After vigorously opposing ICD-10, the American Medical Association (AMA) has now conceded that implementation of the new code set is imminent on October 1, 2015, and they are working with the Centers for Medicare and Medicaid Services (CMS) to educate members and make the transition as painless as possible.

What is worrying, however, is that a survey conducted by the American Health Information Management Association (AHIMA) just three months before the October 1 deadline revealed that the majority of providers were yet to conduct any sort of ICD-10 testing and that 19% of respondents on the survey had no plan to conduct testing.  This is astonishing considering that conjecture and misinformation are flourishing about ICD-10 coding errors and their effect on physician payments.

Sue Bowman, senior director for coding policy and compliance at AHIMA, has clarified that ICD-10 has very little to do with physician payment, which is driven by CPT codes.  ICD-10 diagnosis codes determine medical necessity and therefore it is necessary they are properly coded.  Physicians are concerned that they will be forced to document their procedures in the ICD-10 procedure coding system (PCS) in a manner and form they are unfamiliar with.  In fact, physicians can document their procedures the way they always have.  It will be the medical coder’s responsibility to translate the physician’s description to the appropriate ICD-10 PCS codes.  Additionally, only hospitals will be using these codes, not physician practices.

While specificity in ICD-10 has received the most criticism, it is ironical that specificity itself was inserted into the ICD-10 PCS by physicians through specialty societies.  Just a few months ago, the four largest state medical societies (California, New York, Florida, and Texas) described ICD-10 as a “looming disaster.” However, the announcement that CMS will allow a one-year period of transition where it will not deny claims due to lack of specificity, and AMA agreeing to work with CMS in educating members, has stymied any movement aimed at postponing ICD-10.

Because permitting claim payments and withholding penalties despite errors in ICD-10 coded claim submissions as well as withholding audits would provide relief to physicians, but could also lead to a flurry of Medicare fraud during the grace period, AMA has buried the hatchet and decided to work with CMS.

A strong criticism of ICD-10 has been its focus on billing with no benefit on the quality of healthcare, but according to AHIMA, this is not necessarily true.  Research and analysis on claims data allows for assessment of differences in resource utilization, differences in outcomes of different treatments, and resolution of patient safety issues.  While there is overlap and redundancy in many metrics that puts a severe burden on providers, ICD codes help hospitals with strategic planning, service line creation or termination, and quality control.  Hospitals can utilize these codes for value-based purchasing and critical quality measures.

With the implementation of ICD-10 fast approaching, it is imperative that all providers test ICD-10.  Those practices with the least resources will be the most harshly challenged.  They should make the most of the one-year transition period and exploit all the resources offered by CMS and AMA to train for ICD-10.


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