AMA Wire

Wednesday, May 1, 2013

This Week's News

Bill to prohibit ICD-10 roll-out introduced; AMA gives support

Bill to prohibit ICD-10 roll-out introduced; AMA gives support

As the Oct. 1, 2014, implementation deadline for ICD-10 draws closer, legislation was introduced in the U.S. House of Representatives Wednesday to bar the federal government from rolling out the new code set.

The Cutting Costly Codes Act, introduced by Rep. Ted Poe, R-Texas, would prohibit the U.S. Department of Health and Human Services from implementing, administering or enforcing current regulations that require the new code set to take effect and would commission a federal study to identify ways to mitigate disruptions caused by any replacement of the ICD-9 code set.

Voicing strong agreement with the bill, the AMA on Friday sent a letter of support to Poe.

"The differences between ICD-9 and ICD-10 are substantial, and physicians are overwhelmed with the prospect of the tremendous administrative and financial burdens of transitioning to the ICD-10 diagnosis code set with its 68,000 codes—a five-fold increase from the approximately 13,000 diagnosis codes currently in ICD-10," the letter states.

Experts say the new code set will affect not only claims submissions but also such processes as patient eligibility verification, pre-authorization for services, documentation of patient visits, research activities, and public health and quality reporting. The cost for individual physician practices to adopt ICD-10 is estimated to be around $83,000 for a small practice and as much as $2.7 million for a large group practice.

Meanwhile, many physicians are investing significant time and resources into implementing electronic health record systems and participating in Medicare quality reporting programs. Coupled with the 2 percent reduction in Medicare payments under the federal budget sequester and a possible 24.4 percent cut from the sustainable growth rate formula on Jan. 1, the AMA says the "timing of the ICD-10 transition could not be worse."

At the same time, physicians should make preparations for the new code set to avoid disastrous results if ICD-10 is rolled out as planned. Those who aren't ready by the Oct. 1, 2014, deadline will not receive payment for their services. Resources to help physicians prepare are available on the AMA's ICD-10 Web page and through the AMA Store.

The AMA will continue to work with Poe and others to work toward a solution to ensure physicians' practices are not disrupted by the roll-out of a new code set.