Measure Passes in House; Senate Yet to Weigh In

One-year Reprieve on ICD-10 Implementation Could Be in the Offing

March 28, 2014 04:30 pm Sheri Porter
[2015 October]

Yesterday, the House passed legislation that would, among other things, bar HHS from adopting the ICD-10 code sets for outpatient diagnostic coding until Oct. 1, 2015. That's a one-year delay that family physicians have been hoping for because implementation of the new coding system will explode the number of diagnosis codes from about 14,500 to about 69,700.

H.R. 4302, the Protecting Access to Medicare Act of 2014(, also would prevent a steep cut in Medicare payments scheduled to kick in on April 1. The bill would provide temporary relief rather than a permanent fix to the sustainable growth rate (SGR) formula that determines Medicare payment to physicians.

Kevin Burke, director of the AAFP's Division of Government Relations, told AAFP News that it was "very unusual" to have an issue like ICD-10 attached to a bill dealing with the SGR. "It shows a remarkable level of interest on the part of Congress in wanting to ensure that this conversion to ICD-10 takes place with a sufficient amount of preparation," said Burke.

AAFP Resources on ICD-10

Whenever the transition from ICD-9 to ICD-10 occurs, the AAFP has resources to help, including

However, he cautioned that the House vote wasn't the final hurdle in seeing ICD-10 pushed off for another year. "Remember the status; H.R. 4302 is just the House-passed version of this legislation," said Burke. He added that the bill was scheduled to be taken up by the Senate on March 31, but said the timeline was flexible.

AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., characterized passage of the House bill as bittersweet. On one hand, AAFP couldn't help but be pleased about a possible delay in ICD-10 implementation.

"We have long expressed serious concerns about ICD-10's functionality and the real potential for technical problems that could result in delayed payments for physicians," said Blackwelder. "Any problems in processing payments would be especially devastating for solo and small family physician practices."

Blackwelder reiterated the AAFP's position that HHS must direct CMS to pursue additional ICD-10 testing opportunities to ensure that all systems are go for medical practices of every size in every part of the country. "This delay would give everyone additional time to do that critical testing," said Blackwelder.

However, the downside of H.R. 4302 is that if the bill is passed by the Senate and signed by President Obama, the chance for a permanent SGR fix anytime soon is slim.

"The AAFP is disappointed that this requested delay in ICD-10 implementation is tied to a failure of Congress to repeal the fatally flawed SGR," said Blackwelder.