House Passes ICD-10 Delay Bill, Senate Next to Vote

The US House of Representatives has passed a bill that would delay the implementation of ICD-10-CM/PCS for one year. A similar bill in the Senate is expected to be voted on soon. AHIMA has called on proponents of ICD-10 to contact their senators and ask that they not delay ICD-10.

The bill, H.R. 4302 – Protecting Access to Medicare, mainly adjusts the Sustainable Growth Rate (SGR) for Medicare payments, which dictates how much physicians get paid for services. But bill section 212, a seven line section inserted into the SGR patch bill, also states that the Department of Health and Human Services (HHS) cannot implement the ICD-10 code set until October 1, 2015, a year later than the current date of October 1, 2014.

The bill introduced by Representative Joe Pitts (R-PA) states: “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.”

179281249House Speaker John Boehner (R-OH) and Senate Leader Harry Reid (D-NV) announced they were working in cooperation on the SGR “patch” bill late Tuesday night. The bill passes a temporary one year patch to prevent a 24 percent reduction in physician Medicare payments that would go into effect March 31. The development of the bill, and insertion of the ICD-10 delay, was negotiated at the leadership level in the House and Senate.

The bill was voted on and passed without a roll call vote, and was conducted immediately after an unexpected recess when many House representatives had not returned to the floor. The recess was taken for supporters of the bill to drum up more support. The afternoon vote took place following an objection to the vote in the absence of a quorum by Pitts Thursday morning. A quorum was not present for the afternoon vote.

Senate Set to Vote on SGR/ICD-10 Delay Bill Soon

Action on the SGR patch bill now moves to the Senate. Senators are expected to vote on a SGR patch bill in the coming days that could delay ICD-10, but a vote date has not yet been set. A similar bill, S. 2157, was introduced into the Senate which would also delay ICD-10 for one year. However, the Senate could vote on the House version of the bill, or vote on a different bill featuring larger reform of SGR; one ICD-10 proponents hope would not include an ICD-10 delay.

AHIMA and other proponents of ICD-10 have been rallying members and stakeholders to contact their senators and tell them to not delay the new code set. On Wednesday thousands of AHIMA members contacted their representatives and called for no further delays of ICD-10.

Further requests to contact senators and ask that they “pass a clean bill to fix SGR and not delay ICD-10″ have been made by AHIMA and the Coalition for ICD-10, an advocacy group of healthcare associations, vendors, and insurers that support the implementation of ICD-10. In a statement, AHIMA officials said that “physician reimbursement under Medicare should not be tied legislatively to ICD-10 implementation.”

Rollercoaster Session Ends with Delay Vote

During the House vote debate this morning, several House representatives mentioned that H.R. 4302 included provisions unrelated to SGR that likely many members of Congress were unaware were included in the bill.

“Perhaps we ought to have a criteria of everybody who has read this bill can vote on it. My bet is there would be very few members who would be able to vote on this bill,” said Democratic Whip Representative Steny H. Hoyer (D-MD). “None of us know what the substance of this bill is… I challenge any member to come up here and say ‘I have read this bill.’”

During the House floor debate Thursday morning, House Minority Leader Representative Nancy Pelosi (D-CA) characterized the rushed manner in which the bill had been brought to the floor, with most representatives having no opportunity to see the bill before a vote, as a missed opportunity. “This would be a more appropriate debate a month ago, where the clock does not run out over the weekend. But this is a tactic, it’s a technique, used by the [Republican] majority to force the hand without the proper weighing of equities in all of it,” said Pelosi.

It remains unclear why the language to delay ICD-10 implementation until October 1, 2015 was added to H.R. 4302. The ICD-10 delay section was not a point of discussion during the House floor debate. The SGR has been an ongoing issue in Congress for a number of years and a permanent solution has yet to be passed. Instead, continuous SGR patches have been employed.

After 40 minutes of debate on the bill, H.R. 4302, and an inital call for a vote, House officials decided that a quorum was not present, and therefore a vote would not be conducted. Further proceedings on the motion were postponed while bill supporters met privately with members of the House to gain support for its passing.

Though a vote could have occurred without quorum if agreed upon by House representatives, Pitts, who introduced the bill, objected to a vote in the absence of quorum. This uncommon move is likely because the bill had strong objections from groups like the American Medical Association and members of Congress who are physicians, and bill supporters didn’t think they had enough votes, according to AHIMA’s Director of Congressional Relations Margarita Valdez, who has been monitoring congressional proceedings on ICD-10.

“This is a game unworthy of this institution and of the American people,” said Hoyer, regarding the lack of transparency in the bill’s development and rushed journey to the House floor. “It is unfortunate that we have been put in this position with less than 48 hours’ notice of what’s in this bill.”

Without formal warning, the bill was reintroduced Thursday afternoon and passed by a voice vote without quorum. The move excluded several members of the House from the vote, and made it impossible to know exactly who would have voted for or against the measure.

ICD-10 Proponents Warn of Harmful Implications of Another Delay

AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

In a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner, members of the Coalition for ICD-10 said that CMS and other government officials should move forward with the current ICD-10 deadline of October 1, 2014. Coalition representatives include the American Hospital Association (AHA), the American Medical Informatics Association (AMIA), BlueCross BlueShield Association, the College of Healthcare Information Management Executives (CHIME), and vendors like 3M Health Information Systems and Siemens Health Services.

