ICD-10 might be delayed again. How will we know when squirrels attack?


(EPA/MAXIM SHIPENKOV)

Just last month, the Obama administration said it wouldn’t again delay the scheduled shift to a new comprehensive system for coding and diseases, known as ICD-10.

“There are no more delays and the system will go live on Oct. 1,” Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner told a conference of health information management professionals. “Let’s face it, guys, we’ve delayed this several times and it’s time to move on.”

Well, the administration might not have planned on delaying it, but Congress just might. The House this afternoon approved legislation avoiding a major cut in Medicare provider payments, and that “doc fix” bill includes a delay to ICD-10.

So, what is ICD-10 and why do we care?

It’s not exactly the sexiest topic in health care, but it is an important one. These are the codes the health care industry uses to describe diagnoses and treatment and, ultimately, who gets paid for doing what.

The current system is ICD-9, which has about 14,000 codes. ICD-10, which is much more descriptive, has 68,000 codes. It's so descriptive, there are codes for things like a squirrel attack, as my predecessor on this blog wrote last month.

The shift to ICD-10 was first proposed in 2005. Since then, it’s been delayed twice and was supposed to start this October. The doc fix, which awaits a Senate vote, would delay it at least for a year.

Many provider groups have opposed this latest doc fix, but they are supportive of the ICD-10 delay. Rob Tennant, senior policy adviser for the Medical Group Management Association, said there hasn’t been enough testing of the coding systems used by care providers, insurers and clearinghouses.

“There’s a thousand different cogs that have to work smoothly in the system in order for ICD-10 to be implemented,” Tennant said. “What we’re finding is a lot of these cogs are simply not ready.”

Further, Tennant said, doctors aren’t convinced it’s worth spending money on the systems that could cost a small practice about $83,000, according to a study from the American Medical Association.

The American Health Information Management Association says ICD-10's return on investment comes from better capturing health care data. ICD-10 accounts for new diagnoses and treatment not covered by the current coding system, and it more specifically describes treatment and diagnosis.

“The reason we care about all this is we’re trying to drive down costs, we’re trying to improve quality,” said AHIMA CEO Lynne Thomas Gordon. Having more accurate data, she said, will help with the health care system’s larger transition to rewarding doctors for quality of care instead of volume.

“If we don’t have information to keep our communities well and keep people out of the hospital, it’s going to hurt physicians with that reimbursement in the long run," she said.

The delay isn’t a done deal yet. The legislation passed the House and still has to go through the Senate. But if this legislation should fail, don't be surprised if ICD-10 delay pops up again before October.

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
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