A new bill introduced into the US House of Representatives proposes a two-year “grace period” for accepting codes submitted in ICD-10-CM/PCS.
The bill, H.R. 2652, Protecting Patients and Physicians Against Coding Act of 2015, was introduced by Representative Gary Palmer (R-AL-6) on June 4.
The legislation is the third ICD-10-related bill to be introduced into the House of Representatives in the last five weeks. On May 12, H.R. 2247, the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act) was introduced by Rep. Diane Black (R-TN-6) calling for an ICD-10 transition period. On April 30, H.R. 2126, the Cutting Costly Codes Act of 2015, was introduced by Rep. Ted Poe (R-TX-2) seeking to outright stop the replacement of ICD-9 with ICD-10. Neither bill has gained much traction since being introduced. Black’s bill currently has only five cosponsors, and Poe’s bill has nine—much lower than the 46 sponsors this same bill had when Poe first introduced it in 2013.
H.R.2652 would create a two-year grace period where healthcare providers’ ICD-10-based claims submitted to Medicare and Medicaid would not be denied due to coding errors. Implementing this grace period would ensure physicians are not negatively impacted while ICD-10 is “fully implemented within the healthcare system,” according to a letter sent by Palmer to fellow Congressmen asking for their support of the bill.
Similar to the Black bill, H.R. 2652 would not delay the October 1, 2015 implementation deadline for ICD-10 use, but would require the Centers for Medicare and Medicaid Services (CMS) to pay for claims even if inaccurately coded. Palmer states in the letter that this grace period would create a “true transition” to the new code set, and is needed in order to allow physicians “to grow accustomed to ICD-10 over a period of time without being penalized for unintentional errors.”
During the two-year grace period physicians would not be penalized and their payments would not be withheld by CMS due to “coding errors, mistakes, and/or malfunctions of the system,” according to the bill. The Department of Health and Human Services (HHS) would also be required to conduct a study on how the transition to ICD-10 has affected physicians and other healthcare providers, and state how well HHS has helped physicians transition to the new code set.
The bill is needed, Palmer said, because small and rural physicians have not had adequate time or resources to transition to ICD-10, and that learning to do so by October would harm their ability to provide quality patient care and receive proper reimbursement.
Other healthcare stakeholders have argued that the transition time from ICD-9 to ICD-10 has been ample enough. Also, ICD-10 advocates have pointed out that currently CMS offers numerous resources to help physicians and other providers with the transition, including fact sheets, checklists, guides, timelines, teleconferences, videos, and local training programs, through their Road to ICD-10 website located at www.cms.gov/Medicare/Coding/ICD10/index.html.
“Although another delay would assist many in the medical community, if ICD-10 is to be implemented on October 1, patient care should not suffer,” Palmer’s letter states.
This is not the first time Palmer has tried to stop ICD-10’s outright October 1 implementation. In March he unsuccessfully tried to introduce a delay amendment into the Sustainable Growth Rate replacement bill during the House Rules Committee process.
H.R. 2652 had 32 co-sponsors as of June 8, and has been referred to the House Committee on Energy and Commerce as well as the Committee on Ways and Means.
AHIMA Against H.R. 2652
AHIMA officials have said they are against this bill since the grace period would lead to inaccurate coding, improper payments, and potential medical billing fraud. With no official repercussions for inaccurate coding, AHIMA officials said they feel it would open the door to both intentional and unintentional coding errors—improperly paid claims at best and rampant fraud at worst—since proper payment of claims depends on accurate coding. Coverage determinations and validation of medical necessity of healthcare services also depend on codes submitted on claims, and would be impacted.
Also, claims data are used for many purposes beyond payment, including health policy decisions, assessment of quality of care, patient outcomes and safety, and evaluation of costs. Allowance of miscoding on claims will render claims data useless for any purpose, AHIMA officials said.
There are already appropriate mechanisms built into ICD-10-CM for reporting less specific codes when necessary and appropriate. There are “unspecified” codes in both ICD-9 and ICD-10, and unspecified ICD-9 codes are currently already allowed in Medicare fee-for-service payment systems, AHIMA officials said. There is no indication that allowance of unspecified codes will change under ICD-10.
While this bill implies that the increase in the number of codes in ICD-10 will cause hardship for physicians trying to find the right code, AHIMA officials counter that physicians and any other medical biller won’t need to learn every ICD-10 code in order to properly bill.
Just as no healthcare provider uses every code in ICD-9-CM today, physicians and other providers will not use all the codes in ICD-10-CM, AHIMA stated in an ICD-10 FAQ.
Physicians should use a subset of codes based on their practice and patient population. “The ICD-10-CM code set is like a dictionary that has thousands of words, but individuals use some words very commonly while other words are never used,” the FAQ states. “Also, laterality accounts for nearly half of the increase in the number of codes in ICD-10-CM–information that is typically already documented in patients’ medical records.
AHIMA officials have said the grace period is unnecessary since CMS end-to-end testing has shown that only two percent of claims were rejected due to ICD-10 coding errors during the most recent testing period, which ran April 27 to May 1. This is actually lower than the number of claims, 3 percent, currently rejected by CMS after annual ICD-9-CM code updates.