“Although many of the signatories to this letter were at odds over the timing of implementation when the National Committee on Vital and Health Statistics (NCVHS) and HHS embraced ICD-10—which has already been adopted outside the U.S. worldwide—we are now in agreement that any further delay or deviation from the October 1, 2014 compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending,” the letter reads. “By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing,” the letter stated.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients,” the letter continued. “Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

The impact of another delay in ICD-10 would be far reaching across the healthcare industry, AHIMA officials said. Many healthcare education programs have been teaching ICD-10 exclusively to students in preparation for the October implementation, while healthcare organizations have invested time and money into preparing staff and systems for the switch.

Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

The call for a delay likely came as a surprise to CMS. On February 27, Tavenner announced at the Health Information and Management Systems Society Annual Conference that ICD-10 would not be delayed any further, stating “we have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. There will be no change in the deadline for ICD-10.”

AHIMA Calls on Members to Request Removal of Delay Provision

AHIMA has put out a call to members and other stakeholders to contact their senators and ask them to take the ICD-10 provision out of the Senate’s version of the SGR bill.

When contacting congressional members, AHIMA has instructed callers to state that their senators should:

  • Oppose the specific language in the SGR patch legislation
  • Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ”This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,” AHIMA wrote in a statement, which it encouraged its members to use when contacting Congressional representatives. “Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished…  Let Senate Majority Leader Reid and Chairman [Ron] Wyden know that a delay in ICD-10 will substantially increase total implementation costs in your district.”

Contacting Your Congressional Representatives

For more information on contacting your senators in Congress, visit AHIMA’s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/.

For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy.

90 Comments

  1. Please clarify was the vote passed – at the end your article mentions a quorum not being met and the vote was postponed.

  2. to vote on something that is this important, and to sneakily tuck it away in an issue is underhanded and unfair. To take a vote without quorum is also underhanded as we have all come to expect from the politicians of this nation.
    You have effectively screwed those of us who have been in training for ICD-10. You have cost us several thousand dollars in this state alone in having to re-train in the ICD-9 system. As students we have spent the last 2 years in training and learning the new system of ICD-10.
    I can understand your reason for rushing through and pushing to vote without a quorum as it is your underhanded way of getting your way.

  3. Please postpone for one more year…Let us get MU under our belts first.

  4. The ICD 10 delay seems to have resulted from the concerns physicians have with regards to payment and accountability. I am sure the large lobby groups had a voice in this decision. My concern is other providers will keep being under scrutiny for charges and documentation, but physicians will not. As much as we are disappointed in the decision made there is no need to bash our government. I have lived in other countries and we should feel thankful we have a voice and the freedoms that our service men and women have fought and died for.

  5. We have always had to deal with the doctors not “doing their part” and waiting until the last minute, and then expecting everyone to do it for them. This is totally unacceptable…they have known about this change as long as everyone. Our facility has been working diligently for over two years to prepare for this, including hiring extra personnel and spending a fortune training them, making sure that we were ready. The M.D. offices have paid little attention to I-10. Did they think it would go away? It would be moving backward to delay this now. The new coders coming out of school have learned I-10, so what do they do for another year? Unemployment? I cannot believe that this change, that has been in the news for over 10 years already, can be delayed one more time. The sheer sneakiness of the way things were done sheds light of incompetence. This was a lowly-graded trick, and will hurt a lot more than it helps.

  6. Agree 100% with Bonnie. I teach coding, and in anticipation of AHIMA’s having a compatible CCA exam next week, I changed the school’s curriculum to I-10 4 months ago. Once again, I’d like to thank our dysfunctional government.

  7. The house passed the Bill. The senate now has to decide before April 1st whether or not to pass it. We will know soon. We may as well prepare for ICD 11 now, which is not a big step from ICD 10. At least then we will all be on the same page across the globe.

  8. If passed what does that mean for students who are studying for 10 now for a CCS certificate? I am too far into studing to turn back to 9 even though I have studied both!! It would be costly and frustrating for me!

  9. Delay it. Most of us independent docs aren’t ready because our EHR isn’t ready. Force the vendors to comply and then there’s an argument for it. AMA doesn’t represent most docs anyway.

  10. Our Hospital here in the Nassau were I work has been preparing for the global introduction of ICD-10. All I have to say is WOW! This information certainly has stepping backwards and its unfortunate that physician offices had not prepared themselves for this move.

  11. Our Hospital here in Nassau Bahamas where I work has been preparing for the global introduction of ICD-10. All I have to say is WOW! This information certainly has stepping backwards and its unfortunate that physician offices have not prepared themselves for this move. Makes me feel us if all of the webinars, class room preparations & lectures series have all been for nothing. This is truly a blow.

  12. The MD’s staff has paid little attention to this? And, we’ve had to deal with doctors “not doing their part”? Harsh words! We all work for the government, doctors and staff. Do you even know what goes on day to day in a medical practice? With meaningful use requirements among other requirements, please don’t forget what we do. We take care of SICK people, yes, daily we are seeing critically and sometimes terminal people, that’s our full time job. Do you think they even CARE about ICD10? They are SICK! Our “side” job is being compliant with all required regulations. We are not ICD10 professors and worry about the new kids coming out of school. What will they do? I agree with Kathleen, study for ICD 11 and let’s all make a jump together. When CMS tells you to prepare for ICD10 by “storing” six months of living/salary expenses aside, that’s a little scary! Cara – MU and MU2! Give us a break and don’t forget why we are in business. It’s not the dollar, that’s for sure!

