Wiki Congress to vote on delay March 27, 2014

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The real question is why isn't everyone ready? This has been planned for several years now. The code set has been available in code books since 2010. That is 4 years of real prep time. This code set has not changed at all since 2011 except for one code that was deleted. What is one more year going to add? You will never have 100% readiness no matter what the issue is. One more year is not going to assure that everyone is prepared any better than they are right now. We need to just pull this trigger and do it. That is when everyone will he ready and not a day sooner. Most will wait until the last minute no matter what.
 
Exactly right, Debra. The hospital where my wife works would have been ready for the Oct 2013 implentation had it not been delayed. We started training last fall and were scheduled to start dual coding on April 7. Wednesday, before management became aware of the pending legislation, they decided to delay dual coding until April 14. I'm not sure what's going to happen now, but I would rather just get it over with.
 
Petlorilea said:
I have 48 providers; about 1/3 of them simply will NOT document specifically now because ICD9 does not encourage it. (See 729.5) My ever present thorn in the side is diabetic manifestations.... 250.60 is not diabetic peripheral neuropathy, Dr.!
I believe that ICD10 actually will help providers in their selection of specific codes; we just won't have that benefit for 18 MORE months at least :mad:
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So you know EXACTLY what I am talking about.
The provider I currently work for is also bad about specificity in documentation...and again, this is because ICD-9 does not encourage or even really require it.

ICD-10 is going to FORCE this specificity.

The way I'm looking at this is that I now have another year to train my providers to document in the manner needed.

Just today, I showed my doctor how Gout, which has about 11 codes in ICD-9 is going to have about 340 codes in ICD-10.

And I showed him the level of specificity needed.

For the example of Gout, we need

First, is it Chronic or not?
Second, if Chronic, is it with or without tophus?
Third, is it idiopathic, lead-induced, drug-induced, due to renal impairment, or other secondary gout?
Fourth, need to know which body part is affected - foot/ankle, knee, hip, hand, wrist, elbow, shoulder, vertebrae...and then
Fifth, if applicable, need to know if it is right-side or left-side.

ICD-9 lets you get away with 274.9 - Gout, NOS.
Not so, ICD-10.

So, getting providers up to - and in the habit of - precise documentation...is a very important part of ICD-10.
Me, I could care less if my provider knows the code numbers...frankly, that's my job anyway.
But it IS his job to give me the information I need in order to code correctly.
 
mitchellde said:
The real question is why isn't everyone ready? This has been planned for several years now. The code set has been available in code books since 2010. That is 4 years of real prep time. This code set has not changed at all since 2011 except for one code that was deleted. What is one more year going to add? You will never have 100% readiness no matter what the issue is. One more year is not going to assure that everyone is prepared any better than they are right now. We need to just pull this trigger and do it. That is when everyone will he ready and not a day sooner. Most will wait until the last minute no matter what.
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True, but now I am glad I held off on all the expensive training.
Since the actual coding rules, the E/M rules, etc are not actually changing...just the codes themselves are changing...why spend hundreds of dollars to get certified in the new code set when you can't even use it yet....and now they are going to delay it yet another year.

The problem is that this is like learning a second language...if you don't use it, you lose it.

So I have tried my best to coordinate any formal training I will take...to coincide with implementation, so that my training will complete right around the time implementation happens, thus I do not have a long time to wait before using it, risking losing too much of the knowledge due to lack of use.

I mean, let's face it this training isn't cheap. So who wants to go through it...only to have a delay happen...and then have to pay more money for a refresher course later on....and possibly have the thing get delayed yet again?

So...I'm on the fence about implementation, really.

On one hand, I'd like to see them pull the trigger and go forward, thus I could then start my formal training and have it fresh when the implementation happens.

On the other hand...another year to hammer home to my providers about the need to get into the habit of specificity in documentation might not be such a bad thing.

Not sure what EMR's actually are requiring doctors to actually know the codes...I do not think Practice Fusion actually requires them to know it...I think they can type in the name of the diagnosis and get a list of codes to choose from...and once that diagnosis is in the Patient History, it stays there, so the doctor can pull it back any time he needs to...no need for him to know or memorize the codes.

