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Stop Complaining About ICD-10 and Start Training

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   July 07, 2015

Misinformation and misunderstandings surround ICD-10 as the go-live date nears. One result is that too many providers have yet to conduct testing. They should take advantage of CMS's grace period, starting now.

The announcement yesterday that the American Medical Association is now working jointly with CMS to educate its membership about ICD-10 is better late than never.

Consider that, according to a survey conducted by the American Health Information Management Association (AHIMA) between May and June, the majority of providers have not yet conducted ICD-10 testing. This annual survey found that 19% of respondents do not even plan to conduct any end-to-end testing.

That is a fairly astounding finding, nearly as astounding as some of the continuing misinformation being circulated about how coding errors in ICD-10 will affect physician's payments. For some clarification on this, I again turned to AHIMA.

"ICD-10 has very little to do with physician payment," says Sue Bowman, AHIMA senior director for coding policy and compliance. "On the hospital side, it drives the DRGs and all kinds of payment issues. On the physician side, their payment rates are driven by the CPT codes."

Sue Bowman

ICD-10 diagnosis codes do determine medical necessity, and wouldn't we want those to be properly coded? I am puzzled by the continuing procession of physicians who speak of having to document their procedures in the ICD-10 procedure coding system (PCS). "It's not true that [physicians] have to document in ICD-10 PCS lingo," Bowman says. "There's actually a coding guideline that says the physicians can document their procedures the way they always have, and it's up to the hospital coder to translate the physician's description of [procedures] to ICD-10 PCS codes. But only hospitals are going to be using those codes, not physician practices."

One big irony of some recent criticism of the specificity of certain ICD-10 codes themselves, Bowman says, is that specificity was itself inserted into ICD-10 PCS by physicians, through specialty societies.

Yesterday's announcement that CMS would not deny claims for the first year of ICD-10 due to lack of specificity, along with AMA's acquiescence to working with CMS to educate its members, will immediately take the wind out of the sails of the usual movement to postpone ICD-10. In a June letter to CMS, the four largest state medical societies (California, New York, Florida, and Texas) declared ICD-10 a "looming disaster." Denied and delayed claims could bankrupt many small physician practices, the societies said.

Proposed physician relief in this letter and in H.R. 2247, the ICD-TEN Act, would have permitted claim payments and withholding of penalties despite any errors and mistakes in ICD-10-coded claims submissions for up to two years, and to withhold Recover Audit Contractor (RAC) audits related to ICD-10 coding mistakes during that period of time.


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Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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