Senate Passes ICD-10 Delay Bill

The Senate voted today to approve a bill that will delay the implementation of ICD-10-CM/PCS by at least one year. The bill now moves to President Obama, who is expected to sign it into law. The bill was passed 64-35 at 6:59 pm ET on Monday, March 31.

463105901The bill, H.R. 4302, Protecting Access to Medicare Act of 2014, mainly creates a temporary “fix” to the Medicare sustainable growth rate (SGR). A seven-line section of the bill states that the Department of Health and Human Services (HHS) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015. The healthcare industry had been preparing to switch to the ICD-10 code set on October 1, 2014.

In a statement on the Senate vote, AHIMA officials said they will work to clarify outstanding questions raised by the delay and continue to work with government officials to implement ICD-10.

“On behalf of our more than 72,000 members who have prepared for ICD-10 in good faith, AHIMA will seek immediate clarification on a number of technical issues such as the exact length of the delay,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “AHIMA will continue our work with various public sector organizations and agencies such as the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator for Health IT, and the National Center for Health Statistics (NCHS) along with our industry partners such as the ICD-10 Coalition so that ICD-10 will realize its full potential to improve patient care and reduce costs. These are goals that AHIMA and other healthcare stakeholders and our government leaders all share.”

Since the transition to ICD-10 “remains inevitable and time-sensitive because of the potential risk to public health and the need to track, identify, and analyze new clinical services and treatments available for patients,” AHIMA said in a statement the organization will continue to lend technical assistance and training to stakeholders as they are forced to navigate the challenge of preparing for ICD-10 while still using ICD-9.

Thousands of AHIMA members and ICD-10 proponents contacted their congressional representatives and senators over the last week asking them to vote against the SGR bill and not delay ICD-10.

Congress Working Against SGR ‘Fix’ Deadline

Congress was working against a deadline of today, March 31, to reform or “fix” the SGR before it directly impacted physician payment. Without a fix to the SGR formula, Medicare physicians faced a 24 percent reimbursement cut beginning April 1. H.R. 4302, introduced by House Representative Joseph Pitts (R-PA), will replace the reimbursement cut with a 0.5 percent payment update through the end of 2014 and a zero percent payment update from January 1, 2015 to March 31, 2015.

Physician groups, including the American Medical Association and a coalition of nearly 90 state and national medical societies, have come out against H.R. 4302 since it does not provide a long-term solution to the SGR issue. The insertion of the ICD-10 delay section into H.R. 4302 was likely done to placate physicians who are against an SGR patch. The AMA has said they are against moving to ICD-10 entirely.

The original House bill was negotiated at the senior leadership level and quickly pushed through the House on March 27 via a voice vote, where no roll call was taken, no votes were tallied, and with the majority of representatives still out on a previously called recess.

“There’s no integrity in what we’re getting ready to vote on,” remarked Senator Tom Coburn (R-OK) as he spoke against passage of the bill despite the pressing deadline. Drawing a comparison with the principles of medicine that you don’t treat symptoms but instead treat the disease, Coburn also noted that the continued passage of SGR patches represents a corruptible process that hides truth from the consumer and demonstrates a lack of transparency from Congress. Coburn also displayed a poster that he said characterized Congress’s current methods during his speech that read “Put Off Until Tomorrow What You Should Be Doing Today.”

On Monday Senate Finance Chairman Ron Wyden (D-OR) did introduce a new SGR bill, S. 2157, that did not include the ICD-10 delay provision and would have addressed not just a “fix” for SGR but wider reform. However, Sen. Jeff Sessions (R-AL) objected to voting on S. 2157 and instead proposed the Senate vote on S. 2122, a SGR reform bill introduced on March 12 and sponsored by Sen. Orrin Hatch (R-UT) that would also repeal the individual insurance mandate of the Affordable Care Act. This vote was also objected to by senators, who in the end voted on H.R. 4302 which put off larger SGR reform to the future and delayed ICD-10 for at least one year. This legislation will become the 17th patch of the SGR since 1997.

This is the second time ICD-10 implementation has been delayed. The original compliance date of October 1, 2013 was officially pushed back a year on September 5, 2012 by CMS, who noted in their ICD-10 delay final rule that “some provider groups have expressed strong concern about their ability to meet the October 1, 2013 compliance date and the serious claims payment issues that might ensue if they do not meet the date.”

But this recent legislative call for a delay likely came as a surprise to CMS. On February 27 CMS Administrator Marilyn 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.”

Impact of Delay Wide Reaching, Next Steps Unclear

The impending delay of ICD-10 raises a vast slate of questions for coding professionals, provider administrators, education entities, and even the federal government. The focus will likely turn to CMS, who will need to provide the healthcare industry guidance on the exact new implementation deadline and how to move forward.

The delay of ICD-10 impacts much more than just coded medical bills, but also quality, population health, and other programs that expected to start using ICD-10 codes in October. The extent of the logistical challenges and costs associated with “dialing back” to ICD-9-CM are not yet fully understood, AHIMA officials said, but are expected to be extensive.

CMS has estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay.  This does not include the lost opportunity costs of failing to move to a more effective code set, AHIMA said.