Though, since I, myself, do not generate SOAP Notes within PF, I am not sure how that aspect of it works for the provider. But I know I can find all the patient's diagnostic history within the patient's chart on PF.
 
Consider both ramp up and implementation

It's important to consider not only all that iss involved with implementing and launching ICD-10 but what happens when it?s implemented. I don't hear much discussion about the initial rush of denials and confusion that will certainly occur. Thousands of new, more specific codes will give insurance companies new opportunities to deny claims and in some instances, it will come down to who knows ICD-10 the best ? payer or payee. With payers, physicians, coders, billers and other HIM workers all having a different level of training and expertise in ICD-10, it will be a bumpy ride for a while. I hope ICD-10 is not delayed but if it is, I hope the issues above will be more closely examined.
 
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MedCodeNet said:
It's important to consider not only all that iss involved with implementing and launching ICD-10 but what happens when it?s implemented. I don't hear much discussion about the initial rush of denials and confusion that will certainly occur. Thousands of new, more specific codes will give insurance companies new opportunities to deny claims and in some instances, it will come down to who knows ICD-10 the best ? payer or payee. With payers, physicians, coders, billers and other HIM workers all having a different level of training and expertise in ICD-10, it will be a bumpy ride for a while. I hope ICD-10 is not delayed but if it is, I hope the issues above will be more closely examined.
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That is my biggest concern with ICD-10. It gives insurance companies more reasons to deny claims. And I am of the belief that insurance companies do their level best to delay, pend, and deny claims, because they don't really WANT to pay. I have been self-training myself in ICD-10 ever since 2013...and waiting on formal training and certification until it appears that implementation is really going to happen...and trying to time it such that the formal education/certification is completed very shortly before actual implementation...thus there is little time where the new knowledge is not used, thus retention remains high.

If I am gong to invest money in further education, I want to do it at a time where I will get the most benefit from it - and that means not having too much time between the end of the education...and actually USING the new knowledge.

This is like a second language, and if you are not using it, then you're going to lose it. Training in ICD-10 is not cheap, not anywhere.
 
2015?

I have my doubts about ICD-10 ever happening, or at least for a long time. There is nothing to stop congress from voting annually for an ICD-10 delay the way they do the SGR fix every year. The reality is that the lobbyists including AMA are more powerful than anything we have.

Since I've been writing about ICD-10, I'v learned it pretty well. And it is far superior to ICD-9 on many levels. And it isn't that hard. Maybe it would have resulted in more payor denials initially. But the specificity in the long run would have prevented denials (I think, no excuse for the payor to put in medical review).

But the worst part is the hypocricy of the medical community. And physicians who had learned anything about ICD-10 know it's a better system for tracking trends in disease, linking trends to outcomes and treatment etc. Hell, right now with ICD-9 a specific finger injury can't be tracked.

I do agree that pretty much the only stakeholder in ICD-10 that would have been ready on 10/1 is our industry. And coders being ready if providers, IT and payors weren't really would have been a mess. But I have no confidence they will be ready next year since skepticism will set in about this ever happening.
 
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Oh, I think it may eventually happen, but when...who can say.

My OWN take would be they should slowly transition this in...in other words, have an overlap period of a year or two in which both reporting in ICD-9 OR ICD-10 would be acceptable.

This would possibly allow for more time to use it and get used to it...because we could actually USE what we are learning in ongoing education - instead of having the education in place...no place to use it...and then risk losing a lot of that knowledge to lack of use.

This would also give us some time to show our physicians we serve...the differences in the coding, thus the changes they will need to adapt to in their documentation. I know many doctors really hate documentation - they rightly see it as bureaucratic stuff that eats up time they could be in the examining room. But they are the only ones who can do that documentation...they need to document what they are doing so that we can code properly.

When I showed my doctor the differences just in coding Gout, for example...he was shaking his head.

The way you'd work a transitionary shift to ICD-10...would be to extend it over a three-year period, perhaps...allowing both code sets to be used. The first two years, you'd get a bonus in payments FOR using ICD-10 versus ICD-9. The third year, you'd be penalized for NOT using ICD-10. The fourth year, ICD-10 ONLY would be acceptable.