  13. I reached out to my Georgia State Representatives regarding the delay of ICD-10 until 2015 and was basically told this bill would be passed due to some payers were not financially able to make the upgrades necessary before the implementation date. In my opinion if this is going to be case every year, I suggest we just eliminate going forward with ICD-10. I have been a coder for many years and this has been an ongoing battle to transition to ICD-10. Our facility as well as many others have spent time training staff and resources to promote the implementation of ICD-10 but to no avail it never occurs. I do suggest those that have not reached out to your State Represenatatives do so at least our voice will be heard.

  14. Its truly sad how far behind our country is. These people knew it was coming and now its a surpirse all of a sudden. It shows how lazy we are. disgusting.

  15. I agree with the delay. Many providers not ready, CMS, FI’s, and payment processors may or may not be ready–can’t know since have not completed end to end testing. Also, fact that other countries have been using I-10 really not appropriate as we use the codes (DRG’s) also as a reimbursement system. Which of course, impact of I-10 on DRG reimbursement not fully quantified.

  16. Please delay the implementation for ICD-10

  17. I am saddened by the delay. I know so many who have dreaded the October 1st deadline but have worked hard to be ready for it. To delay will only postpone the inevitable transition; it is coming one way or another. There has been such a huge investment already in money and time. Delaying another year will put us right back where we are now…having to update training after a year of inactivity. And what about the contract coders who have been employed to supplement coding staff for the expected decrease in productivity? We all know the transition will not be easy but delaying for another year will not make it any easier.

  18. This country is full of lazy people. I ve been studying this ICD 10 even brought the book for the CCS and now they want to push it back. I knew about ICD 10 since 2012. So why are clinicians trying to delay for another year. Its time to move on.

  19. Don’t forget, the House is Republican controlled, whereas the Senate is Democratic. I wouldn’t panic just yet because the House passed the bill on a voice vote. It requires more than just that for a bill to become law. I suspect that this resolution or bill will be DOA in the Senate, as well it should be. It puzzles me though, why the issue of an ICD-10 delay wasn’t part of the floor debate. I’m also concerned because apparently there are a bunch of people in the House who never even got to read the bill before it was voted on. This is like signing the papers for a mortgage without knowing what you’re buying. Nobody with any sense does that, and I’m surprised that Congress would resort to such a tactic.

  20. Kudos to Cindy. I am curious to know what people like Rosie think we physicians do day in and day out? ICD 10 is a bureaucratic morass that does nothing to improve patient care! Any benefits to tracking public health issues will be marginal at best. We need less red tape in health care not more. As far as doctors “not doing their part” I would like to have this individual or anyone else that thinks we don’t “do our part” follow myself one of my partners around for just one day. I didn’t go into medicine to checkboxes and make bureaucrats happy. I went in to it to take care of patients and their families.

  21. Pass this bill if the pass a unemployment estension . Lets see how dumb the Senate is. Dumb and getting dumber and even the world laughs.

  22. I am shocked by the number of people saying to delay ICD-10. This is an industry full of change and you knew that when you decided this career path!

  23. Go forward with ICD-10, us big guys are ready for it. Delay Meaningful Use, the real monster in the room that’s even scaring the 500 lb gorillas.

  24. Those who support meaningful use (MU) and the coding transition to ICD-10 are the health information staff. They know the structure of the new system, they understand it’s impact, and have been preparing for it for several years. If you are not ready for MU or ICD-10 you are a laggard and have had the time necessary to make the transition. If it’s because of the cost of MU or the cost of changing your fee-sheets then you should have been convincing the government, over the last five years, that you needed more subsidies or incentives. The infrastructure, monetary incentives, and staff have been there to support these transitions for some time. This needs to happen, and if it doesn’t, it only hurts those who have justly prepared and let’s the unprepared complain until next October.

  25. Caring for SICK people? Most deaths in America is due to medical error. Lack of time and effort to implement an EHR? ICD-9 is 30 years old and there are plenty of funds and resources to setup an EHR. Physicians/providers need to be paid more? Teachers deal with SICK people everyday, yet receive 1/4 of a physician’s paycheck. If they want to postpone ICD-10, might as well make everyone go back to pen and paper

  26. Delay it… Most doctors can’t document correctly under ICD9 let alone ICD10 especially PCS. ICD10 is just another (among many) excuses not to pay hospitals what they are entitled too. HIM already has too much on us. We don’t need anymore headaches to deal with. Let some of these “so called” experts work some claim edits or code some charts… then we’ll talk.

  27. Why didn’t our representatives ask the hard question, “Why aren’t you ready for the conversion, financially or otherwise, when you’ve literally had years to prepare?” There’s no reason why these entities should not be ready to move forward with ICD-10. This has been heading our way for more than a couple years, more like 10+ (actually 20+ if memory serves). These code changes are long over-due. Let’s make the change and quit stalling.