Many coding education programs had switched to teaching only ICD-10 codes to students, hospitals and physician offices had begun moving into the final stages of costly and comprehensive transitions to the new code set—even the CMS and NCHS committee responsible for officially updating the current code set changed the group’s name to the ICD-10-CM/PCS Coordination and Maintenance Committee.

The delay directly impacts at least 25,000 students who have learned to code exclusively in ICD-10 in health information management (HIM) associate and baccalaureate educational programs, AHIMA said in a statement.

The United States remains one of the only developed countries that has not made the transition to ICD-10 or a clinical modification. ICD-10 proponents have called the new code set a more modern, robust, and precise coding system that is essential to fully realizing the benefits of recent investments in electronic health records and maximizing health information exchange.

While today’s vote delayed ICD-10 implementation, AHIMA officials said they will continue working to ensure that another delay does not occur legislatively. Over the upcoming weeks, updates will be added to AHIMA’s Advocacy Assistant with instructions on how members can continue to advocate their members of Congress on behalf of ICD-10.

“As demands for quality healthcare data continue to increase, this delay will add an additional significant hurdle for the healthcare system to fill these important HIM positions,” Thomas Gordon said. “It is truly unfortunate that Congress chose to embed language about delaying ICD-10 into legislation intended to address the need for an SGR fix in their effort to temporarily address the long outstanding and critically important physician payment issues.”

 

102 Comments

  1. I don’t understand why the AMA is against any coding, they are not the ones doing the coding, they just need to treat the patient. Leave the coding to the professionals!!!

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  2. This frustrates me. For the last 4 years of my career I have prepared for this transition, passed the AAPC ICD-10 Proficiency Assessment, and our government once again decides THEY aren’t ready. How am I supposed to convince my surgeons that they have to work on this when it keeps getting delayed?

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  3. I did appreciate the impassioned, informed and direct speech that Senator Coburn, (R) Oklahoma gave on the Senate floor.

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  4. I am a student in the Health Information Technology Program at Onondaga Community College, in Syracuse, New York. Part of my training included preparation in ICD-10 for entry into the workforce. I am graduating in May, 2014 and am now going to struggle to quickly learn ICD-9. A delay in the implementation of ICD-10-CM/PCS will cause financial hardship for me and my family. A delay will also create difficulty in securing employment in my chosen field.

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  5. AMA is a powerful lobby and an average office-based physician is not interested in coding, billing, audits, cost containment, or patient’s access to their notes. If you read between the lines of the AMA letter to CMS http://www.ama-assn.org/resources/doc/washington/icd-10-letter-to-cms-12feb2014.pdf, the office-based physicians would really like to simply send a bill and have it paid. It is not to say that they do not care about their patients as long as they remain their patient. Our whole healthcare system is hopelessly outdated and postponing the ICD 10 for a year or till the ICD 11 is ready is simply a consequence.

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  6. This is so unfair to our students who are getting ready to graduate in just a few weeks.

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  7. Icd 10 should only be implemented after extensive trial by all insurance carriers and specialty societies approve.

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  8. ICD 10 should only be implemented after extensive trial by carriers and acceptance by medical speciality societies.

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  9. Being two months away from graduation, I just wonder how this will affect the RHIT certification exam for this year. It’s very disappointing and discouraging to learn of this news.

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  10. This is very bad for students and staff that have been learning and teaching ICD-10 exclusively. What a mess. Congress is so broken and beholden to big money.

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  11. Just graduated and was taught ICD-10. Now my education that I worked so hard for is useless. I have worked hard and my family have sacrificed so much, this just doesn’t seem right.

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  12. For those of us preparing to take the CCS examination in ICD 10 for June 2014, what will be the course of action AHIMA will be taking regarding this situation? Will those us that have prepared in ICD 10 have to revert back to ICD 9 and prepare to take the CCS examination in ICD 9? Please advise.

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  13. Disappointing beyond words.

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  14. I am very upset about the time and money I’ve put into learning and relearning ICD10 (because of the delay) – but I feel most for the poor people who have been in school learning 10, but will now graduate without employment opportunities because they don’t know 9. How incredibly unfair

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  15. This is the biggest bunch of hull-a-ba-loo I’ve ever heard! The postponement of the implementation of ICD-10, is in no way going to impact public health!

    “Physician groups, including the American Medical Association and a coalition of nearly 90 state and national medical societies, have come out against H.R. 4302 since it does not provide a long-term solution to the SGR issue. The insertion of the ICD-10 delay section into H.R. 4302 was likely done to placate physicians who are against an SGR patch. The AMA has said they are against moving to ICD-10 entirely.”

    Thanking my Congress for the postponement! Finally, something that I agree with! Sorry for the “techies” that are going to have to look for other work over the next year and a half. ICD-9 isn’t that difficult, coders! If you can code ICD-10, you can certainly code ICD-9.

    Good luck everyone! And, congrats to the “small providers” that have a bit more time to save for this very costly implementation, and put some money in the bank to cover the lag in payment of claims that is going to happen in 2015 when implemented. I see this as another healthcare.gov catastrophe!!!