This way, you give them an incentive to do these things. Why not? This is how they have phased in Meaningful Use, right? The first couple years, the HITECH Act gave physicians incentives for using EMR systems, as long as they met MU criteria...and starting 2015, will begin penalizing doctors who do not meet and report MU.

So why could we not do the same with ICD-10?

Start with an incentive...allowing both code sets to be used...then move to a penalty for not using...then just phase out ICD-9. Most doctors will WANT the incentive...and will certainly wish to avoid the penalty.

This way, those of us who do coding...will have opportunity to become accustomed to ICD-10, to USE the knowledge we are spending lots of money in obtaining...and the physicians will have an incentive to go along with it.

By the time we get to the penalty phase, ICD-9 would probably just about wither on the vine, as it were...and we'd have a successful transition.

This would also allow payers to have a time period with which to ramp up...and experience in dealing with ICD-10...this could provide a less bumpy path forward.

On the payer end...they could assign certain agents only...ones who have knowledge...to handle incoming ICD-10 claims...while others handle the ICD-9. Then you begin educating those agents still doing ICD-9 into ICD-10, and then let them work under the wings of the ones already handling ICD-10...and so on...thus insuring everyone gets properly educated, and has plenty of time to slowly transition.

I think the main reason for the hesitation and delay in using the new code set involves the fact that this is NOT just an update to the code set, like ICD-8 to ICD-9 was...this is a complete overhaul...and it has some powerful people resisting it because it is such a radical change.

MY own opinion is that radical change is best accomplished slowly...by implementing it a piece at a time. But just my $.02 worth...
 
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Transitional Approach

I also think some type of transitional approach could work. Those of us who have been around a few decades remember the RBRVS transition in the early 90s. Initially it was going to be a hard date implmentation from the old UCR reimbursement method to RBRVS. But after a lot of commotion similar to ICD-10, feds went to a 5 year transition. Hell, they are still transitioning and refining...SGR
But something making sense and politics and lobbying don't always jive. The medical provider industry is lined up against this ever happening. And Obama doesn't ever want Obamacare roll out deja vu. But maybe our industry could learn from Obamacare's errors. They initially did a poor job communicating the value of it to young people. Now you see movie stars and mega star athletes (Lebron included) selling it to young people. I don't know if it's possible but if high level physicians who do research, people like Jesse Pines in the ED industry, started publishing about the positives of ICD-10 for medicine, that might turn the tide.
But I'm not holding my breath. So years more of E-Codes since ICD-9 can't identify a freakin puncture wound, and multiple diabetes codes because ICD-9 never heard of combination codes, and no tracking which finger was injured or if it was left or right.
 
jimbo1231 said:
I also think some type of transitional approach could work. Those of us who have been around a few decades remember the RBRVS transition in the early 90s. Initially it was going to be a hard date implmentation from the old UCR reimbursement method to RBRVS. But after a lot of commotion similar to ICD-10, feds went to a 5 year transition. Hell, they are still transitioning and refining...SGR
But something making sense and politics and lobbying don't always jive. The medical provider industry is lined up against this ever happening. And Obama doesn't ever want Obamacare roll out deja vu. But maybe our industry could learn from Obamacare's errors. They initially did a poor job communicating the value of it to young people. Now you see movie stars and mega star athletes (Lebron included) selling it to young people. I don't know if it's possible but if high level physicians who do research, people like Jesse Pines in the ED industry, started publishing about the positives of ICD-10 for medicine, that might turn the tide.
But I'm not holding my breath. So years more of E-Codes since ICD-9 can't identify a freakin puncture wound, and multiple diabetes codes because ICD-9 never heard of combination codes, and no tracking which finger was injured or if it was left or right.
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Pretty much.
But I like the idea of a transitional approach...one which makes it more "voluntary" - and to do it, you start off incentivizing early adopters...then you start penalizing those who don't jump on-board...then you give them no choice.

