Doc groups griping over ICD-10

Some physician groups are still unhappy with the federal government’s plan to implement the more modern ICD-10 reimbursement diagnostic codes, saying that even with a two-year extension many physicians will take an administrative and financial hit.

A month after the Obama administration announced March 5 that it would follow a Bush administration plan to push back implementation of the rules for the latest iteration of electronic transactions and for ICD-10 diagnostic codes, physician groups say the new dates are still too soon.

“We have never gone through something like this before,” said Robert Tennant, senior policy adviser with the Medical Group Management Association, of the upcoming ICD-10 transition. It took nearly four years for the industry to adopt the new National Provider Identifier. “ICD-10 is going to be a much more complicated change than NPI,” Tennant said.

The two rules, which are intertwined, call for moving the deadlines for updating Health Insurance Portability and Accountability Act standards governing electronic transactions to Jan. 1, 2012, and for replacing ICD-9 codes with the ICD-10 codes to Oct. 1, 2013. The original plans called for April 1, 2010, and Oct. 1, 2011 compliance dates, respectively.

Moving to the new ICD-10 diagnostic codes increases the number of codes to more than 68,000 from 13,000. The new HIPAA upgrade on electronic transactions concerns what is known as the “5010” electronic claim form, Tennant said.

Even with the right technology in place, acquiring the software to make these changes is expensive, plus physicians are reliant on the cooperation of third parties—the vendors and insurance companies—to make this transition go smoothly, he said. Providers trying to comply with HIPAA electronic standards in the past have been stymied by the fact that software vendors have often been slow to change their products to reflect the latest upgrades, Tennant said.

Once the new and more complex 5010 standard is required on claims, these issues are bound to get worse, particularly for small practices, which may have to purchase hardware upgrades in addition to any software upgrades, Tennant said.

The CMS says it’s trying to assist small practices by developing a comprehensive national outreach and education strategy for the implementation of ICD-10 and 5010 that will target all affected entities. “Our strategy will include partnering with our Medicare provider communications group, trade associations and others to ensure small providers and others receive support through such avenues as tailored education,” said Tony Trenkle, director of the CMS’ Office of E-Health Standards and Services, in an e-mail.

New federal incentives to adopt electronic health records should ease the transition to ICD-10. Cindy Hughes, coding and compliance specialist with the American Academy of Family Physicians, said, “This is a time to consider whether purchasing a new electronic health record is worthwhile,” to comply with the new ICD-10 regulations.

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