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  16. I will continue to be unemployed due to this delay. Many Families are being affected by this decision.

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  17. Yayyyyyyyuuu!

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  18. Saddened by the delay. As clinical documentation improvement specialist, we are prepared for the transition and this delay discourages everyone with the process of the new coding system. The time, money and effort of being prepared for Oct 1, 2014 has been wasted!!!!!

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  19. As one of the 25,000 students who have only been taught ICD-10, this is very frustrating. Mostly likely I will be paying for and attending classes for ICD-9 when I should be taking my certification exam.

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  20. For the past three years I have prepared to be ready for ICD-10, countless hours away from family training physicians and coders. Patients (WE) have the right to be diagnosed correctly , ICD-9CM , unspecified diagnosis do not report the severity of illness.

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  21. I am one of the students (mature) who has been working full time, going to school half time, to learn ICD-10, for the last two and half years. The hospital which I work for paid for my education, which I totally appreciate. This delay is unbelievable.

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  22. Where has the AAPC been on this issue? I haven’t seen or heard a peep from them; yet they have coders and have been selling ICD-10 products/services.

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  23. Our coding language is outdated and is in need of the overhaul I-10 brings. How will this impact the US’ relationship with the WHO organization and healthcare statistics globally?

    ICD-10 has been in the works since I started my career almost 2 decades ago. The issue is, and remains, that some providers are not taking this seriously and instead of working on getting there, they continue to complain to their respective medical society boards. The government does not help when they continue to make deadlines and not hold fast to them.

    The opposite of progress is TRULY congress!!

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  24. Chris, good coverage of today’s decision. Thank you for your leadership.

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  25. It is very unfortunate that the “first world” lags behind the third world when it comes to advancement in clinical diagnosis of diseases. Progressive leaders show by example that they know what is important and a priority, but this has not been the case with the USA. How long will the USA keep “kicking the ball down the road” and not take possession of it? The 30 year old coding of disease needs to be updated….I hope Washington leadership will come to that realization sooner than later!!!!!

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  26. So now we might be stuck using an outdated coding system for yet ANOTHER year. Hopefully, AHIMA officials are successful in making sure that the delay doesn’t occur legislatively. Since before the vote, I’ve been Dual Coding ambulatory charts in my hospital, using both the I-9 and I-10 code set. Non-coders need to understand that it’s almost impossible to update a coding system as outdated as ICD-9. I might consider not buying new ICD-9 coding books in protest just in case.

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  27. AHIMAs rabid support for ICD 10 implementation has made one thing abundantly clear: the National Coordinator for Health IT, and the National Center for Health Statistics (NCHS) along with their industry partners such as the ICD-10 Coalition do not give a damn about the survival of physicians attempting to survive under difficult circumstances. Their only concern is to continue to line their own pockets.

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  28. On the other hand, some of us, are celebrating : ) –
    Tired of the bureaucracy, parasites and pointless useless middle men..

    Signed, your friendly critical care physician, Olaf.

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  29. Wow,I am so dissapointed in our congressional leaders. How are we to move forward in HIT when there is patch after patch, and delay after delay in implementation? We all know this isn’t about introducing the new code set, it’s really about opposing parties trying to block the ACA until they can “BUY” a President to veto the bill. At the very least opponents want to repeal the individual insurance mandate. Thanks to our Congress, my newly acquired coding skills amount to a big pile of doo doo until 2015 or beyond!

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  30. Working as Program Manager on my third ICD-10 conversion project, I do understand the frustration that the industry is feeling; however, everyone needs to understand that we made this bed we are now lying in. The US is the only major industrialized nation that uses ICD coding for everything beyond what it was intended. We intertwined it into our medical billing, diagnosis coding/grouping, procedural payments and insurance systems. This is our fault, not those that do not understand the ICD system. Let us move on to Version 11 that at least supports a significant form of EHR/EMR which is the real medical advantage for patients, physicians and hospitals. This administration will ensure a single payer system soon, and then the ICD as a medical support system for billing will disappear as it has in the UK, Canada, and in other civilized nations. Socialized medicine removes the need for ICD utilization as a billing platform and puts it back into that of which it should have stayed – a way to categorize, track, analyze, and archive human medical conditions – not to bill for services, in my opinion.

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  31. It is extremely unfortunate for the thousands and thousands of students who could be entering the health information field but now cannot because we are “too advanced” for so many physicians. One of the largest growing career field is being brought to a screeching halt because a few complaining providers can’t handle change, even when the change is obviously for the good of their patients.

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  32. It’s just like our government to use a band-aid to patch up a leak. It’s NOT fair to all of the people who have followed the rules(not procrastinated) in order to get ready. There has been more than enough time for this to fall into place. I am more than ready for this implementation. It makes me sick how the ones who drag their feet get rewarded(enabled) once again, and all my hard work gets pushed aside. Maybe we should just jump into ICD-11 and just be done with it…. Very Frustrated!!!!

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  33. Why couldn’t we push to have another bill passed to include a revised effective date of 10/1/14?

