Physicians and other eligible professionals are expected to implement the International Classification of Diseases–10th edition (ICD-10) diagnostic coding system effective Oct. 1, 2015. Under ICD-10, the number of diagnostic codes would increase from the 13,000 currently in place under ICD-9 to more than 68,000 codes.

Many physicians and medical associations, including the American Association of Orthopaedic Surgeons (AAOS), have focused on the difficulties in moving to the more complex ICD-10 coding system. In addition to providing members with education and resources to help them make the transition, AAOS has worked with Congress to encourage consideration of alternatives to the mandate. In response, various measures have been introduced that address the concerns of physicians.

Cutting Costly Codes Act
Rep. Ted Poe (R-Texas) has introduced HR 2126, the Cutting Costly Codes Act of 2015, which would prohibit the Secretary of Health and Human Services (HHS) from replacing ICD-9 with ICD-10 entirely. The bill has been referred to the Energy and Commerce and Ways and Means Committees. According to Rep. Poe, “Big government must get out of the way and let doctors do what they were trained to do—help people.” Similar legislation was introduced in 2013, which the AAOS supported.

“The new ICD-10 codes will not make one patient healthier,” said Rep. Poe. “What it will do is put an unnecessary strain on the medical community, which should be focused on treating patients, not implementing a whole new bureaucratic language. Instead of hiring one more doctor or nurse to help patients, medical practices are having to spend tens of thousands [of dollars] just to hire a specialist who understands the new codes.”  

In May 2015, AAOS sent a letter of support to Rep. Poe stressing the need to prohibit the transition to ICD-10. AAOS pointed out that adopting ICD-10 would be costly to implement, detract from patient care with very little benefit, and will likely disrupt revenues in physician offices across America.

“It is clear from the limited testing of ICD-10 use that electronic health records, hospitals, physicians, and payers are not prepared for processing claims in the efficient and prompt manner that we have come to expect,” wrote David D. Teuscher, MD, AAOS president. “Prohibiting the transition to ICD-10 will enable physicians and other stakeholders to assess an appropriate future alternative to such a burdensome regulatory requirement and help to reduce costs weighing on physician practices, as well as help to keep new, more efficient models of healthcare delivery and payment on track.”

The bill already has a number of cosponsors, including Reps. Blake Farenthold (R-Texas), Tom Price (R-Ga.), Phil Roe (R-Tenn.), and Mike Rogers (R-Ala.), but challenges remain. Rep. Joe Pitts (R-Pa.), chair of the Energy and Commerce Health Subcommittee, supports the transition to ICD-10 without further delays.

Transitioning effectively
Taking a different approach, Rep. Diane Black (R-Tenn.) introduced legislation that would provide for a transition period rather than an all-out delay. The Increasing Clarity for Doctors by Transitioning Effectively Now Act, HR 2247, asks HHS “to provide for transparent testing to assess the transition under the Medicare fee-for-service claims processing system from the ICD-9 to the ICD-10 standard, and for other purposes.” The bill would have HHS closely monitor ICD-10 implementation for 18 months to ensure that unforeseen issues are being addressed. It would also prevent rejection of claims and denial of payment based solely on subcoding specificity during the transition period.

AAOS has written to Rep. Black, supporting the 18-month “safe-harbor” period, but urging her to consider adding language that would allow a transition period of 2 years, especially considering physicians will have to use the two systems concurrently anyway.

“The potential for simple mistakes in classifying one of ICD-10’s thousands of subcodes could lead to delays in reimbursement and unfair penalties,” wrote Dr. Teuscher. “This could be devastating to smaller provider offices with fewer resources. Physicians in the United States are already impacted by several administrative changes affecting the practice of medicine, and we thank you for your efforts to ensure the transition does not unfairly cause burdens and risks to providers.”

Protecting patients
Finally, Rep. Gary Palmer (R-Ala.) proposed a bill aimed specifically at ensuring that patient care in rural and small town areas does not suffer with the ICD-10 implementation. As with Rep. Black’s legislation, HR 2652—the Protecting Patients and Physicians Against Coding Act of 2015—would not delay the Oct. 1, 2015, implementation date but would ensure a 2-year grace period during which physicians and other healthcare providers who submit claims would not be penalized for “errors, mistakes, and malfunctions relating to the transition to such code set.”

However, Rep. Palmer’s bill differs from Rep. Black’s legislation in its approach to easing the transition period. AAOS submitted comments to Rep. Palmer in June, emphasizing support for the grace period but expressing concern over some ambiguity.

“The ongoing implementation of ICD-10 creates significant hurdles for rural and small town healthcare providers,” Palmer said. “[The grace period] will provide time for the system to be implemented and kinks worked out without threatening the quality or availability of health care for Americans who live in small towns or rural areas. Physicians are in medicine to provide patient care, not to focus on implementing a complicated and burdensome federally mandated coding system.”

Outside of these specific bills, AAOS leadership has submitted numerous letters to CMS and prepared testimony in advance of a February 2015 congressional hearing on the issue, which focused specifically on U.S. preparedness to adopt ICD-10 as scheduled. AAOS Past President Frederick M. Azar, MD, stressed the tremendous burdens orthopaedic practices will face in verifying patient eligibility, obtaining preauthorization for services, documenting the patient’s visit, and conducting research activities, public health reporting, and quality reporting. He also expressed concern about decreased productivity and the potential for denied claims.

“The AAOS has consistently expressed opposition to the implementation of ICD-10,” stated Dr. Teuscher in an April letter to CMS. “We remain gravely concerned that many aspects of the undertaking will cause serious disruptions.”

Elizabeth Fassbender is the communications specialist in the AAOS office of government relations. She can be reached at fassbender@aaos.org

Current ICD-10 Legislation

• HR 2126, the Cutting Costly Codes Act of 2015, introduced by Rep. Ted Poe (R-Texas)
• HR 2247, the Increasing Clarity for Doctors by Transitioning Effectively Now Act, introduced by Rep. Diane Black (R-Tenn.)
• H.R. 2652, the Protecting Patients and Physicians Against Coding Act of 2015, introduced by Rep. Gary Palmer (R-Ala.)

AAOS Advocacy Center—http://advocacy.aaos.org

ICD-10 information— http://www3.aaos.org/member/prac_manag/icd-10.cfm (member log-in required)