  28. Delay in the ICD-10 implementation is ridiculous! Physicians need to get their act together! Of course, I could blame it entirely on the AMA and physicians, but the fact of the matter is the federal government (Dept of Defense) isn’t even prepared. AHLTA and VISTA can’t even communicate with each other.
    It’s sad and pathetic that the USA is like a 3rd world country when it comes to medical coding! Now we have Congressional Republicans voting on bills that they have not read and clearly do not understand. Who hires these illiterates anyway? Oh, I know – lobbyists, big Pharma and big corporations. I don’t mean to sound partisan (OK, yes I do) but Republicans are complete idiots… but that doesn’t matter at all – as long as someone is padding their pockets they will block, obstruct and destroy anything and everything to impede progress. VOTE!! November can’t get here fast enough! VOTE! VOTE!! VOTE!!!

  29. The problem is the insurance companies and vendors, Rosie. It’s not so much the physicians. Georgia Medicaid and our Work Comps all said there’s no way they will be ready by October.

  30. Go back to pen and paper? Excellent idea! The entire EMR experiment has done little to improve care, just make bureaucrats happy and IT folks think they understand healthcare, which they absolutely do not! 18,000 codes isn’t enough? You want us to go to 85,000? Patient care is suffering. Next time an EMR “expert” gets sick, let their iPad take care of them!

  31. Hypocritical, the representatives who did not read the PPACA yet passed it, have quite a lot of nerve criticizing House reps who may have hastily voted for this bill. The bottom line is that the entire health insurance system is in a state of disarray with the formidable rollout of the ACA. Every other aspect of the reform has been delayed with democratic support, so why the outrage now? Before we know it, we will be executive ordered into a single payer system. As originally intended.

  32. Come on folks – ICD-10 has been coming for a long time. Doctors really are not being asked to document anything for 10 – that they werent supposed to do for ICD-9 – some are just better at it. Documentation is also by specialty – so they really arnt being asked for anything extra – just tell the patients treatment story accurately.
    My suggestion to the AMA – is require a doctor’s curriculum to include a class in good documentation practices – taught by a HIM or CDI professional. If it isnt documented “it didnt happen”, and if it isnt legible what good is the documentation? The difference is that they are not just documenting for one audience anymore (other clinicians). Now their audience includes, insurance companies, work comp, and the patients themselves and each utilize the information differently. Yes documentation does effect “good patient care”. If the documentation isnt accurate then the next doctor to treat the patient will not be treating them appropriatly based on previous treatments received. The bottom line is: Coding is based on the doctors documentation and treatment the patient received, revenue is based on billing based on the coding. All this is now predicated on different payment programs and governement entities now saying “prove it was medically necessary – and that is where the documentation comes in.

  33. I would agree our government is underhanded all the way around but let’s face the truth of the matter, the prep for ICD-10 is much more involved than anyone cares to admit. Some facilities are prepared(or should I say more prepared than others) and some are not. Bottom line is we need more time for this transition. I was glad to hear it might be delayed. I hope it passes both houses because I truly believe more facilities are not ready than are/will be. Those of you who think you are ready, get over it and cut the rest of us some slack.

  34. I vote for delay of ICD-10. Unlike the new Coders us old Coders have just began to get ready for the AAPC exam for 10, and need time to learn 10. For once I am proud of the House.

  35. ICD-10 as a piece of legislation is relatively insignificant to the passage or failure of this bill. In fact, the AMA is against passage of this bill as is the MGMA. And it’s not because of the inclusion or exclusion of ICD-10. ICD-10 is a casualty of war in a never ending and quite remarkable demonstration of political indecisiveness (yes redundant, I know).

  36. CMS will not be ready for ICD-10, not to mention state Medicaid programs. Has the IT fiasco of healthcare reform not recently shown that. That is my concern.

  37. Medicare will not be ready for ICD-10, not to mention state Medicaid programs. Has the IT fiasco of healthcare reform not recently shown that. That is my concern.

  38. Wholly smokes! I can’t believe the comments from the likes of Pelosi and Hoyer. Maybe we should repeal Obamacare so that the same level of “review” that they want for this bill can be applied to it before its passed.

  39. Delay the icd-10 for a year. It gives confusion to all in the medical industry.

  40. Why in the wild blue yonder would we delay the implementation of ICD-10. We have known for at least five years this was coming. The U.S. should be in the forefront regarding this implementation since ICD-9 is antiquated and unable to track morbidity results. Other countries implemented ICD-10 several years ago. Instead, we are way in the back pasture stumbling around not making good decisions.

  41. Someone mentioned just skipping ICD-10 and going on to 11. Why? Someone will just want to not do it either and push it back like they are trying to do with 10.

  42. Everyone has known about icd-10 for years and should now be ready or almost ready. Our employers have spent millions of dollars to make sure we have the proper training. I’ve spent countless hours away from normal work hours and family to learn this. It’s time to stop messing around and implement 10/1/14!!!