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  34. Maybe a good speech but it was not in favor of ICD-10.

    “In separate legislation (H.R. 1701/S. 972), Representative Ted Poe (R–TX) and Senator Tom Coburn (R–OK) would block implementation of the ICD-10 and require the comptroller general of the United States to conduct a study on the impact of a transition from ICD-9 to ICD-10 and make legislative recommendations.”

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  35. If we are not using ICD10, why do we have to use the new claim form already?

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  36. Sorry about your last four years learning icd 10. welcome to the world of gov medicine. To force implementation of a coding system that has not been tested end to end would be a second disaster to the gov health system. thousands of medical groups and providers are not ready for icd 10.Force CMS to test and certify that it does work before requiring icd 10 in effect

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  37. I am in my last months of completing my bacholors in Health Information. Since the RHIA exam was slated to change later this month, how is the exam affected? Will exam remain unchanged until next year? I was planning to take the exam in September of this year.

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  38. Someone please explain to me how would one become coder if you’ve only been trained in ICD 10. The tests are now using ICD 10. What will jobs do with newly certified coders who don’t know ICD9? What are the coders supposed to do for the next year? Will there be changes made to this complete draft set? Will this push people away from coding, since we’re so together? Will we be visiting this same discussion next year? Does not the Senate nor the House realize what they’ve just done? Am I in the Twilight Zone? Should we all be on our knees praying for a veto!

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  39. Senator Coburn – sorry you can’t retire, that would leave a intelligence void in the Senate concerning the medical community. Get healthy and get back in the game!

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  40. The small practice MDs were panicking, but doctors don’t have to code, this is why we have coders! I contacted all my representatives and no one let me know their position, it’s like they don’t know what ICD-10 is. I do applaud Sen. Wyden who is trying to have a permanent doc fix done, I’m sure he was too busy working on that to pay attention to the ICD-10 delay. The government should reimburse all the students’ tuition.

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  41. Will this affect all payer types? Have you heard anything from the commercial / managed care insurance companies as to their intent? Are they going to follow suit and delay icd-10 rollout as well?

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  42. What does this mean for students who have been prepared for a job market of ICD10? It seems one group was placated but at the expense of many others.

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  43. “…..at least October 1, 2015″?! ICD-10 is dead. Long live ICD-11. Better get ready now for 2018. What, you don’t have an ICD-11 steering committee. You’re already behind.

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  44. I was a bit concerned that payers were not ready. We were not hearing positive feed back therefore our group was concerned about hold ups in payments. Although, we were ready I prefer ALL payers to be on board. Considering the constant battering of the physician fee schedule, changes and loss of revenue in other areas physicians cannot afford to have an additional delay in revenue.

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  45. I have spent thousands of dollars and spent almost 2 years of my time learning ICD-10 as a student. This is very frustrating to those of us that have been learning the new code sets to obtain a career in the Medical Coding field as well as to those that have been working in the field and trying to learn ICD-10 to make the transition. It is kind of discouraging to us students as we don’t know what this will mean for us now.

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  46. I just finished a coding certification that had ONLY ICD-10, and just over a week ago signed up for my CCA exam–an exam that transitions to ICD-10. (Not to mentioned paid for current coding books for the exam!) I thought this would help me get a coding job, but I don’t know how anymore! I put a lot of time, effort and money into this, and am left with really nowhere to go!

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  47. I am at a complete loss as to what us students will do that have been in school the last couple of years learning ICD-10. I am 5 weeks from graduation in something that now we don’t even know when it is going to be implemented. I don’t know what to do now. I was planning on taking my ICD-10 certification this October, but what good is that going to do me now? My college doesn’t even offer ICD-9 classes anymore because they were instructed to only teach ICD-10, so I am not trained in or do I know ICD-9 coding. I am just devastated.

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  48. BRAVO to the 35 Senators who voted NO!! So sad that our US Senate voted to approve H.R. 4302, Protecting Access to Medicare Act of 2014, which included language delaying the implementation of ICD-10-CM/PCS by at least one year. The vote was 64 to 35 at 6:59 p.m. ET. The bill now moves to President Obama, who, unfortunately, is expected to sign it into law.

    Congratulations to the AHIMA Board, Staff and members for rallying so hard and giving a good fight for #NoDelay!! I am proud to be a member of AHIMA.

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  49. I understand everyone’s point of view on how frustrating this can be for them, especially those who are presently working in the field. But the students who haven’t learned ICD-10 and who have just graduated only have a limited amount of time to pass the RHIT/RHIA examinations. It is not the students fault that they were not taught ICD-10 when they should of been, just in case it went into effect. Not all education systems are teaching ICD-10, ex: Rasmussen College. Some students were taught ICD-9 and some were ony taught ICD-10. I believe that the edcuation systems and AHIMA need to communicate more effectively on a better way to implement a better program for students (especially online students) to successfully learn and pass the RHIT/RHIA examinations. Some people are hoping for ICD-10 not to be in effective, obviously for different reasons.
    Thank you.

