House Hearing Dampens Hope of ICD-10 Delay

February 13, 2015

Physicians hoping for a Congressional reprieve from the rollout of the new ICD-10 diagnostic codes on October 1 could find little comfort in Wednesday's House hearing on the issue, which was dominated by the message of "full speed ahead."

Six of the seven witnesses, hailing from various quarters of the healthcare industry, told the health subcommittee of the House Energy and Commerce Committee that Congress should not delay the deadline. The industry is ready for the new diagnostic codes, which they said would modernize patient care and research and help prevent billing fraud. Further delay would waste enormous investments already made by insurers, hospitals, and other healthcare organizations to prepare for ICD-10 Day.

Kristi Matus, the chief financial and administrative officer of medical software maker Athenahealth, said her company and its 60,000-plus providers have been ready to make the switch for months.

"Either IDC-10 is worth doing, or it's not," said Matus. "If it is, then stick to the deadline this year.

"Pull the trigger, or pull the plug."

The lone naysayer in the lineup of witnesses was William Terry Sr, MD, a urologist from Mobile, Alabama, who warned lawmakers that the cost and complexity posed by ICD-10 could "do irreparable harm" to physicians like him.

"Physicians have to have a guarantee that we're going to get paid if we don't code right," said Dr Terry, representing the American Urological Association. "You're not going to pay me because I code it wrong? Some doctors won't be able to do it. Do they deserve the death sentence and be put out of business?"

Despite Dr Terry painting a doomsday scenario, several members of the subcommittee, including chairman Rep. Joe Pitts (R-PA), said the October 1 deadline should stand. Their statements echoed a position staked out by Sen. Orrin Hatch (R-UT), chairman of the Senate Finance Committee. Referring to a study showing that the Centers for Medicare and Medicaid Services (CMS) was on track to process and pay claims with the new codes, Hatch said last week that he saw no reason for further delays. With Republicans controlling both chambers of Congress, the remarks by Pitt and Hatch suggest that another postponement is a legislative nonstarter.

The October 1 deadline, set by CMS, has been postponed twice from its original date of October 1, 2013.

Lawmakers Learn About Coding an Artery Suture

The Health Insurance Portability and Accountability Act calls for the healthcare industry to switch from the current ICD-9 codes to the ICD-10 set, which has five times as many. Like ICD-9, ICD-10 consists of diagnostic codes physicians can use in all settings as well as procedural codes for inpatient use only.

The new codes have more characters per code, which allows for greater specificity in classifying diseases, procedures, and anatomic sites. In Wednesday's hearing, a witness who represented the American Health Information Management Association (AHIMA) explained how ICD-10 procedure codes allow clinicians to distinguish between suturing an artery in a finger and suturing the aorta. In contrast, ICD-9 has only one code for any sort of artery suture, said Sue Bowman, AHIMA's senior director of coding policy and compliance.

"There are enormous differences in complications and the cost for repairing the aorta vs other types of arteries, but we're lumping it under the same [ICD-9] code," said Bowman. "On the procedure side [with ICD-10], we can really fine-tune information about the cost of treatment, which then links to the appropriate reimbursement."

The American Medical Association and other medical societies have opposed ICD-10 as one more government mandate that will drive their members out of medicine. They point to an AMA-funded study that put the cost of implementing and using the new codes as high as $75,000 per clinician. A study published last month in the in-house journal of AHIMA came up with a per-physician cost of only $3430. Both studies were cited at the House hearing, clouding the debate.

Should Physicians Have the Choice of Either Code Set?

Several GOP members of the House subcommittee, including two who are physicians, extended sympathy to organized medicine in its fight against ICD-10. Rep. Larry Bucshon, MD (R-IN), a cardiothoracic surgeon, said he was disappointed that nonclinicians who testified in support of ICD-10 were denying the short-term hardships that it would impose on physicians. Rep. Michael Burgess, MD (R-TX), an obstetrician-gynecologist, called ICD-10 "a system that revolves around reimbursement and not around the patient."

Dr Burgess appeared sympathetic to a compromise floated by Dr Terry: a transition period in which physicians could use either ICD-9 or ICD-10. However, the notion of a dual coding system was panned as costly and unfeasible by Carmella Bocchino, executive vice president of America's Health Insurance Plans, one of the hearing's witnesses.

"Having two tracks will just create more confusion for providers as well as for payers," Bocchino said. "It's important to send a very strong message that we're going to implement on October 1."

Not all the physicians who spoke about ICD-10 at the hearing were skeptics. One ICD-10 supporter was Edward Burke, MD, who belongs to an independent practice in rural Missouri that includes another physician, three nurse practitioners, and a mental health provider. Dr Burke testified that his practice switched to ICD-10 in 2013 as a part of a pilot program offered by its software vendor. The changeover did not require training and did not reduce provider productivity, he said. "It wasn't hard, it wasn't expensive, and it wasn't time-consuming."

John Hughes, MD, a professor at the Yale School of Medicine, also testified in support of ICD-10. He said a more detailed code set would help him in his study of complications of care. Because of its simplistic structure, Dr Hughes said ICD-9 cannot expand to provide new codes that adequately describe new treatments and technologies, such as minimally invasive surgery.

"If we continue to use ICD-9, these new procedures will have to be described in general terms or included in codes that contain open surgical approaches, resulting in insufficient detail to track their increasing use," he stated.

Dr Hughes acknowledged that an ICD-10 code used in a patient encounter probably would not improve that particular individual's quality of care. However, by helping researchers understand patterns of medical care, ICD-10 would indirectly benefit all patients, he said.


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