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AAOS Now

Published 3/1/2015

Don’t Count on ICD-10 Delay

Based on the results of a recent report by the Government Accounting Office (GAO) and a hearing by the House Energy and Commerce subcommittee on Health, physicians should not expect another delay in the requirement to implement the ICD-10 diagnostic coding system on Oct. 1, 2015.

The GAO report noted that the Centers for Medicare & Medicaid Services (CMS) has undertaken several efforts to address physician concerns, including developing educational materials for providers and payers, conducting outreach and in-person training for small physician practices, initiating end-to-end testing periods, and consulting focus groups.

Many in the physician community, including the American Association of Orthopaedic Surgeons (AAOS), have stressed the difficulties in moving to the more complex ICD-10 coding system.

“Early in the transition to ICD-10, a significant percentage of claims are anticipated to be denied or held back for payment,” said AAOS President Frederick M. Azar, MD, in prepared testimony for the House hearing. “In addition, orthopaedic practices will face tremendous burdens in verifying patient eligibility, obtaining preauthorization for services, documenting the patient’s visit, and conducting research activities, public health reporting, and quality reporting.”

However, the consensus from the hearing appeared to be to move forward, based on the fact that many providers and payers, including CMS, have already made considerable investments in the ICD-10 transition. Many medical providers continue to worry about the move to ICD-10. According to the results of a survey conducted by the American Health Information Management Association and eHealth Initiative, progress in preparing ICD-10 is being made, but healthcare delivery organizations are concerned, although optimistic, about the impact the new code will have on practices.

According to the survey results, 35 percent of respondents believed that their organization’s revenue will decrease during the first year of ICD-10 and only 6 percent believed their revenue would increase. Several respondents expressed concern about the impact of ICD-10 on common clinical and administrative processes. Some also indicated that coding and documenting patient encounters would be more difficult under ICD-10.