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  50. The comments are all very interesting. We must not forget….This is not all about coding. This is an entire health care industry reboot. Billions of dollars has already been spent on IT infrastructure, education, and implementation. Physicians are being heavily impacted because the documentation required for ICD-10 is much more specific. No one can code in 10 unless the documentation by physicians and other clinicians is appropriate. This is also not about government medicine. This is about our representatives in government listening to those who are lobbying against advancement past ICD-9, which is completely ignorant. Keep on fighting. We have to implement ICD-10 before moving to ICD-11.

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  51. It’s early days yet as to what we will do academically regarding teaching ICD-9 and ICD-10 given this new delay. For recent grads and near grads I would suggest you focus job seeking on other areas of HIM – Release of Information, Clinical Documentation Improvement, Data Management, training, etc.

    Rather than focus on lost opportunities, let’s focus on the fact that HIM is a multi-faceted career field – if your program was light in some of these areas, go back and re-read your texts, do web searches and educate yourself on the topics, and offer to do some volunteer work in a HIM department on that area so you can gain some practical experience in that capacity.

    It may not be what you want to hear…but it is what you need to hear.

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  52. If we don’t implement ICD-10 this year, healthcare industry will be without new medical coders for a year – year and half. There a lot of new ICD-10 coders ready to take exam and start working, but there are no educational facility teaching ICD-9 anymore.

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  53. As an office administrator of a small group, specialty practice I can say that my doctors, office staff and I all feel like an anvil has been lifted from us. A temporary reprieve has been granted and now we can focus on taking care of our patients, not on the ICD-10 implementation. Our government is going to drive medical practices into bankruptcy with all the regulations and jumping through unnecessary hoops over and over again with first one thing then another. The inmates have been running the prison long enough!! No one in their right mind is going to want to go into medicine in another 10 years. Who is going to take care of the patients then? FINALLY some glimmer of common sense has come out of Washington.

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  54. I am a career changer who returned to school, and just graduated with an associates in HIM March 1st. My ICD9 classes were cancelled, and I was enrolled in ICD10 content courses because the school no longer was teaching ICD9. I was supposed to be moving forward, but this dream has been ruined. Plus, my student loans are due to begin being paid this June. My chances for landing a job just diminished. Hey Congress, how about an extended delay in making me repay my Fed student loans since it was your votes that screwed me over.

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  55. ICD-10 was first introduced in 1992. So-called physicians and the AMA and others with vested interest in protecting their patented and registered CTP Codes have won again by anonomously and cowardly slipping in the ICD-10 adoption delay. Most likely it was some highly paid lobbyist’s back-door finagle — in line with how the paid political hacks calling themselves US Senators and US Representatives conduct business these days in the name of the public who pay their salaries and healthcare costs. Perhaps American physicians are not capable of dealing with the “new” ICD-10 coding. If so, perhaps they are not capable of dealing with medicine in 2014. Shameful and disgusting. No wonder European and Canadian physicians question the abilities of our ‘protected’ medical professionals.

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  56. I can’t believe all these colleges/learning institutions only taught ICD-10. That was a bad decision. And now the students will pay for your negligence. Have you not learned anything since the current President has been in office? Due to the many stalemates and Dem/Rep arguing, nothing has been done since Obama took office. And it will remain so until he is gone. It is sad these students weren’t taught ICD-9 also. When it does go into effect, that coding classification will still be needed. Can’t understand why both ICD-9 and ICD-10 weren’t taught. Sad situation.

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  57. I understand why the student’s anxiety level has increased. My concern is that we don’t have any planned updates to ICD 9 this October and only have minimal updates last year. ICD 9 is a dead classification system.

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  58. Re: the comment as to why learning institutions have switched or are in the process of switching to solely teaching ICD-10 over ICD-9 is, perhaps, in part a matter of time (and cost). Courses have only so much time designated to address the material; many if not all learning institutions have to abide by regulatory mandates at various levels (state, regional, federal, and accrediting organizations) that require change-submission documentation and associated fees when credit hours in a given program change. How do you adequately teach more coding content (to address the differences between ICD-9 & ICD-10) without allotting more time? It’s not a simple matter … much more involved in this process than people outside the industry — including members of Congress — likely realize or appreciate.

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  59. What will ahima do about the rhit exam after April

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  60. Astonishing ignorance is all I can write here.

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  61. I think it was a big mistake to postpone any longer but also wonder why we have to have 7 digit codes in ICD10. Providers will
    have to spend so much time documenting they won’t have time to see patients. It is the patients who will suffer once again.

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  62. Has anybody from AHIMA considered starting a petition to get the ICD-10 implementation put back to 2014? Change.org has shown to be effective, also the White House has a place where you can petition them directly. Enough signers and they have to address it.

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  63. The comments are interesting. Yes – we can code from poor documentation in ICD-10 just as well as we can in ICD-9, it is just as non-specific as it was before. The AMA should be the biggest propoponent for ICD-10 in the health care industry, as they should support the most specific information available for purposes of reseach, disease tracking, and epidemiology. I wish CPT was subject to Congressional approval, perhaps that would open their eyes. We, as industry, need to be united on the subject of ICD-10, quit trying to blame it on the ACA, the President, or whomever someone wishes to blame it on. Watching the Senate in action yesterday was appalling in re: to the lack of consideration of what was included in this Bill, the format of the voting; but even worse in the House where they didn’t even record the voting record. We have work to do!

