ICD-10 Deadline Delayed 1 Year Under HHS Proposal

April 09, 2012

April 9, 2012 — Physicians would have until October 1, 2014 — an extra year — to begin using a new and expanded set of diagnostic codes, called ICD-10, under proposed regulations announced today by the US Department of Health and Human Services (HHS).

The news was expected. In February, HHS Secretary Kathleen Sebelius had promised that her department would extend the deadline in response to physician complaints about the administrative burden of converting to ICD-10 by October 1, 2013, as originally planned. The American Medical Association (AMA) said the switch to the more voluminous and complex set of diagnostic codes could both cost medical practices tens of thousands of dollars apiece and interfere with their adoption of electronic health records and electronic prescribing.

ICD-10 stands for International Statistical Classification of Diseases and Related Health Problems, 10th Revision. In 2009, the Centers for Medicare and Medicaid Services (CMS) ordered the change from the ICD-9 code set, which is now in use, to ICD-10, as part of implementing the Health Insurance Portability and Accountability Act.

"The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets," HHS said in a press release. The department warned that if everyone does not change over to ICD-10 at the same time, providers could see their claims rejected or their payments delayed.

The AMA wants HHS to develop a more physician-friendly replacement for ICD-9, but HHS today once again affirmed the value of ICD-10. The new code set, the department said, will improve the quality of care and "lead to improved accuracy for reimbursement for medical services, fraud detection, and historical claims and diagnosis analysis."

HHS noted that physician protests about ICD-10 dovetail with those about a new set of standards for electronic claims called Version 5010. CMS pushed back its deadline for enforcing the use of the new standards to March 31, 2012, and then to June 30, 2012, after some physicians complained that Medicare bills submitted under Version 5010 were not getting paid. Healthcare providers cannot use the new ICD-10 codes until they have updated their billing software to the Version 5010 standards.

The plan to delay implementation of the ICD-10 codes appears in proposed HHS regulations that also would introduce a standardized identifier code for health plans. This new identifier would replace a mishmash of health plan identifier codes that vary in length and format, and that create billing problems for physicians and other providers.

HHS will accept comments from the public about the proposed regulations for 30 days after their publication in the Federal Register. The proposed regulations set forth several ways to send those comments to HHS.

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