  43. I agree! We, the “little guys” have been raked over the coals with mandates! Now, we are in the midst of MU2, PQRS, and the implementation of ICD-10. Can the government give us a break already? Most clearinghouses and vendors aren’t even ready. If the healthcare.gov marketplace is any indication as to how this is going to roll out, it is going to be catastrophic to the small practices, who in no way have the finances to carry their practice for months on end with no revenue coming in. To those that have been learning the ICD-10, grab an ICD-9, it doesn’t take school to learn that coding! Too many schools are ripping off students, convincing them that they need a year long course on how to code. So long as you have your basic anatomy and physiology down pat, you can do it. I have been coding for 24 years, and never had one course in college to teach me. ICD-10 is a flipping nightmare… let’s just move onto 11 next year! Typical “any time the government is involved” problems are awaiting if we go live 10/1/14. Patients complain now that they don’t have enough time with their docs. Imagine, the docs having to cut their visits by an extra 5-10 mins. just to maneuver this new coding system. It’s just the government gaining more and more personal info on the patients… pretty soon, they will be sitting at our dinner tables at night. LET PHYSICIANS DO WHAT THEY WERE TRAINED TO DO! TREAT THE SICK!

  44. I wonder if the same representatives in The House that failed to read HR-4302, are the same ones that failed to read all of the ACA? My point is, the government, clearinghouses, physician/hospital staffs (at least 50%), and IT vendors aren’t even ready for this transition, despite knowing that it was coming. When given the choice of treating the sick patient vs. learning approximately 50k new codes, I wonder which the patient feels is a priority? DELAY IT! The information that the government is hoping to gain, will in no way affect public health concerns, guaranteed!

  45. Healthcare depends on physicians. Physicians are NOT ready for ICD-10 and it will make minor impacts on patients’ outcomes. I am told that ICD-10 was never meant for use in the outpatient setting and is only in hospitals in Canada and Europe. Public health will suffer not one iota because of a code. The CDC does not depend on codes for investigations of
    outbreaks of disease. This serves only the bean counters and paper pushers and does not help me take care of sick people. And as for the remark above about teachers’ pay, remind me of the educational requirement to teach vs practice medicine; not to belittle teachers but my spouse is one and she spends a helluva lot more time at home than I do. Get over yourselves.

  46. I am extremely disappointed with the passing of this vote. Healthcare organizations have spent millions of dollars to implement a required regulation which was guaranteed by CMS NOT to be delayed again. The code is sitting in our test systems and we have been conducting testing and moving forward. We have held many other project efforts. If this vote goes forward that effort is negated, we must move forward with other projects, and start all over again. This bill does not even say that the next date will be in a year. It only says that it will not be implemented before October 1, 2015. With something this huge, are we to put our large team on the shelf and for how long?

  47. I think our physicians always get the short end of the stick, so to speak-We coders become coders so that physicians can do what they have trained so many years to do-Take care of the sick-it is our jobs to know how to code no matter what system we are trained to use-I agree with so many of those physicians that say, “just follow us around for a day”-there is no way on Gods Green Earth I could do what a physician does which is why I chose to help them by abstracting appropriate codes from their medical documentation and if they are missing something or document something that may be contradictory it is my responsibility to bring it to their attention so they may correct it and improve on how they document-Whatever the situation-we continue to do the coding and our physicians continue to take care of the sick-For those who have studied and learned ICD-10 you will have no problem learning ICD-9-Whatever the “vote” or the “delay” our careers remain the same and we adapt.

  48. Does anyone know if the legislation passes, if they will still put the ICD-10 on the next RHIA exam starting April 21? Thanks.

  49. Really Dan? Need to Re-Google your “Most of Americas deaths are due to Medical error”. You should have studied Medicine for ten years and then find out some months you can’t even take home a check because your overhead is so high just trying to stay compliant with the government. W Thanks and Gig ‘EM

  50. ICD-10 – Increased documentation burden. Increased clerical burden. Lengthened revenue cycles. Increased rejections. What’s not to like?

  51. I have been preparing our office for ICD10. Our EMR vendor is not ready yet, although they say they will be in time. Ive attempted to arrange to be part of testing with our big insurance vendors to make sure we are ready before October 1st. Our practice is prepared, but my concerns are this hasnt been tested end to end to ensure it will work correctly, and claims will be paid. Our practice sees 85% Medicaid patients, and if this doesnt work correctly, then yes cash flow will be affected. My worry is this will be another rollout similar to the healthcare.gov website. It wasnt tested thourghly before implementation. I just want to know it will work and we will be paid for taking care of these patients.

  52. I think if you are not a coder – then you shouldn’t voice your opinion on what we do or judge us & call us lazy. Coding from ICD 9 to ICD 10 is a HUGE change and will impact the coder greatly. Yes, we chose this profession but we didn’t choose to have the government make MORE red tape for us to cut through to perform our jobs to the best of our ability. Most of us are ready to implement the new changes but still, I wouldn’t mind retiring BEFORE ICD 10 comes. I realize that is NOT going to happen and ready or not – here it comes. I hope the Senate DOES delay it… Just my opinion….from a long time coder…

  53. LOL! These comments crack me up. I am an OR RN turned coder/auditor. Many of the surgeons I worked with just suffered through clinic in order to be able to get into the OR where they really wanted to be, with sleeping patients. Though, I am sure there are many very caring physicians out there who enjoy their patients. This bill was bipartisen negotiated at the leadership level and designed not to be debated. And, the WHO has delayed I-11 until 2017. Even when it comes out at that time, the US will need time to develop its clinical modification so the idea of skipping I-10 and going straight to I-11 is ludicrous. I-9 is archaic. I-10 is much better and the PCS part blows away CPT. PCS is 100 times better. I don’t care either way whether we delay it or not, though there is no excuse that any entity across the healthcare spectum is not ready for it to begin Oct. 1, 2014. That is just plain dropping the ball.