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  64. I’d like to see an intermediary period where people can submit either/or. That way they can switch over as their software is ready, and as their billing staff is changed. I don’t like this flipping a switch model. It’s just going to lead to unpleasant surprises and medical providers with a delay in payment as they work any bugs out that weren’t caught in their testing environments.

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  65. I’ll confine myself to one comment: How can anyone, in any industry, be expected to do business without some assurance that final rules are actually final? You may not like the provisions of a rule but it’s been through the democratic process and at least you know know what’s coming and can plan for it. This kind of instability creates chaos. In addition to every other problem with delaying ICD-10, it’s just plain bad for business.

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  66. Svetlana on April 1, 2014 at 10:20 am said:
    If we don’t implement ICD-10 this year, healthcare industry will be without new medical coders for a year – year and half. There a lot of new ICD-10 coders ready to take exam and start working, but there are no educational facility teaching ICD-9 anymore.

    Svetlana, I think there are plenty of us already around who can do both and our world isn’t going to end either way. We aren’t clueless and we’ve worked hard to gain our knowledge over the years. I’m not sure what your concern is?

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  67. This is so upsetting as a coding student. I will graduate this May with my coding certificate. Fortunately I have had classes in ICD-9 and 10 but I was hoping for better job prospects with my 10 training. Now I don’t know if I will be able to get a job. What coders will leave or retire now because of the delay? Why should they? Will there be a need for new coders now? Probably not. There has already been one delay. Now the second one is here. How many more will we have. So now we will have to take the certification exam in both ICD-9 and 10? From what I have read here, the delay is costing millions of dollars. Who is benefiting from this delay?

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  68. Margarita – Thank you for posting the link to find each senator’s vote. I called both of mine to voice my opposition. But both of them voted Yea. I can’t believe I voted for these two bozos.

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  69. Obviously people are upset but the rhetoric may be getting out of hand. Implying that not implementing ICD-10 is a “risk to public health” could be an exaggeration. It is highly unlikely the delay will cost any lives. Other countries of the world are moving to ICD-11 in 2017. It seems the US is always one code set behind the rest of the world? Why not just move to ICD-11 in 2017 along with them? We certainly DO NOT have to “implement ICD-10 before we can move to I-11.”

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  70. It surprises me that diagnostic coding with both ICD-9 and ICD-10 is not being taught. Anyone who has had to deal with billing knows that non-HIPAA covered entities would not be required to use ICD-10…it is just in their best interests to convert. Tell that to Worker’s Comp! That being said, the coding methodology is the same…look in the index, go to the tabular, read and follow instructions and guidelines. The emotional hype that has arisen over the conversion is out of proportion. Yes, we won’t be able to easily 10-key input and no more memorized codes (at least for a while!), hence a big slow-down until we get used to the new code set. The major impact is to the providers who will have to document better (which has always been a challenge), to the systems to be able to handle the increased alpha/numeric codes, and to insurance carriers to reprogram the computers to match CPT/ICD-10-PCS to the new diagnosis codes to avoid denials. The contract coders who have been temporarily hired to dual code during the transition may be the worst hit because now their services may not be needed to fill in the gap. Us older coders had to be prepared to learn the new code set and we have…so get an ICD-9 book, look it over and you will see that not much has changed really.

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  71. With the limited testing CMS had planned, there is not a wisp of a chance that CMS is ready to process claims coded in ICD-10 in October 2014, 2015, or 2114. They live in a very special part of the ethernet.

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  72. I recently graduated as a HIT in ICD9. What is going to be on the RHIT exam, ICD9 or 10?

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  73. I am very disappointed in the decision as well. I spent my own money preparing to learn I-10, and then with the help of my employer became a I 10 train the trainor, and we just finished our 8 week sessions and everyone was ready to get this started come October. We were just going to start next week with our dual coding to see where we were and now for what…this was all for nothing a waste of my last year…personally and profesionly. I agree with Meagan we need to petition the White House. From my understanding ICD10 was not even brought into the discussion before the vote. The 2 Senator’s that tried to get another bill (with I-10 revision taken out), my hats go off to you, and maybe if there would have been more discussion about that part allowed it would have turned out much differently. The United States is suppose to be world class….how can that be when we can’t even implement ICD-10…come on…people across the board have been given more than ample time to prepare for this….stop crying and just put your minds to it and get it done. We have to jump through some pretty inconsistent and stupid payor rules all the time……concerned but annoyed coder in Michigan

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  74. In response to the comment from a specialty group “I can say that my doctors, office staff and I all feel like an anvil has been lifted from us.” I understand your concern, however, if you don’t see an implementation of a more refined code system like I-10 you may see payment changes anyway. ICD-9 is old, cramped and cannot take any more additions. Technology, identification of diseases and clinical treatment outdistanced I-9 years ago. Payment comes on codes. Old codes don’t reflect current practice. Change is inevitable. This reprieve gives you time to start learning I-10 and seeing how it is advantageous to give a true picture of disease processes and treatment. This is not just about outpatient treatment – it is about inpatient treatment also.