The point is...if you get some early adopters jumping on - to get the incentives (same way MU was done with EHR/EMR) then you get some people out there USING ICD-10...who can then say...look, it works for us...this isn't so bad, the sky is NOT falling, Chicken Little!!

On the other hand...supposing it starts out a royal disaster. OK, so you can STILL go back to ICD-9 while the problems are worked out - and you have REAL PEOPLE doing REAL CLAIMS in the REAL WORLD...using ICD-10...and so you get a better idea where the problems are and how to fix them.

The transitional approach would thusly reward those who adopt it early...later, penalize those who don't jump on-board...and then, finally, give them no choice. But the transitional approach, I think, would meet with far less resistance.
 
The Senate is adjourned until 2pm today. They are expected to vote on the bill around 5:30 pm.
 
Voting in progress - but vote is currently 62 yes and 35 no. The bill passes for a delay of ICD-10. 60 needed to pass. Now onto the president for signature or veto.
 
Official count in Senate

64 Yea
35 Nay

Has bi-partisan support and averts the fiscal cliff" for doctors...you might as well call this thing signed.

I can't find any official word as yet whether Obama has signed it but I believe it is a foregone conclusion.
 
He had to sign it by midnite or the whole thing is for naught. The bill is all about the SGR and truely had nothing to do with ICD-10. However this is much like the whole APC thing back in 2000. Same thing we get ready and then congress pushed it back. Then when no one was looking the last meeting before congress recessed for the summer, they passed the APC for facility outpatient to be effective in a 2 week time frame. It was so quick and no one was ready because of the constant delays. I see this same thing happening here, we will get a 2 week notice and go.
Obama will not veto this bill, it would be a huge mistake for him to do that. But this is not yet dead.
 
I don't think he has a choice whether to sign it. If he doesn't sign it there will be a 24% reduction in Medicare reimbursement.
 
Presidental Signature

Does anyone know if President Obama signed HR 4302? Can he do a line item veto and just strike implementation of ICD-10 from the bill leaving it with an effective date of 10/14?
 
The President is not allowed a line item veto. And even is he dosen't sign the bill today it will take effect retroactivly, when he does sign it. CMS has already stopped processing claims until April 10th so they can make necessary adjustments.
 
ICD10 and Politics

Poli(y) = many (we knew that)
Tic(k) = blood-sucking parasite (we knew that, too)
Politics = many blood-sucking parasites.....we know this for sure everyday
 
Ok, so I'm not crazy. I thought Sebelius had, "put her foot down" on that recently. I can't believe this might be happening. What's wrong with these people?!?
 
The President has signed the bill. The AMA and other physician groups were in favor of the delay. I subscribe to the Medscape newsletter and they had an article about the delay. I was really surprised by the comments. The overwhelming majority of doctors are opposed to ICD 10 because they think it will be more work for them and be something that the insurance companies will use to deny payment.

The AMA was also against this bill(the doc fox) because it provided a temporary patch to Medicare Reimbursement and they wanted a permanent fix. It's been speculated that the ICD 10 delay was inserted to placate the medical community since they didn't pass legislation for the permanent fix.
 
pathfinder57 said:
Poli(y) = many (we knew that)
Tic(k) = blood-sucking parasite (we knew that, too)
Politics = many blood-sucking parasites.....we know this for sure everyday
Click to expand...


If "PRO" is the opposite of "CON"

What is the opposite of PROGRESS??

Think about it.
 
Ellacott said:
The President has signed the bill. The AMA and other physician groups were in favor of the delay. I subscribe to the Medscape newsletter and they had an article about the delay. I was really surprised by the comments. The overwhelming majority of doctors are opposed to ICD 10 because they think it will be more work for them and be something that the insurance companies will use to deny payment.

The AMA was also against this bill(the doc fox) because it provided a temporary patch to Medicare Reimbursement and they wanted a permanent fix. It's been speculated that the ICD 10 delay was inserted to placate the medical community since they didn't pass legislation for the permanent fix.
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I suspect you're right about why docs are opposed to ICD-10. They think it will be more work for them...AND they believe insurance companies will use it to nitpick things and increase denials, and pended claims.