  54. Um, did anyone with a heart or an ounce of compassion think of all those poor students who have spent all their time and money learning Icd 10 and now are about to take a certification under Icd 10. Ok, now just sit back for a year, because you weren’t taught Icd 9 so we don’t need your skills util next year. Perhaps you can find some company thats going to pop up and offer RETRO-ICD9-CM courses for 2014 at a discounted rate for this week only. This way by the time you’ve finished learining Icd 9, Icd 10 will be implemented. Is it me, or does this entire mess appear to be, too “Political”??!!

  55. @ Stacey: WHOEVER taught you ICD 10 should have taught you ICD9 FIRST. Knowing that the US has not implemented ICD 10 YET, you should have never been taught ICD 10. Where do you go to coding school? Online?

  56. For patient sake only I am glad they are considering a delay. While I personally think ICD 10 is needed, the amount of doctors offices that have not prepared is astoundingly high. With the expectation that there will be problems and disruption in cash flow, the offices that didnt prepare will be hit the most as they will have no idea what is going on. From the market research in my area, it has been PCP offices. 99% of these offices have outsourced their billing to 3rd parties, while the specialists and IDTF’s have been obtaining the authorozations for the patients they refer out for years. The amount of services that are actually scrutinized in IM/FP offices is nothing compared to major medical, so they have been lulled into a false sense of security. I know this is my opinion, but it is based on fact, many of these offices have become spoiled/lazy by companies that market to them for referrals offering to do anything to get their business. It is what it is, and what ever happens, you have to make sure your practice is ready both financially and procedurely to adjust.

    Why I said for the sake of the patients is that if these offices are not prepared and it does happen, a lot of practices might simply close up shop or refuse to take insurance all together. This is already a growing trend, and it has been widely reported that many physicians have stated they would rather retire than deal with ICD10.

  57. Please do not delay ICD-10 any longer. We have put in so much time and effort into learning it. Just because some doctors office’s are not prepared should not influence the start of ICD -10. These doctors have known for over a year that it was coming. Shame on them for not being ready.

  58. I work with a large healthcare provider and we have spent a lot of time, effort and resources preparing for ICD-10. We have aligned our medical staff around this new code set and have developed processes to assist our medical staff in their documentation efforts to support the coding of their cases. We have taken the position that we won’t make our physicians coders, they document and through systems tools or good old fashioned coding expertise will compliantly code their cases. Delay is inexcusable and all of “us” who have developed significant momentum and will be ready should not be held hostage by those who have had two years to prepare for this and did not do so.

  59. I think what aggravates me most about this, is that we were assured, October 1, 2014 was it, there would be no more delays. Well, here we are. Much time and money has been spent all around, because we were assured this was it. If everyone was not ready, why not? ICD10 is not new. I have been hearing about this since the late 1990’s. My question, is this bill really about helping those who are not ready, or is just to ease the pain of the SGR patch? Adding “ICD10 delay” to the bill, was sudden and sneaky. I do agree with those that state, let the coding be the coders job. Our job is to assist the doctors with their documentation for compliance and accurate billing. I agree the doctors should have an understanding about ICD10, but isn’t it our jobs to help this along? I feel if ICD10 is delayed, then we should just stick with ICD9 once and for all, Otherwise, we will be having the same conversations next year. Hopefully, we wont have already spent thousands of more dollars by then.

  60. By an overwhelming margin, the folks who are upset by the notion of delaying ICD-10 implementation are folks who are going to make money off of the conversion. The folks I don’t see upset are the providers who have to treat patients, document the higher level of detail necessary to support ICD-19 codes and wonder if they will get paid when all of this rolls out Oct 1.

    Why can’t the government take the same approach as was done with meaningful use. Allow either ICD9 or ICD10 from Oct 1, 2014 to Oct 1, 2015 and reward the early adopters…perhaps with a bonus incentive. At least the small to mid-sized practice with limited resources will not be put out of business because of the cash flow slamming shut in November due to “unintended consequences”.

  61. Here is my suggestion…why can’t those who are ready begin using ICD-10 and just don’t make it mandatory for those who have delayed their training waiting to see if it would really happen? If enough people get on board with I-10 and prove that it works, then they can make it mandatory a year from now. If it gets delayed, nobody will ever again believe that it will be implemented in the U.S. because up until the day before go-live, Congress could once again delay implementation. If given the chance to avoid the 2014 deadline, those who are not prepared will continue to find something more important to do with their time until they are forced to comply. Those who have spent millions of dollars in preparation, training and non-productive employee hours, should be allowed to move forward and begin using ICD-10 on October 1, 2014. Many Medicare carriers and Medicaid agencies have already begun testing, and commercial payers like Anthem BCBS are ready. Making it optional for now would ease the financial burden anticipated with delays in payments and allow vendors to adapt over a period of time instead of everyone racing to be compliant by October 2014. This, to me, makes the most sense for everyone.

  62. It is wise to move ICD 10 to 2015, so many clearing houses are not ready along with doctors office and many insurance companies. The fear of holding up money for provider for months, will put a lot of providers out of business. Having more time to prepare is never a bad thing, and 12 more months to work on implementation should be looked at positively….

