology, to focus on any possible advantages in mandates and make our lemonade while mitigating and working to correct the downsides, there will be more specificity in identifying diagnosis locations by eye to reduce the hassle of modifier use when applying for reimbursement. There is also the government and third-party payer goals of knowing more about the health care being delivered for which specific disease states in order to better design our funding systems.
According to the Medical Group Management Association, 51% of groups of three or more physicians are using some kind of EHR (http://www.informationweek.com/news/healthcare/EMR/232602537). “Some kind” does not necessarily mean even they will all be able to accommodate ICD-10 efficiently. Waiting until more physicians have the technology to deal with such a large paradigm change seems wise.
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