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  75. What will be on the RHIA and RHIT exams a after April 17, 2014.

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  76. I followed the link posted above to comment on pending legislation. Too late. Obama signed it. We are officially on hold.

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  77. It would be nice if all of the schools would offer a crash course, (perhaps summer school?) to all of their students that have only learned ICD-10 so they can still move into coding positions.

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  78. For the HIT educators who are talking down on students you should be ashamed of yourselfs. Of course we have high anxiety. We are worried about the education we paid for. Most of us have been reading and studying since we graduated. And most of us already know that have to get any kind job that involves getting our foot in the door with the HIM field, even if it risks a pay cut. What I don’t appreciate are the people who have been in this field and are talking down onto the students/individuals who are worried. Please think before you speak/type.

    Sincerely,
    A hard working student

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  79. Do you understand that they are planning to shut down until all the training is done? They are telling physicians, hospitals, & ambulance providers they will not receive payments for approx 6 months?!! I understand the transition needs to be made but they obviously need more time to figure out a smoother transition!! I dont for see many dr offices, hospitals, or ambulance services surviving that long w/no payments from government!

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  80. We have been the victims of irresponsible legislators and private interests again. Both the House and the Senate members voted without discussing the bill and without regard to what it contained. ICD-10 was irrelevant to the subject of the bill.
    They should all be out of a job. As some mentioned it, AMA should not be trying to eliminate ICD-10. AMA’s interest in their CPT product is blinding them.

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  81. I agree with Sue Roehl. As an May 2014 graduating AAS HIT student, and having worked as an account manager for a transcription company, the fact the AMA is so compliant to stick with diagnosing, treating, documenting, analyzing, researching and reporting our country’s population health using a very limited code set based on 35 yr old info regarding diseases, and injuries is sad. The primary focus is to advance what we do for our healthcare consumers and how we report and utilize the info regarding the services. I remember back in 2008 when I started in this field, I questioned the extent of quality in the documentation being submitted by providers, and noted how we should be advising them about best practices. The physicians’ reporting of healthcare services rendered ignites the entire process. Their component needs to be held to a higher level of accountability to help us all ensure efficient and quality care from visit to billing and beyond.

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  82. I think we need to do something. I have sent something to Obama and I think we need to start something on Change.org. I am game.

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  83. Our company ( MD On-Line ) have already implemented ICD-10 in our EMR/PMS software. Cheers !!!

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  84. This is for the best for now. There are too many changes too fast going on in the medical field and patient care is going to suffer. We already have changes from ObamaCare and electronic medical records to deal with. Let’s get comfortable with all that change first, then switch to ICD-10. Focus on one thing at a time so patients do not suffer.

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  85. I have been vocal on the LinkedIN AHIMA group about how the delay may affect students. Thank you to the other educator here who recognizes that students can utilize other strengths in their programs to bring to bear in their job searches during this time of uncertainty with the coding classifications. This is sage advice. I also appreciate the person who recognizes the challenges of curriculum. Academia does not lend itself well to a fluid environment. The program I direct will be exploring in the coming days and weeks how we can best utilize resources to help students. Challenges may seem to prevail for the time being, but they are challenges that can be overcome. We must all continue to work towards our goals, even if it involves Plan B or beyond.

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  86. I didn’t read all the comments so someone might have said this already, but I don’t necessarily think being taught only ICD10 will affect new coders getting a job. You can still code, can’t you? It’s the same concept. What does it matter if ICD10 is delayed? You still know how to code, right?

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  87. I work for a state agency in DE that serves adults and children with developmental disabilities, and like the rest of the country, the Division I work for has been busy preparing for the transition to I-10. I’m not sure yet that news of the delay has even reached the senior leadership of the Division, but when it does I am sure there will be some comments about it. It’s going to cost the Division and the state money- a lot of money- to delay this for another year.

    The one bright spot in all this, at least for me, is that I no longer under as much pressure as I was to try to find an affordable way to update my coding skills so my credential doesn’t become invalid. It hasn’t been easy to do this, because unlike most credentialed HIM professionals, I don’t have the luxury of having an employer who will pay my tuition so that I can do some real professional development. The universities and colleges in this area do not offer classes in I-10, and some of them don’t even offer I-9 classes either. So I am stuck in a lot of ways. News that I don’t have to race to find a program that I can afford on my own for awhile is a help.

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  88. Small one doctor operation, few out side the unreal world of school have a clue about life in the trenches. New claim form April 1, 2012, interesting day for that to start, following with a completely new coding system that was to start October. Please! I may have spent more on my new computers, software, staff training, and can we price aggravation. Go back to your schools and question them directly you won’t get a straight answer from the government.

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  89. My question lies in the issue that to the rest of the world ICD-11 will be introduced in 2015. Are they now going to scrap ICD-10? They just keep dragging their feet on this implementation but the rest of the world seems to be moving ahead.

