ICD-10 ‘Grace Period’ Bill Introduced in US House

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.

Close Up Angle Capitol Building DomeThe 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.

20 Comments

  1. It seems the only one that might gain traction is H.R. 2652 with the 32 co-sponsors. Does anyone know when the House Committee on Energy and Commerce and the Committee on Ways and Means might say either yea or nay to it?

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  2. Wonder who is funding the opposition, and why?

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  3. Icd-10 implementation should be postponed as it will hinder patient care and require too much money, that private physicians and hospital do not have to spare to continue giving the best care for their patients. The timing is off, as our healthcare is suffering enough without additional problems to hold back the quality of our medical patients.

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    • ICD10 has absolutely nothing to do with how providers will continue to care for their patients. Patient care will not be hindered in any way. ICD10 has everything to do with how providers document the treatment of their patient.

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      • I agree Chris. ICD-10 will make coding easier and more convenient for physicians and billing. How much does Congress actually know about ICD-10 and how it works?

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    • ICD10 has already cost my employers thousands if not hundreds of thousands of dollars in new training and software changes for a large hospital system. If it doesn’t go through all that money will have been wasted.

      This has been an ongoing process for the last few years, so the training could have been a gradual process instead of last minute like some are doing. This will in no way affect patient care other than the fact that the diagnosis can be documented more accurately.

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  4. The bill, H.R. 2652, Protecting Patients and Physicians Against Coding Act of 2015, was introduced by Representative Gary Palmer (R-AL-6) is in essence asking for permission to commit fraudulent coding and billing. I hope that the members of the House will see the error of opening Pandora’s Box.

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  5. Most physicians don’t code, they need to chart what transpires. Isn’t there also a check sheet that supplies ICD 10 code equivalent to ICD 9? Change is difficult for some, but must be done.

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  6. I am currently enrolled in taking classes to get my RHIT. In all of our classes we are learning about ICD-10 not ICD-9. If we keep putting off the ICD-10 arrival, these classes will be somewhat useless. When will this be decided??

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  7. REALITY is that there is not enough coders FULLY trained to adequately code ICD10 correctly. I have coded for over 20 yrs. I get calls for jobs all day everyday. sometimes they are worst than bill collectors. The recruiters are in a state of panic. It is the inevitable that this will be a disaster. #nightmare.

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    • Would appreciate some calls for coding!!!

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    • I agree with this, that is my biggest concern in transitioning to ICD 10. I am not alone, many of my coworkers feel the same way. This is going to be disastrous for a health care system already in a mess. Who makes these decisions? They obvious have no concern for the global picture/outcome. Staggers the imagination.

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  8. ICD-10 has no affect on patient care. This has been postponed too many times already, it is time for us to catch up with how the rest of the world is coding and billing.

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  9. The rest of the world is far behind us in every aspect of healthcare including coding. Our ICD10 is far more advanced than what the rest of the world is using, that is why it has taken so long for its implementation. It had to be upgraded to be used in our health care system as ours is beyond any in the world.

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    • Jeffrey Pike? Are you serious? Do you know anything about healthcare and coding? WE are so far behind the REST of the world which has been using ICD-10 codes for quite a while now and is already looking ahead to ICD-11 and 12.

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      • SO TRUE, SARA, SO I ALWAYS WONDER WHY THEY JUST DIDNT START US OFF WITH icd-11,12 WHEN THEY KNOW IN A FEW MORE YEARS THAT WILL BE OUR FOCUS.

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    • Jeffrey, the rest of the world has been using ICD-10 for more than 20 years now and is planning on transitioning to ICD-11 in the near future. Other countries do not use coding the way the US does, every other country only uses the coding process for documentation and statistical purposes as they are all government health programs. We are the ONLY country that uses the coding system as a determination of payment to the physicians and facilities. We did not transition to ICD-10 when the rest of the world did due to the -CM part of the equation. The -CM means Clinical Modification, almost every country has their own version of ICD-10, however, the US is the only country that has allowed Politics to play a roll in it’s implementation. Believe me, I am not in favor of a one payer, government health care program for the US, but I am not in favor of our politicians making decisions about how our physicians and hospitals deliver our health care either!

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  10. In reference to physician practices that aren’t prepared and ready for the transition of I-10, here is a kind suggestion or solution. Research and locate a reliable credentialed AHIMA approved I-10 associate or agent(Out-source) to perform your billing services need, perhaps have them provide some additional training to you and or your staff. This solution could initially provide some relief when I-10 is implemented and to help curve a potential backlog of claims submission rejects. Being proactive in this transition from I-9 to I-10 implementation would be far more rewarding as well has compliant that your billing claims would be approved and paid.

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  11. I think, the ICD-10 is a big Challenge for health care industry, especially physicians, and Billers.

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  12. Does anyone know if any feedback from payers will be provided, regardless of the lack of denials? It won’t serve much purpose to provide for a grace period if coding accuracy isn’t honed during this time frame.

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