What’s the Delay in the ICD-10 Delay?

Just when the Department of Health and Human Services will announce its final decision on a delay for ICD-10-CM/PCS compliance is the question on many minds lately.

While a firm announcement date has not been determined, AHIMA’s Advocacy and Policy staff in Washington, D.C. are closely monitoring a variety of governmental communication outlets and regulatory bodies in anticipation of an ICD-10-CM/PCS compliance date final rule, which could be released in the near future, according to Dan Rode, MBA, CHPS, FHFMA, AHIMA’s vice president of advocacy and policy.
  
While the industry waits for HHS’ announcement, Rode explains below the background and process for the ICD-10-CM/PCS compliance date delay, where the decision currently sits, and just what steps the federal government will take before the final ICD-10-CM/PCS compliance date is announced.

First, Some Background

The notice of proposed rulemaking (NPRM) regarding ICD-10-CM/PCS was published in August 2008. In that proposal, the Centers for Medicare and Medicaid Services (CMS) suggested a two-year process for implementation.

The final rule was published in January 2009 and became effective on March 17, 2009 (a unique aspect of the HIPAA rule is that it requires a 60-day period between the publishing of a final rule and its effective date). The final rule indicated that the implementation period would be extended to October 1, 2013, about four and a half years from the effective date.

A political decision was made in February 2012 to extend the delay. Undoubtedly political pressure from the American Medical Association contributed to the decision, as did other legislative issues being debated by the US Congress at the same time. Nonetheless, an official announcement was made by the HHS Secretary indicating that a delay in the compliance date would be considered.

The official notice of a delay was posted as an NPRM in the April 17, 2012 Federal Register. Part of the process before publishing is essentially a risk assessment by the White House Office of Management and Budget (OMB). While normally the healthcare industry would be alerted by the listing of a NPRM or final rule on the OMB website, the ICD-10-CM/PCS notice was buried in the title Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD–10–CM and ICD–10–PCS Medical Data Code Sets.

The April 17 NPRM gave organizations by May 17 to respond, or 30 calendar days. Reports estimate 530 responses were submitted for consideration. Under the law, CMS is required to read and respond to all 530 comments, although it is not clear that all comments were related to ICD-10.

AHIMA’s Advocacy and Policy staff learned that CMS staff arrived at recommendations on the delay—proposed by CMS to be one year—by late June. But this was essentially a political change in the rule, not technical, so the options and decision have to be shared with the CMS Administrator, the HHS Secretary, and potentially the White House.

Next Steps for the ICD-10 Decision

Once a decision is made to accept an option, the final or potentially the interim final rule (a rule that has some requirements that might be changed given more public input) must again be assessed by the OMB. The healthcare industry then starts the watch for an OMB listing, a CMS announcement of a “display copy” (not the final rule but its draft), and the final or interim rule itself published in the Federal Register.

The effective date of the rule in this case should be 60 days after the Federal Register final rule. In the rule will be the new compliance date or dates.

HIPAA established that the federal government oversees the use of standards for administrative transactions. CMS, the designated agency for all the requirements other than privacy and security, must provide its guidance and direction under HIPAA and several other federal rules.

These rules were established to provide order and afford public comment; therefore, AHIMA staff, its members, and the entire healthcare industry will have to wait and monitor the process to determine the final decision on a new ICD-10 compliance date.

6 Comments

  1. So…. what’s the delay in the delay?

    Why are we not seeing a decision to accept an option followed by a display copy? When will we? What are the issues and why is this dragging?

    ICD-10: Hurry Up And Wait

  2. ICD-10-CM/PCS first published 2008; CMS suggested 2 year process for implementation. Final rule 2009 became effective 3/17/2009; final rule indicated implementation period extended to Oct 13….. 4 1/2 years from the effective date. Political Decesion (here’s the issue) was made 2012 to extend delay. The offical notice of a delay was posted 4/17.

    A few questions and comments for the powers to be:

    When should the healthcare providers believe you when you issue an “OFFICIAL NOTICE”

    What does ICD-9-CM stand for?

    What do you stand for?

    Why was there a delay anyway? Do you even hae a clue?

    The only thing about this mess is the healthcare providers and elderly you are hurting. “Shame on you” You should walk with your head hung down every day.

    POP POP FIZZ FIZZ! (MAKING A HISSING OR SPUTTERING SOUND”

    HIPAA should have been called PPFF……………….

    I feel better !!!!

  3. We should do away with I-10 altogether. The cost to implement I-10 is not going to provide better health care. The I10 is for documentation only, the individual is not going to get better care so why even change the present system, to keep up with the Jones’s(Europe)

    If Europes healthcare to better than ours because they have ICD-10 then what do they come to the US to get better treatment?

    Do away with ICD-10. A waste of time and money. Time and money that can be spent on actual people needing medical care.

  4. A coworker of mine went to a 2 day auditing seminar in Orlando not too long ago and the instructor had said that they might do away with ICD-10 and move straight to ICD-11 since other countries are there already. I think we should STAY with the ICD-10 coming out in October 2013 and be done with it. Otherwise why push it back again, start up ICD-11 if we don’t do ICD-10 next year. I’m sick of all this waiting.

  5. “…A coworker of mine went to a 2 day auditing seminar in Orlando not too long ago and the instructor had said that they might do away with ICD-10 and move straight to ICD-11 since other countries are there already.”

    It is the case that while the rest of the world has long since migrated to ICD-10 (or a clinical modification of ICD-10) the US is still using a clinical modification (ICD-9-CM) based on the WHO’s long since retired, ICD-9.

    Work on the ICD-11 Beta drafting is running behind schedule. According to Christopher Chute, MD, who chairs the ICD-11 Revision Steering Group, publication of ICD-11 is now expected “around 2016.”

    Given the ambitious scale of the ICD-11 project, its technical complexity and with ICD-11 still at the Beta drafting stage, with a two year period scheduled for field trials and ongoing consultation, I would not be surprised if at some point before the end of this year, ICD-11 Revision Steering Group announces an extension to the projected dissemination date or a scaling back of the project, if completion of ICD-11 is to be reached by 2016.

    Assuming that ICD-11 Revision does complete its targets, is presented for World Health Assembly approval in 2015 and is ready for pilot dissemination of ICD-11 (or an ICD-11 lite) in 2016 – a US Clinical Modification isn’t going to unpack overnight.

    The US might be looking at another 8, 10, 12 years or more down the road from where we are today before ICD-11 has been modified for US specific use and an ICD-11-CM ready for implementation.

    According to Page 3332 of the DHSS Office of Secretary Final Rule document (Federal Register / Vol. 74, No. 11 / Friday, January 16, 2009 / Rules and Regulations):

    “…We [ICD-9-CM Coordination and Maintenance Committee] discussed waiting to adopt the ICD-11 code set in the August 22, 2008 proposed rule (73 FR 49805)…

    “…However, work cannot begin on developing the necessary U.S. clinical modification to the ICD-11 diagnosis codes or the ICD-11 companion procedure codes until ICD-11 is officially released. Development and testing of a clinical modification to ICD-11 to make it usable in the United States will take an estimated additional 5 to 6 years. We estimated that the earliest projected date to begin rulemaking for implementation of a U.S. clinical modification of ICD-11 would be the year 2020.”

  6. why are we going into ICD-10 when ICD-11 will come out for the rest of the world very soon? we will once again be years behind the world.

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