Wiki Senator Proposes Indefinite Delay to ICD-10

Thanks for posting this Dawson

It is a very well written letter with a lot of valid points. I totally agree with him.

What I find quite funny though is the fact he talks about better serving the patients. Wouldn't it be nice if that was actually the driving force behind any of the regulations that come from the government?

I also am very interested to see how the money piece of rolling out ICD-10 will actually pan out. Unless I am missing something every estimate I have seen is based on what other countries, like Canada, went thru. Which is all well and good but they aren't using the full version that we are going to have to use. I am thinking that the loss of productivity and financial burden will be much greater than they are anticipating.

Interesting paper and it makes some very valid points. As a matter of fact, Dr. James Taylor in one of his AAPC webinars had similar feelings. He said that he did some research on whether the use of ICD-10 in other countries had imporved patient outcomes and found that it hadn't. ICD-10 usage is great for statistic keeping but doesn't have much impact in the real world of medicine.
I completely agree.

I'm afraid small facilities aren't going to have the money to implement ICD-10 and may be forced to close their doors because of it. I know there are a lot of people who want to stay current with the rest of the world, but we need to ask ourself, is that more important than keeping hospitals and physician offices open? With the way our economy is and all the EHR changes, I don't believe we can afford to implement ICD-10 just yet. The only regret I have is that so many people have already spent a lot of money on implementation, and I hate to see that money being wasted.
The amount time and money which has already been put into the implementation by payers and providers is huge. I think the one year delay to 10/1/2014 is a fair compromise.
I disagree with everything he has stated. First of all there is no delay to the implementation of ICD-10 CM yet. It is only a proposal at the current time and is currently in a 30 day response mode. So as of right now the effective go live for ICD-10 CM is OCt 1 2013.
Yes there are some silly codes but then there are these same codes in ICD-9 Cm.
Why should there be any increased work on the physicians part? Coding is a job best performed by coders, doctors should document and rely on the coders to do the rest.
There are many ways ICD-10 is much better, for instance HTN no longer is unspecified or benign or malignant. Immunizations no longer need to be specified as to type of immunization, annual prevent cannot be billed with symptom codes so no more split encounters, diabetes with complication no longer will require 2 codes so no more controversy on which one is listed first.
Claims will be more exact and complete and will actually leave much less leeway for the payers to deny for arbitrary reasons.
Prior to 1977 we use to change ICD version every year to every other year and no one complained so why is this such an issue now?
Most everyone is electronic and once you convert to the 5010 transaction, the rest of the conversion to ICD-10 CM is simple.
I could go on and hed to head point to point with him on why ICD-10 Cm is necessary and overdue.
I am a big fan of the new code set and encourage you to really look at it, as in use it for a day or two in practice.
I have to agree with Deb here too.

From a GI coding perspective ICD-10 is going to be a relief.

It'll be a lot easier to show the payor different sites for polyps as opposed to just 211.3 or 211.4.

I don't really know what all the hubbub is about ICD-10. It's just different codes. Sure it's all totally different codes, but it's going to put a lot of specualtion as to what dx code to use to rest.

It's not like CPT is changing. So for the facility end I understand a bit, but not for the physician.

EHR and clearinghouses are going to bear the brunt of the work on this. Doctor's offices don't have to do much except make sure their vendors are doing the work they are paid to do. Make a couple of new cheat sheets for front desks and business offices.

I just think it's alot of people just being scared of change.
Must be the Libra in me!

As is typical for debates like this, I do see both sides. I agree with just about all of Debra's points in her passionate post on the virtues of ICD-10-CM (won't go into PCS here) and how it will actually simplify coding some conditions such as hypertension.

There are some good points in Sen. Coburn's paper as well, however. The one that I will discuss that really stuck a chord with me was the argument that ICD-10 will make it easier for the government to catch perpetrators of fraud. He stated that this would simply "produce new fraud charges against physicians and other providers who simply did not understand or misunderstood..." the codes.

On this note, I am in full agreement with the Senator, as having worked with government auditors reviewing sites (both state and federal), they do not seem to understand that not all mistakes are made to commit fraud. Or that sometimes the mistakes are in the data mining or the auditors are the ones who "simply did not understand or misunderstood" the issue and proper coding guidelines. Transposed digits on a code does NOT equal fraudulent claims, but some overzealous auditors don't seem to understand that concept!
In my rather extensive experience with government and its auditing, the reason they hired teams of folks to assess whether a specific instance of mis-coding was or was not fraud was to ensure inappropriate cases from going to court or settlement. Ultimately, that came down to context: does the provider have qualified staff? Does the provider do his or her own coding and billing? Is the provider intentionally misrepresenting facts? I have never found that the government went in looking to shut a place down or take someone to court. Truthfully, it does not make any difference. If providers are not educated enough to hire a credentialed coder and make good choices about what entity performs the billing, then "spooking" them a little bit to taking it more seriously is not a bad thing. It will highlight our importance in all health care settings. Too many providers already "guess" at the coding anyhow, and expect one of us to fix it on the back end (if that's possible). If I-10 can help to rearrange the responsibilities, then great. I agree with mitchellde, a physician's job is two-fold: treat patients according to his/her clinical judgment and ensure the coding and billing are done by individuals qualified to do it. Write the notes, get out of our way and we'll chase you down the hall when we've got a question or concern.
I work at a major hospital doing clinic coding and even with cooperative physicians getting them to document properly for E/M services is like pulling teeth. And then each year with new residents!!!!! It boggles the mind what our physicians' response to enhanced documentation for ICD-10 is going to be; major Jaw surgery!!!
Just my Opinion

I definately agree with Debra's post. I think this letter is an example of backwards thinking and not wanting to advance with the rest of the world. The US has had plenty time to get ready for ICD-10. This is not new information. I think that a delay will only give people another year to procrastinate instead of giving them more time to get ready. If you are not ready by 2013 then you will not be ready by 2014.