House Committee Sides With Physicians on ICD-10

The U.S. House of Representatives Small Business Committee has sided with America's physicians in a tug of war with HHS regarding its proposed Oct. 1, 2011, deadline for implementing a new codes set for outpatient diagnosis coding.

In a Nov. 19 letter, Rep. Nydia Velazquez, D-N.Y., chair of the committee, asked HHS Secretary Michael Leavitt to delay conversion to the International Classification of Diseases, 10th Revision, Clinical Modification, or ICD-10-CM.

Velazquez's letter referred to a recently released study, "The Impact of Implementation of ICD-10 on Physician Practices and Clinical Laboratories," (40-page PDF; About PDFs) and asked that HHS reassess the economic impact the regulation would have on small businesses. The letter noted that the Regulatory Flexibility Act "requires agencies to examine the economic impact of their regulations on small firms and assess less burdensome alternatives."

Velazquez said it was clear that the proposed rule would have a "significant economic impact on many small medical practices" -- perhaps in excess of $83,000 per provider.

Physicians who couldn't comply with the regulation's deadline would face payment delays and claims denials, she continued.

"When coupled with the prospect of not being reimbursed due to transitional issues and expenditures associated with implementation, HHS' timeline may be too costly for most small practices to bear. These problems can be avoided with an orderly and rational timeline for conversion to ICD-10-CM," said Velazquez.

The letter noted that 50 percent of U.S. physician practices have fewer than five physicians and yet account for 80 percent of outpatient visits. Many of those practices will have to upgrade their electronic health record systems and retool their practices to accommodate the five-fold increase in diagnostic codes -- from 13,500 to 68,000 -- that ICD-10 will bring.

The committee pointed out that HHS' rapid timetable for implementation was substantially shorter than that recommended by the National Committee on Vital and Health Statistics, or NCVHS, an official advisory panel to HHS.

NCVHS members recommended an October 2013 deadline for ICD-10-CM conversion, a full two years longer than HHS has proposed.

A group of health care stakeholders, including the AMA, the Medical Group Management Association and the American Academy of Professional Coders, commissioned the impact study that influenced Velazquez's committee. Those same groups have called for an extended implementation timeline.

The AAFP recently urged CMS (6-page PDF; About PDFs) to delay adoption of ICD-10 indefinitely.