Stakeholders Split Between Moving Forward With ICD-10, Reassessing Current Timetable

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By James Swann  

April 8 --Health-care industry stakeholders participating in an April 8 webinar had a mixed reaction to the yearlong delay of implementation of the ICD-10 (International Classification of Diseases, 10th Revision) code set, with some arguing for staying the course toward implementation while others said the industry should step back and reassess how, or if, to move forward.

It's essential for the health-care industry to keep moving toward ICD-10, regardless of the delay, Margarita Valdez, the director of congressional relations for the American Health Information Management Association (AHIMA), said during ICD10monitor's Talk Ten Tuesday webinar.

“We need to stress to everyone to stay the course; we cannot stop ICD-10 preparation,” Valdez said.

President Barack Obama signed the Protecting Access to Medicare Act of 2014 (H.R. 4302) on April 1, delaying the implementation of ICD-10 until Oct. 1, 2015 (see previous article).

The bill was intended primarily to extend current Medicare physician payment rates through March 15, 2015.

ICD-10 originally was supposed to be implemented by Oct. 1, 2013, but the Centers for Medicare & Medicaid Services issued a one-year delay in 2012, moving the implementation date to Oct. 1, 2014.

ICD-10 is a code set updating health-care diagnoses and procedures from the currently used 13,000 codes in ICD-9 to 68,000 codes. Upon implementation, all Health Insurance Portability and Accountability Act (HIPAA) entities will be required to use ICD-10 codes.

Valdez said AHIMA felt Congress had the votes to stop the ICD-10 delay, but said the voice vote approving H.R. 4302 occurred when many members of Congress were not in the chamber.

“I think the majority of the health-care industry is ready for ICD-10. It's a small minority that is holding things up,” Valdez said.

Praise for Delay

However, not all participants agreed with the idea of continuing to move forward with ICD-10 implementation.

Stanley Nachimson, president of Nachimson Advisors LLC, Baltimore, said the ICD-10 delay was a blessing, not a curse.

“Staying the course is not great advice, it's not working. We need to come up with a consensus agreement about moving forward,” Nachimson said.

Nachimson said health-care industry stakeholders should take a step back and reassess how to handle ICD-10. For example, perhaps only hospitals should initially move to ICD-10, to be followed by physicians at a later date, he said.

Nachimson said a reassessment may even determine that implementing ICD-10 is the wrong thing to do. He said that if the health-care industry merely stays the course on their ICD-10 implementation, “we'll be in the same position next year,” with groups not ready for the implementation date and calls for further delays.

Stay the Course

In addition to AHIMA's Valdez, several other webinar participants supported moving forward on ICD-10 implementation.

Chris Powell, president of Precyse, a health-care consulting company based in Wayne, Pa., said he expects most health-care industry stakeholders to stay the course with their ICD-10 implementation efforts.

“Folks are really interested in keeping the train moving,” Powell said.

Powell said that although the law prevents the CMS from requiring ICD-10 implementation prior to Oct. 1, 2015, it may not preclude dual coding opportunities, which would allow organizations that are ready for ICD-10 to test it alongside the existing ICD-9 codeset.

Rhonda Buckholtz, vice president of business and member development at the American Academy of Professional Coders, said her organization would actively work with members to ensure their ICD-10 training remained fresh. “We're committed to making sure anyone with the AAPC gets the best value and isn't penalized for events outside their control,” Buckholtz said.

Buckholtz said AAPC members who purchased ICD-10 training software prior to Oct. 1, 2014, will receive extended online access to training through Sept. 30, 2015, as well as free monthly refresher webinars that will run until the new ICD-10 implementation date.

ICD-10 Concerns

Robert Tennant, senior policy adviser for the Medical Group Management Association (MGMA), said the ICD-10 delay may lead to a better implementation approach.

“Obviously, we have a lot of concerns about the glide path adopted for ICD-10 transition,” Tennant said.

He said MGMA was concerned about the lack of readiness among trading partners, such as electronic health records (EHR) vendors and practice management software vendors.

Tennant said MGMA also was concerned about the CMS's reluctance to conduct full end-to-end testing of ICD-10. In February, the CMS announced it would offer end-to-end testing in July for select health-care organizations.

A possible solution to improving the ICD-10 implementation process may involve staggering the implementation dates for the various stakeholders, Tennant said, which could help physician practices that already are facing the burdens of Stage 2 of EHR meaningful use.

Brock Slabach, senior vice president for member services at the National Rural Hospital Association, also said the ICD-10 delay was a positive move that could lead to a smoother implementation.

Slabach said getting trained coders into rural hospitals, for example, is a major expenditure, in addition to the time and effort necessary to update rural facilities for ICD-10.

“Many rural hospitals are losing money, and any program that potentially slows down cash flow is worrisome,” Slabach said, referring to ICD-10 implementation.

He said the association's advice to members is to reassess ICD-10 implementation and continue to provide education on ICD-10.

Industrywide Collaboration

Jim Daley, chairman of the Workgroup for Electronic Data Interchange (WEDI), said WEDI is planning to use the delay to organize an industrywide summit on the future of ICD-10.

He said the industry face-to-face summit will be held at the end of April to gather reactions to the delay as well as examine what impact it is having.

So far, Daley said he hasn't heard anyone talking about speeding up ICD-10 compliance. Rather, he said he has heard some people talking about slowing down ICD-10 implementation programs or even stopping them.

Daley said that while WEDI has “never really taken a position for or against ICD-10,” the current delay brings into question the reliability of any future implementation dates as well as whether ICD-10 will ever go into affect.

Tim McMullen, executive director of the Cooperative Exchange, a Dallas-based association of health-care transaction clearinghouses, echoed Daley's concerns over future ICD-10 implementation dates.

McMullen said Congress took ICD-10 guidance out of the hands of the CMS, and he said this could happen again in the future.


To contact the reporter on this story: James Swann in Washington at

To contact the editor responsible for this story: Ward Pimley at

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