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ICD-10 deadline sparks battle of titans: AMA vs. CMS


The American Medical Association House of Delegates has voted to “work vigorously to stop implementation of ICD-10” by an October 2013 deadline. But don’t get your hopes up. The smart money is probably on the government. Find out what the Centers for Medicare and Medicaid Services said about changing the deadline, and why the agency is so anxious to start using the new coding system.

The American Medical Association (AMA) House of Delegates has voted to “work vigorously to stop implementation of ICD-10” by a government-imposed deadline in 2013. But don’t get your hopes up. The smart money probably is on the health agency bureaucrats.

Under current regulations, all Health Insurance Portability and Accountability Act (HIPAA) entities must adopt the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), by October 1, 2013. The Centers for Medicare and Medicaid Services (CMS) has left no wiggle room, stating in a provider guide posted in September: “The compliance standards are firm and are not changing.”

The issue came up for a vote at the AMA’s semi-annual meeting in November. “The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patients’ care,” said Peter W. Carmel, MD, AMA president. “This massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions. The timing could not be worse as many physicians are working to implement electronic health records into their practices.”

A three-physician practice would spend $83,290 on the conversion, and a 10-physician practice would be out $285,195 to adopt the new codes, said the AMA, drawing on costs calculated by Nachimson Advisors in 2008. The report estimated that between one-half and two-thirds of the total cost of conversion comes from increased documentation costs associated with the five-fold increase in codes used in ICD-10 compared with ICD-9.

The problem is that the United States is almost 20 years late in making the switch. ICD-10 was widely adopted in Europe and elsewhere by 1994. CMS pushed back the date for ICD-10 implementation by 2 years in 2009 but has consistently said that the 2013 deadline is firm. The World Health Organization, which creates the coding systems, has said that an even newer version, ICD-11, will be ready in 2015.

To help practices meet the ICD-10 deadline and minimize costs and disruption associated with the conversion, CMS released four implementation handbooks recently that offer step-by-step guides and customized templates for small- and medium-size  practices, large practices, small hospitals, and payers. The handbooks provide checklists to ensure that practices take the appropriate steps throughout the conversion process, offer timelines to facilitate meeting the October 2013 deadline, and include questions and processes to assess vendor readiness.

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