Feds May Delay ICD-10 Deadline

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Healthcare providers could get some regulatory deadline relief soon. The acting head of the Centers for Medicare and Medicaid Services said today the agency is considering extending its timeline for ICD-10 code conversion compliance.

With pressure and complaints mounting from healthcare organizations juggling Meaningful Use deadlines, ramped-up security and privacy compliance, and various other healthcare reform-related mandates, CMS will "reexamine the timeframe" for ICD-10 through a rulemaking process which CMS is expected to elaborate on in coming days, CMS acting administrator Marilyn Tavenner reportedly said at a American Medical Association Advocacy conference in Washington, D.C. today.

Under current ICD-10 rules, healthcare providers, payers, and others have until Oct. 1, 2013 to switch over their claims, billing, and other systems from current ICD-9 to ICD-10 codes for medical diagnosis and inpatient procedures. The transition from ICD-9 to ICD-10 involves expanding medical diagnosis codes from the current 14,000 to more than 67,000, and procedure codes from 13,000 to 85,000.

The U.S. Department of Health and Human Services hopes the move will help the industry identify more billing fraud, allow more detailed quality reporting by healthcare providers, and enable refinements in reimbursement models through more detailed diagnostic and procedure data.

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HHS also expects the conversion will improve patient care and outcomes through new insights that may be uncovered in analysis of the more detailed clinical data.

However, the conversion to ICD-10 is described by many in the healthcare industry as a project as massive as the Y2K transition a decade ago.

There is a lot at stake for healthcare organizations to successfully transition to ICD-10. Failure for healthcare organizations, including doctor offices, clinics, and hospitals, to meet the current ICD-10 deadlines could result in major disruptions in getting paid for patient care.

On top of that pressure, healthcare providers are also in the midst of trying to comply with the HITECH Act's Meaningful Use programs, the transition to accountable care organizations, ramped-up HIPAA rules and penalties, and a host of other mandates and expectations.

In recent months, demands have been growing on the federal government to reconsider the ICD-10 rules. CMS has been pressured by healthcare associations, including the American Medical Association, to delay the ICD-10 deadline.

AMA President-elect, Dr. Jeremy A. Lazarus said in a statement to InformationWeek Healthcare that "the AMA appreciates that Ms. Tavenner and the administration have heard our concerns and have recognized the significant challenges and burdens ICD-10 implementation will create on the practice of medicine, and that they are committed to reviewing the pace of implementation. The AMA welcomes the opportunity to discuss ICD-10 implementation, along with many overlapping regulatory requirements that are burdening physician practices."

A delay would be welcome by Beth Israel Deaconess Medical Center, said CIO John Halamka.

ICD-10 "needs to be deferred until 2016--after Meaningful Use Stage 3, which will give the time we need to enhance clinical documentation on the front end," said Halamka in an email interview with InformationWeek Healthcare.

"The ICD-10 timeline was conceived before Meaningful Use was proposed. Now, it needs to be rescheduled so that the work on the front end [Meaningful Use] aligns with the work on the back end [ICD-10]."

Still, there are a few healthcare players that are against moving the deadline, arguing that delays will only disrupt larger reform that's already underway.

Dan Rode, VP at American Health Information Management Association, recently called the transition to ICD-10 a "fundamental part of healthcare reform in this country."

In a recent statement, Rode said, "Without ICD-10 data, there will be serious gaps in our ability to extract important patient health information that will give physicians and the healthcare industry measures for quality of care, provide important public health surveillance, support modern-day research, and move to a payment system based on quality and outcome."

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)