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  90. I do not see how pushing back the deadline for ICD-10 will help the medical field. It wastes money and valuable time of students and professionals. The deadline was already pushed back once and has given plenty of time for all medical personnel to get proper training and integrate the new system. No matter when ICD-10 starts there will be set backs and challenges, why put it off any longer?

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  91. Not moving to ICD-10 has saved me a lot of money and aggravation. As a small city doctor I can see no benefit from switching to ICD-10. It doesn’t make anything I’m doing to serve patients health care needs remotely better.

    Funny thing is I have put off doing anything toward transitioning to ICD-10 as I anticipated that it would be delayed. I so glad I turned out to be correct.

    I’d like them to scrape the whole concept as it makes no sense to me whatsoever.

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  92. I am tired of the excuses offered as justification for delay. We have had several postponements, which means there have been several years to prepare. This wasn’t a rush job forced on anyone. The excuse that doctors will spend all of their time documenting and won’t have time for patients is sheer lunacy. Other countries have been operating just fine. If you’re familiar with ICD-10 at all, you’ll know that the only extra documentation required is a few extra words. Shouldn’t accuracy and completeness be of the utmost importance in healthcare? If these are the kinds of excuses offered by the healthcare community, I seriously question the quality of healthcare in this country. My worries now aren’t about the implementation of ICD-10, but instead about what kind of mess have I and others really stepped into by seeking a career in healthcare.

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  93. Here’s a couple facts for this advocating for ICD-11:

    1. ICD-11 won’t be released until 2017. It was just delayed two years. What’s to say it won’t be delayed again?

    2. Once released it has to be modified for use in the United States. Based on experience with ICD-9 and ICD-10, that would take about 4-5 years.

    3. Once modified it has to go to “rule-making” which can add another 2-3 years.

    4. Once rules are passed and accepted, then the conversion activities can start. I won’t even guess how long that would take. But let’s be optimistic and say 2 years.

    So 2017 + 4 + 2 + 2 = 2025 before we get up on ICD-11. More than another decade from now?

    So let’s wait for ICD-11? Really? Really? Get real.

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  94. I think that this is mixed news. As for myself, I’m so glad that I listened to my career counselors’ advice and trained in ICD-9. Actually, I was worried about finding a job and then only using my training for a few months until I had to train for ICD-10 and perhaps spend more money. Now I can at least get my monies worth from my training and have more time until I have to train for ICD-10. However, I do sympathize for those of you who have been adversely affected by this. My best wishes for all of you.

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  95. Wow this is shocking to me…I mean we already have alot of people out of work and delaying this after some students are ready to take exam and start thier new jobs in thier new career is sad…Hopefully Mr.Obama will take some consideration and try to look at the whole picture.

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  96. Aside from the fact that ICD9 is flawed and outdated, forcing new procedures (which came out after ICD9 was implemented) into the same code categories as completely unrelated procedures while leaving many procedures “unspecified”, there are many reasons Congress should NOT have delayed ICD10. Europe, Canada and nearly every first world nation is already on ICD10 (England since 1995), making the transfer of medical records between nations nearly impossible. The CDC and NIH is not receiving accurate information on diagnoses, procedures and outcomes. Hospitals are not receiving accurate reimbursements, all because ICD9 cannot possibly code with accuracy (especially new procedures). If the CDC and NIH cannot tell what is actually happening in our healthcare, how are we to move forward.

    On a moral note, this delay punishes responsible, law abiding behavior and rewards irresponsible behavior. Those entities who spent the money, time and effort to become ICD10 compliant by Oct. 2014 are being told that they have essentially flushed their money down the toilet. Those entities that shirked congress’ laws and were not ready, are receiving a free pass. What does this tell our healthcare professionals? Don’t listen to congress, if you spend your money training ICD10 coders per congress’ demands, you will have paid to train people you cannot employ. If you ignore congress’ laws, they will let you off the hook anyway.

    I left a good job to enter a 6 month training program to become an ICD10 coder. The hospital who is training me, spent hundreds of thousands getting a building with a classroom, a professor, books, computers, projectors, a curriculum etc. All because congress said they HAD to be ICD10 compliant. Now we are all out of a job, and the hospital’s money was wasted. In an economy where healthcare is already strapped for cash, making layoffs and watching quality of care suffer, this bill may be the dagger to the heart.

    I may be out of a job because of these clowns, but at least I know I am overqualified to be a Senator. But what else should we expect from American government….clowns.

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  97. the money spent on coding as become insane! it will never stop !
    patient care has taken a back seat to the “process of patient care” follow the money trail it leads to icd 11 ! the codes are not filled out correctly in the first place and the error rate with icd 10 will be evem greater !

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  98. One more delay in the list of many for this administration. ICD-10 coming into play in October–right about the same time millions more will be negatively affected by the Unaffordable Care Act equals less votes for Democrats. They’re just trying delay the implosion of the healthcare system until after midterm voting takes place.

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  99. I am about to complete the ICD-10 program, and can not take the certification until next year sometime, I spent a lot of money on this program only to delay my education process to make a decent living wage, another thanks to the not so great people who made this decision without considering the effect on the people training for this new coding program. Note: cant wait for the elections !

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