I know my doctor HATES the documentation end of his work - most doctors do. They just want to heal people, and get paid for doing so.

It's OUR job...to make this transition as painless as possible for the clients we serve. To that end, I have been doing everything I can to find ways to minimize the extra work that will be required by my doctor.

I have also switched billing vendors to a vendor who was able to prove they were more than ready for ICD-10 when it came - they have been ready for over a year. And with the claimscrubbing features, I anticipate little to no increase in rejected/pended/denied claims.

I think part of the problem may be a lack of communication - we need to communicate to the medical professionals that we serve...what we are doing to insure a smooth transition to ICD-10.

We can only hope our voices...and our personal relationships with the professionals we serve...will be louder than the voices of the AMA and the insurance lobby.
 
If you've been in healthcare as long as I have, you know that things change, nothing stays the same, and in a regulated industry such as this, our government has the potential to influence us every day.

Frankly, I am OK with the delay, and from what I've heard from colleagues and consultants across the country, my organization was actually one of those who is very well prepared--so we've spent a lot of money on training, education and upgrades at this point.

Still, there's always room for improvement.

So we will continue to dual-code, to train providers and to keep tabs on the Coding Clinic updates so that when the ICD-10 transition takes place, we'll be that much more efficient and prepared.

Lemonade from lemons, people. :D
 
The US Senate has voted for a 1-year "doc fix" preventing a 24% pay cut for physicians who treat Medicare patients, while also delaying by 1 year the implementation of the nationwide conversion to the International Classification of Diseases, 10th Revision (ICD-10), set of diagnostic and procedural codes that was scheduled to occur on October 1.

The bill now awaits President Obama's signature.
 
From: Modern Healthcare

Healthcare Business News

Obama signs 'doc-fix' bill
By Associated Press

Posted: April 2, 2014 - 9:45 am ET
Tags: Associated Press (AP), Barack Obama, ICD-10, Medicare, Payers, Physicians, Reimbursement


President Barack Obama Tuesday signed into law legislation to give doctors temporary relief from a flawed Medicare payment formula that threatened them with a 24% cut in their fees.

A 64-35 Senate vote Monday cleared the measure through Congress. The law also delays nationwide implementation of the ICD-10 diagnostic codes until 2015.
 
What Pam said. I was personally very surprised by this and willing to move forward with ICD-10, but I can't say all of our independents (mom/pops) were.

Am looking forward to more/better education for myself and ways to assist them.

Lemonade indeed.............
 
Where did you find this information? I looked at the AP and checked the Medicare news and couldnt find the article that talks about it.
Thanks

RebeccaCross* said:
Healthcare Business News

Obama signs 'doc-fix' bill
By Associated Press

Posted: April 2, 2014 - 9:45 am ET
Tags: Associated Press (AP), Barack Obama, ICD-10, Medicare, Payers, Physicians, Reimbursement


President Barack Obama Tuesday signed into law legislation to give doctors temporary relief from a flawed Medicare payment formula that threatened them with a 24% cut in their fees.

A 64-35 Senate vote Monday cleared the measure through Congress. The law also delays nationwide implementation of the ICD-10 diagnostic codes until 2015.
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study for ICD-11

Hi Everybody!
Nobody needs to study for ICD-10 because France and India will adopt the ICD-11 in the begging of 2017. So, we need to study for ICD-11 together including our providers.
 
This says it all...only a coder could appreciate this.
By the way, I made it. My idea.

kbvuv8.jpg
 
Eh

I have to say I am of two minds about this. However, not two weeks before this all came about I was saying to one of my coworkers that I was hoping it would be delayed one more year. Oops. Sorry! :)

However, I have not been doing physician coding for very long, maybe 5 years (I did 911 Ambulance billing and then DME/Oxygen billing before that), so until I got to my current job, I knew nothing really about any ICD10 stuff, or that it would be something in the future. (Amazing how much more you learn when you are working instead of in school!) With this new delay, I'm not too confident that it will ever happen now. If we are to change, I'm sort of with those who say forget ICD10 and lets just moved to ICD11. What's the point? So we can get ICD10 and do it for the next 40 years while everyone else moves on to ICD11? :)

Anyway, here's to another year to prepare, and possibly another 4 or 5 if it keeps going this way! Cheers! :confused:
 
What will happen next year?