  63. This is the biggest, most expensive scam, ever perpetrated on health care. …..bench marks that can not be made so HHS can generated reports to screw up more of the US healthcare system. Why make standards that are not comparable to anyone’s else’s system. This is a field day for integration specialists. To get fined yet for rules that are not even concocted yet!!!!! HAD IT. You have to pass it to read what’s in it.
    Someone must be related to EPIC , in congress. Follow the money…..it is flowing away from Patient Care. There should be no time line for assimilation of all of our data that none can access except locally. we should do the best we can to standardize . Stage 12 of meaniless use will state to go back to Stage 1 because we our technology has outlived its useless ness.

  64. Sarah, are you a coding professional? Perhaps you should move into the 21st century and realize many people go to school and earn their degrees “online.” There would be no reason for any person finishing their coding degree after October 1, 2014 to learn ICD-9, since that implementation date was not going to be changed (again). There has been too much money spent on education, training, and preparation for ICD-10 by those institutions and physicians who were smart enough not to put their heads in the sand to go back now. The House of Cards move by our elected officials was ludicrous, but I guess we shouldn’t be surprised. By the way, I am an “online”-educated coding professional who holds a CCS and a CPC. Perhaps the world would be a better place if people thought before they insulted, but trolls will always be trolls.

  65. The physician offices who are not ready have chosen to not be ready. ICD-10 was delayed for one year already and physicians did absolutely nothing with the time to prepare. I have provided classes to small physician groups and they walk away astounded that ICD-10 is really not as difficult for them as the AMA and all the media hype puts on that it is. After all, ICD-10-PCS is the difficult portion to learn and physicians do not need to learn that part. Physicians should document the diagnoses the way they learn to provide diagnoses during rounds in med school – with specificity. They tend to get complacent after med school. Anyway, as an independent consultant, I have spent a lot of money on learning ICD-10, and a lot of time providing free training – time that I will never get back. Hospitals and other providers have spent millions. In the mean time, physicians continue to get their way at others’ tremendous expense.

  66. The people against the delay have to realize that those of us using EMRs are at the mercy of the EMR vendor when it comes to ICD-10. Our vendor has only JUST RECENTLY released a newer version that can handle ICD-10 code sets, and we upgraded to it 2 weeks ago. Now the fun begins with 9 to 10 mapping, getting staff acquainted with ICD-10, and working with clearinghouses to test ICD-10 claims. On top of that, the payors like Medicaid and Medicare will probably not be ready and seriously affect our income as a result even if we are 100% ICD-10 ready. This one year delay will be a big relief to us.

  67. My name is Gail Ostrove and I am a student at Allen School of Health Sciences we are learning ICD-10 coding as well as ICD-9 and I can tell you that the ICD-10 is easier to follow and is more explicit when finding proper diagnosis codes. We have access to the information on the web as well as the ICD-10 2014 draft books. This change over will compliment the use of Electronic Health Record systems in finding proper codes for billing and insurance purposes. I do not understand why there is a push to delay adaptation of this. It is not going to be hard for people to be trained in this. I did not have previous healthcare related work experience prior to my online courses that started in 10/2013 and I was able to figure it out with proper training. Please make certain that the delays do not affect people who are taking courses now. We are looking to gain skills for a career change and I want this to be a plus on my resume so that I have an advantage at gaining a job after all my skills training. At 48 years old it is hard enough to enhance my career and go back to school. Please do not make all the efforts I have put forth inconsequential.

    Sincerely,

    A concerned future Healthcare Professional Current Student

  68. Thanks Denise for your post in response to Sarah’s heartless attack on me. Sarah, I was giving a caring thought to those new to the field. I, myself am a Professional. I also have a degree and I actually went to a college. I am also certified by a few organizations. There’s nothing wrong with online Degrees by the way for those who want it or find it convenient. For the record, I train Coders , so I know Icd 9 & 10. It just seems there’s a bigger picture here and we in the medical arena are being juggled around like circus balls.

  69. I think they should implement it now. If they’re not ready now, then they will never be ready. The health insurance companies had years to prepare for this. My hospital is already dual coding and us codes have been learning icd10 for over two years now. I do not know why everyone is now scrambling at the last second to make their changes, as far as I’m concerned, they had plenty if time to make changes! If they delay it another year, then the hospitals and physician offices should be reimbursed for the extra people that they already hired in the last past year! Stop crying and get on with it!

  70. As a physician, and also part of the HIT Industry, I have mixed feelings about this. I agree that most of the early adopters of MU, as well as the big vendors, are ready – or will be come Oct ’14. That being said, I don’t believe the entire infrastructure will be ready by then – clearing houses, smaller hospitals, SNIFS and other community health facilities, and especially smaller physician practices. So while I believe that many will be ready, I don’t think the entire system is going to be, and thus, I fear for the fiscal impact this will have on everyone. Despite protestations to the contrary, if things aren’t working well, then this WILL affect patient care in an indirect way: the more time spent on non-patient contact, instead dealing with billing, coding, assuring payment, etc., then the less time for patients. This is ALREADY a huge issue (and has been for the last 10-15 years). It is only getting worse. Because of this, and the lack of access to primary care by the poor, is why we’re ranked in the 20’s (not #1) in world healthcare outcomes, infant mortality – you name it.

