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Tuesday Nov 04, 2014

Less Than One Year to ICD-10; Will you be ready?

There are few topics in health policy that I am hesitant to discuss, but today’s topic is one of them. Lucky for me, there is probably an ICD-10 code for “scared to discuss ICD-10 codes, initial encounter.”

The International Classification of Diseases (ICD) coding system has been a part of our national health care system since 1979. Although the implementation of ICD-9 wasn’t without resistance, it was mild compared to the collective negative reaction received to ICD-10. ICD-10 is one of those issues that symbolize what many physicians consider to be the “over-regulation” of the U.S. health care system.

This collection of codes is fascinating to those that study and write about our health care system, but they are costly and of questionable value to those that actually provide patient care. In a world of “paying for value,” ICD-10 seems to miss the mark in the minds of most physicians.  

So, how did we get here? The 43rd World Health Assembly endorsed the ICD 10th Revision in 1990, and limited implementation by some WHO countries began in 1994. In response to the WHO, the U.S. National Center for Health Statistics developed the ICD-10-Clinical Modification (ICD-10-CM) to ensure greater accuracy and clinical utility in 1993 and made the code set available in 1995. In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was enacted into law.  Included in that law were provisions that allowed for a standard code set to be established under the Administrative Simplification provisions of the law. In 2003, the National Committee for Vital and Health Statistics recommended to the Secretary of HHS that the United States move forward with adoption and implementation of ICD-10-CM and ICD-10-PCS (procedure coding system) under HIPAA standards.  

The reaction by physicians and insurers was swift and negative. The sheer costs of implementation would be expensive and, in the minds of many, a complete disaster (not much changed from 2003 to 2014). Remember that, in 2003, the use of electronic health records (EHRs) was nascent, which made the transition to ICD-10 seem, well, impossible. The political pressure to prevent the transition to ICD-10 began to fade following the HITECH Act, which facilitated a broader adoption of EHRs in our health care system. As EHRs became more prevalent, the pressure to transition to ICD-10 intensified. On Jan. 5, 2009, the waiting finally ended when HHS announced that all HIPAA covered entities would be required to comply with ICD-10 on Oct. 1, 2014.

Although an implementation date was set, the opposition to ICD-10 did not subside. In fact, many physicians became even more concerned that the cost of implementing EHRs and ICD-10 would overwhelm their available resources.

The AAFP also was concerned with the impact such a transition would place on family physicians, but we were equally concerned about the ability of our nation’s health care system to shift to a new system. Our health care system isn’t exactly adept at large scale reforms, and ICD-10 is reform on an unprecedented scale.  

On Feb. 25, 2014, the AAFP wrote a letter to then HHS Secretary Kathleen Sebelius outlining these concerns and calling for “end-to-end” testing of ICD-10 with an emphasis on solo and small group practices. As more time passed, the AAFP’s concerns grew more profound, and we called on Congress to delay implementation for one year to provide family physicians additional time to successfully make the transition. In April 2014, Congress agreed to delay implementation one additional year as part of the Protecting Access to Medicare Act of 2014, a larger physician payment bill.

Today, we have less than a year until the new, most dreaded, date of Oct. 1, 2015, arrives. Although the AAFP’s concerns remain, we realize there will be no more delays, and family physicians will be required to comply with ICD-10. Recognizing that our members need resources and assistance, the AAFP developed a number of valuable tools aimed at assisting you and your practice in the transition to ICD-10:

  • Frequently Asked Questions on ICD-10
  • ICD-10 Timeline, which is designed to assist you with budgeting, planning, communicating, training, implementing, and monitoring your transition to ICD-10.
  • ICD-10 Cost Calculator to provide you a cost estimate on implementing ICD-10 in your practice.
  • ICD-10 Flashcards, which provide a crosswalk between ICD-9 and ICD-10 codes for the 823 most common primary care diagnoses. They are color-coded for quick recognition and contain coding tips to assist in accuracy in coding. Purchasing these flashcards will be the best $79 you spend this year.  
  • ICD-10 Educational Series. This set of tools consists of 11 family medicine-specific modules developed by coding experts to assist you and your practice. The modules focus on the top-50 diagnosis codes in primary care. Each module is 10 to 20 minutes and can be viewed individually or with your practice team on your schedule.

In addition to these resources, Family Practice Management has compiled a collection of journal articles regarding ICD-10.

We continue to advocate for greater resources and testing from CMS. To its credit, CMS is listening and working with the AAFP to increase the availability of such resources. CMS has published “The Road to 10” toolkit(www.roadto10.org), which is designed to assist small practices with the transition. In addition, they have announced three additional weeks of testing:

  • Nov. 17-21, 2014,
  • March 2-6, 2015, and
  • June 1-5, 2015.  

For more information on how you can participate, visit the CMS ICD-10 Provider Resource page.(www.cms.gov)

It is incumbent on the AAFP to tell you that ICD-10 is going to happen, and we urge you to prepare your practice. We have numerous resources that can assist you and your staff, and we urge you to use them. In the end, we all can only hope that there is an ICD-10 code for “trauma caused by regulation, reoccurring event."

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.