ICD-10 Delayed Again

02 April 2014 Health Care Law Today Blog

While I didn’t intend for the theme of my Health Care Law Today posts to be delays, there is no shortage of postponements to write about lately. The House and Senate passed H.R. 4302, Protecting Access to Medicare Act of 2014, which delays ICD-10 implementation until October 1, 2015. The main purpose of the bill is to provide a temporary fix to the Medicare sustainable growth rate (SGR), but a small portion of the bill delays the adoption of ICD-10 codes for at least another year.   

Providers, consultants, vendors, and health lawyers have been preparing for the ICD-10 transition since 2009 when the U.S. Department of Health & Human Services (HHS) published a final rule establishing ICD-10 as the new national coding standard effective October 1, 2013. (Arguably, the United States has been preparing for the transition since the World Health Organization (WHO) published the ICD-10 coding system in 1992. Other countries such as Australia and Canada have been using ICD-10 since 1998 and 2000, respectively.) October 1, 2013 became October 1, 2014 when the Centers for Medicare & Medicaid Services (CMS) issued final rule CMS-0030-F on August 24, 2012. Government officials publicly stated at conferences such as Healthcare Information and Management Systems Society (HIMSS) that there would be no delay past October 1, 2014, but the inclusion of the ICD-10 delay in the SGR bill has brought us to 2015.

According to CMS, the adoption of the ICD-10 code sets is expected to:

  • Support value-based purchasing and Medicare’s anti-fraud and abuse activities by accurately defining services and providing specific diagnosis and treatment information;
  • Support comprehensive reporting of quality data;
  • Ensure more accurate payments for new procedures, fewer rejected claims, improved disease management, and harmonization of disease monitoring and reporting worldwide; and
  • Allow the United States to compare its data with international data to track the incidence and spread of disease and treatment outcomes because the United States is one of the few developed countries not using ICD-10.

Beyond deferring the expected benefits of transitioning to ICD-10, CMS states that the postponement till 2015 creates an estimated $1 billion to $6.6 billion in industry costs, and it creates logistical challenges for many entities who have been preparing for the 2014 deadline. However, there are many providers welcoming the additional time to prepare and designate resources for the complicated and burdensome transition. 

CMS will need to provide guidance on the revised implementation deadline and whether materials such as the Crosswalks for Local Coverage Determinations (LCDs) or the pilot version of the October 2013 Integrated Outpatient Code Editor will still be issued in April and August 2014 as planned.

This blog is made available by Foley & Lardner LLP (“Foley” or “the Firm”) for informational purposes only. It is not meant to convey the Firm’s legal position on behalf of any client, nor is it intended to convey specific legal advice. Any opinions expressed in this article do not necessarily reflect the views of Foley & Lardner LLP, its partners, or its clients. Accordingly, do not act upon this information without seeking counsel from a licensed attorney. This blog is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Communicating with Foley through this website by email, blog post, or otherwise, does not create an attorney-client relationship for any legal matter. Therefore, any communication or material you transmit to Foley through this blog, whether by email, blog post or any other manner, will not be treated as confidential or proprietary. The information on this blog is published “AS IS” and is not guaranteed to be complete, accurate, and or up-to-date. Foley makes no representations or warranties of any kind, express or implied, as to the operation or content of the site. Foley expressly disclaims all other guarantees, warranties, conditions and representations of any kind, either express or implied, whether arising under any statute, law, commercial use or otherwise, including implied warranties of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Foley or any of its partners, officers, employees, agents or affiliates be liable, directly or indirectly, under any theory of law (contract, tort, negligence or otherwise), to you or anyone else, for any claims, losses or damages, direct, indirect special, incidental, punitive or consequential, resulting from or occasioned by the creation, use of or reliance on this site (including information and other content) or any third party websites or the information, resources or material accessed through any such websites. In some jurisdictions, the contents of this blog may be considered Attorney Advertising. If applicable, please note that prior results do not guarantee a similar outcome. Photographs are for dramatization purposes only and may include models. Likenesses do not necessarily imply current client, partnership or employee status.

Related Services