  71. Sarah, actually most colleges are teaching ICD 10 due to the fact that it was expected to be in effect October of this year. ICD 9 to most college professors is pointless to teach due to this change. I currently am majoring in this in college. My teacher, who was an RN, was informed by officials within major hospitals that ICD 10 should be taught, not 9. As I’m almost finished my degree, I really hope they do not delay this implementation as it will set me back in terms of employment.

  72. Denise & Sarah,
    I am a nurse manager for a Risk Adjustment team taking online ICD9 training and ICD10 in the classroom. You need to know both…just my opinion! The doctors are not ready. The recommendations for optional implementation sounds link a great compromise if you can get the clearing houses to run dual claims programs. Even after official implementation dates, systems will need to be able to process 9 &10, based on DOS., and work comp is not required to change to 10. Learn them both!

  73. My opinion about the passage of bill H.R. 4302 – Protecting Access to Medicare. In my professional opinion the best approach to resolve this issue for all healthcare providers is to begin implementation of a pilot program for acute care facilities. Work out any problems with implementation of ICD-10. Second phase is to allow all other providers to participate in the implementation in 2015. This will allow a incremental transformation of ICD-10. Healthcare providers will have minimal financial impact with a phased in approach. It is important to consider this approach for implementation of ICD-10 and deadline.

  74. Sarah – It sounds like perhaps you are not in the field of education. There are requirements involved in teaching ICD-10 when the end goal is passing the national certification exam. The national coding exams already postponed including ICD-10 in their exams previously because of the implementation issues last time. When given a more definite extension, and Meaningful Use Stage 2 has continued to move on, they had to act. Coding positions are still tricky to secure for the new graduate due to the preference for experience. To expect these new graduates to dedicate a year or years of their education learning ICD-9, but then being expected to do ICD-10 on the job is rather asinine. The new healthcare coder still has a lot to learn and apply in the basics of coding post-graduation, or don’t you remember what the learning process was like? These students have to learn ICD-10 to be competitive and, in my opinion, need an understanding of ICD-9, but not proficiency in it when ICD-10 should be implemented this October. There is no difference between a good online education and a good on campus education; I’d be more concerned about the for-profit institutions and pop-up training sites that promise to deliver a trained and efficient coder after the end of the week.

  75. Hospitals and consulting companies will hire students with ICD-10 training. Most of my clients want them now for cross-walking.

  76. I hope that icd10 is delayed. I realize that time & lots of money have been spent, but if the USA is not ready delay it. Every coder I know is on pins & needles because we are being cramed with the icd-10. We need more time. Everybody need to be on the same page for this to work.

  77. Delaying ICD-10 is pure politics. If you are not ready now, for the mandate that was announced in 2009, you will not be ready next year either. Adding another year will only add cost to an already costly healthcare system and those not ready now will not likely use the time any wiser than the time given in the last delay.

  78. I am a coder of many years and teach coding. Providers who are not ready are not going to get ready. I have watched this for quite a while and the providers that I work around who are not ready are the providers who refused to begin training because they were convinced that the implementation will never take place. My healthcare system has participated (successfully) with CMS’ claims testing. Most of our EMR’s are ready and we have helped providers who have EMR’s that are not ready to transition to a system that will be ready.

    I am only teaching ICD-10 at the college I work with because I have a set amount of time alloted for my course and it does not include a sufficient amount of time to teach both I-9 and I-10.

    Having worked with both ICD-9 and ICD-10, I find ICD-10 easier to code.

    We were assured by CMS that ICD-10 would not be delayed and I, my healthcare system, and the institution I teach for have all taken steps based on this assurance.

  79. I don’t see ICD-10 mentioned anywhere in the Senate bill S.2157. Can anyone point out what section it’s in?

  80. The vote will be on this H.R. 4302 according to the floor schedule for the Senate. They are voting on the House version that contains the seven lines delaying ICD-10.

    Senate Floor Schedule
    Monday, Mar 31, 2014
    2:00 p.m.: Convene and begin consideration of H.R.4302, Protecting Access to Medicare Act of 2014.

  81. SEC. 212. DELAY IN TRANSITION FROM ICD–9 TO ICD–10
    CODE SETS.

    The Secretary of Health and Human Services may
    not, prior to October 1, 2015, adopt ICD–10 code sets
    as the standard for code sets under section 1173(c) of the
    Social Security Act (42 U.S.C. 1320d–2(c)) and section
    162.1002 of title 45, Code of Federal Regulations.

  82. I think that ICD-10 should not be delayed, it has already been delayed once. Everyone in and out of healthcare new this change was coming about. If it is delayed, then what will be proven? The same organizations that are not ready now will never be ready, and its no one’s fault but their own for lack of planning.

  83. I have been an inpatient coder for six years and trained in ICD 9 & ICD 10 CM/PCS. I can relate to both sides of the issue at hand. We a medical specialist regardless of our title must be honest with ourselves as well as everyone else. If we (anyone involved) in ICD 10 readiness/implementation were dragging our feet and NOT ready in October 1, 2012, October 1, 2013, October 1, 2014, why is anyone saying/asking one more delay to October 1, 2015? I personally do not for one minute believe that another delay is going to solve anything.

  84. Has anyone heard the result of the vote today?

  85. Bill passed in Senate with over 62 votes YES

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