Ellacott said:
This is so great!! :)
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I love Jean-Luc as the Borg! However, the caption "resistance is futile" is now kind of a joke. Whether it is insurance companies or doctors that pushed for the delay, the ones who are being penalized are the ones who prepared for the change like they were supposed to.
I guess 6 billion dollars is not considered a lot of money to waste. In any case, it will all have to be respent again when some new version does go into effect. I find it interesting that other than "not being ready", there is no real rationale for the delay - and really there is no excuse to not be ready at this point.
Will ICD-10 re-emerge in a modified form that will make everyone happy? We shall see.:confused:
 
K_Schwacha said:
I love Jean-Luc as the Borg! However, the caption "resistance is futile" is now kind of a joke. Whether it is insurance companies or doctors that pushed for the delay, the ones who are being penalized are the ones who prepared for the change like they were supposed to.
I guess 6 billion dollars is not considered a lot of money to waste. In any case, it will all have to be respent again when some new version does go into effect. I find it interesting that other than "not being ready", there is no real rationale for the delay - and really there is no excuse to not be ready at this point.
Will ICD-10 re-emerge in a modified form that will make everyone happy? We shall see.:confused:
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I've been comments on a newletter I receive from Medscape. I'm really surprised at the amount of physician resistance. They want to change at all. They don't want ICD 10 or ICD 11. They feel it would increase their time on clerical things like picking a more specified code and take away from time that could be spent on patient care. They also feel it would give insurers more incentive to deny the claim if the code selected is not specific enough.

There is definitely a divide between the physicians and the coders. The AMA is a much bigger and more powerful lobbying group than AAPC of AHIMA. The lawmakers probably have no idea about coding.

This will be a huge financial hit for people in our profession. Many of the new coders have been trained exclusively on ICD 10 and will now need training in ICD 9.

I have my doubts if we will ever change. It will be just like the metric system. People felt it was too big of a change.
 
I tend to agree on the source of the resistance is coming from providers.

Recently I saw results of a survey about ICD-10 and the overall results of the survey were pretty negative...and it seemed a large amount of the survey pool was providers...although some coders, myself among them, were in the pool.

The biggest concern...and one I share...is that insurance companies will use this to deny/reject/pend more claims. and it will also slow down their processing of claims until THEY become more familiar with the new coding. This will create revenue stream problems, and remains MY biggest concern regarding ICD-10.

This is why I still believe a transitional approach, where implementation is done over a period of a few years, would be the best approach. Let's face it...this is NOT a tweaking of the codes, like ICD-8 to ICD-9 was...this is a major overhaul! This IS very much like converting from standard American measurement units into Metric.

I can do it...but most Americans can't. And even though I can do it...still...a mile means something to me...something I can visualize without a lot of thought. A kilometer doesn't do that for me (although I know a mile is 1.62 kilometers...and therefore a kilometer is just about 6/10 of a mile (a little over that, really, if you wanted me to break out a calculator)

For my part, I have been doing everything I can to educate the provider I serve about what documentation changes he will need to be making...and TRYING to get him in the habit of doing it NOW...rather than when (or if) implementation occurs. To that end, I am also doing everything I can to minimize the amount of extra work that will be required.

Most of us serve professionals who just want to do medicine and hate the bureaucratic side of it...and really don't care for the documentation all that much, either. From THEIR point of view, it takes time from them...time they could be in the examining room.

And I don't know if the majority of coders out here feel as I do...but it isn't the doctor's job to pick out a more specific code...that is our job. It is HIS job to give us the level of documentation we need in order to select the best possible code. And so that is where I am focusing my efforts. Educating my provider as to the level of specificity I need in his documentation. Trying to get him in the habit of doing it now, rather than only when it is required.

And that is all WE can really do at this point. Keep ourselves educated and sharp, and try to ease the transition as much as possible for the professionals we serve.
 
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