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HHS wants to delay ICD-10 deadline until 2014

May 25, 2012

The Department of Health & Human Services (HHS) is proposing to delay until Oct. 1, 2014, the compliance deadline for the use of International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes on insurance claims and other health care-related transactions.

HHS officials proposed the one-year delay in the Federal Register last month. The department will formally announce a new compliance date later this year following a required comment period.

The HHS had previously announced the compliance date would be Oct. 1, 2013.

ICD-10 codes are already in use in most nations around the world. The HHS has been planning to implement the codes in the United States since at least 2000.

“Implementation of ICD-10 will accommodate new procedures and diagnoses unaccounted for in the ICD-9 code set and allow for greater specificity of diagnosis-related groups and preventive services,” according to an HHS statement. “This transition will lead to improved accuracy in reimbursement for medical services, fraud detection, and historical claims and diagnoses analysis for the health care system. Many researchers have published articles on the far-reaching positive effects of ICD-10 on quality issues, including use of specific reasons for patient non-compliance and detailed procedure information by degree of difficulty, among other benefits.”

However, implementation has been repeatedly held up in the United States.

The HHS formally proposed regulations for the conversion in 2008, targeting implementation in 2009. A finalized version of the rule delayed the proposed conversion date several years to 2013.

The latest delay comes as the result of concerns repeatedly expressed by some provider groups regarding the ability of providers to meet the Oct. 1, 2013, compliance date, the HHS said. Those concerns were based, in part, on implementation issues providers have experienced meeting HHS’ compliance deadline for the Accredited Standard Committee’s (ASC) X12 Version 5010 software standards (Version 5010) for electronic health care transactions.

Compliance with Version 5010 is necessary prior to implementation of ICD-10.

While hospitals and other health care institutions will be required to use both the ICD-10 diagnosis and procedures codes in 2014, optometrists and other office-based health care practitioners will be required only to use the ICD-10 diagnosis codes at that time, the AOA Clinical and Practice Advancement Group (AOA-CPAG) emphasized. Current Procedural Terminology (CPT) will continue to be used for procedure coding and ICD-10 procedure codes will not be required in office-based practice until the end of the decade.

“ICD-10 for Optometry,” a comprehensive continuing education course for optometrists and paraoptometrics, is under development by the AOA-CPAG and will be scheduled to provide training on the new coding system as optometric practices are preparing to implement it, according to Charles B. Brownlow, O.D., AOA medical records consultant. Additional information on the ICD-10 codes can be found on the AOA website ICD-10 page (www.aoa.org/ICD-10).

New insurance identifier

The HHS called for the ICD-10 compliance date change last month as part of a proposed rule that would also adopt a standard for a new, unique health plan identifier (HPID), similar to the national provider identifiers (NPIs) currently required for all physicians and other health care providers and suppliers.

A unique identifier for health plans could make it easier for optometrists to determine patient eligibility and benefits, the AOA Advocacy Group noted.

When health plans and entities like third-party administrators conduct transactions with health care providers, they are identified using a wide range of different identifiers that do not have a standard length or format, HHS officials noted last month in their news release on the proposed rule.

“As a result, health care providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors, and difficulty determining patient eligibility,” the HHS statement continued. “The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This will allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.”

The proposed rule would also establish a new “other entity” identifier (OEID) for entities such as health care clearinghouses, third party administrators (TPAs), and re-pricers that are not health plans, health care providers, or individuals but that need to be identified in health care-related transactions.

Such entities are currently identified in the standard health care transaction using the same fields and the same types of identifiers as health plans, “but are not health plans and so cannot obtain a health plan identifier,” the HHS noted.
The proposed rule would also give pharmacies more leverage to demand that prescribers obtain and disclose National Provider Identifier (NPI) numbers. While most U.S. health care practitioners now have NPIs, some pharmacies report they are having trouble completing pharmaceutical claim forms, including those for Medicare Part D, because prescribers do not always have or disclose the identifier on prescriptions.

A fact sheet on the proposed delay in the ICD-10 compliance date may be viewed at www.cms.gov/apps/media/fact_sheets.asp. The proposed new HHS rule (CMS-0040-P) may be viewed at www.ofr.gov/inspection. aspx. A news release on the proposed rule may be viewed at www.hhs.gov/news.

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