ICD-10 debate hits Washington: Most prepared, but worry persists

While majority of experts testifying Wednesday said the industry is ready, some worry about its impact on physicians.

All but one expert testifying to the Subcommittee on Health on Wednesday in Washington said healthcare providers are ready to enact ICD-10 coding on Oct. 1. However, his dissent could represent the consternation of physicians across the country.

Dr. William Jefferson Terry of the Mobile Urology Group called ICD-10 a “costly, unfunded mandate” that threatens to put physicians out of business due to the cost of conversion, the three-month cash cushion needed after going live and the lack of proper reimbursement for doctors who submit the wrong codes.

[Also: Live tweets from the hearing]

ICD-10 is expected to increase the number of billing codes from a current 13,000 to an estimated 68,000.

Diabetes alone has 250 codes, Terry said.

“It’s going to kill me,” he said. “I can’t sit there through all those codes. Physicians have to have a guarantee we get paid if we don’t code right.”

Terry’s view is shared by the American Heart Association, which has been lobbying for another delay on behalf of concerned physicians across the country.

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Another delay, however, could be costly as well.

Last year’s postponement  cost the healthcare industry $6.5 billion, said Rich Averill, director of public policy at 3M Health Information Systems.

“We need it, we’re ready,” Averill said, a comment echoed by five other members of the seven-member healthcare panel.

Kristi A. Matus, chief financial and administrative officer for Athena Health said, “Our point of view is simple: It’s decision time. … Pull the trigger or pull the plug.”

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Heart surgeon and subcommittee member Rep. Larry Buschon, R-IN, pushed panelists to think about how physicians will face the change in coding. “In the operating room …you’re not going to be looking through a code book,” he said. “They’re going to deny the payment. Then what do you do? Do you modify the record?”

On the other hand, subcommittee Chairman Rep. Joe Pitts, R-PA said, “I support ICD-10 moving forward rather than (having) another delay. We need to end the uncertainty.”

The subcommittee, as well as the Commerce Committee, are taking written questions until Feb. 26.

Terry suggested a transition period between ICD-9 and ICD-10, in which both systems are in place.

“The vast majority of American physicians are not prepared for implementation all in one day,” he said. Delaying a year wouldn’t help, he said.

Joe Barton, R-Texas, agreed it could work.

“Why couldn’t CMS provide incentives to switch to ICD-10, but if a small practice didn’t want to, let them use ICD-9 and they may not be reimbursed as much, but would get something?” he said.

Morgan Griffith, R-Virginia, also said a dual system might make sense.

Dr. John Hughes, professor of medicine at Yale University, said the overlap would be too expensive.

Carmella Bocchino, executive vice president of clinical affairs and strategic planning at America’s Health Insurance, said a dual system would create confusion when it was important to send a strong message that ICD-10 was the system going forward.

Some question whether the healthcare industry could wait to implement a new coding system in five years with the worldwide transition to ICD-11.

That could only happen if the U.S. took a leadership role in implementation of ICD-11, said Mathus, who called the concept, “a bridge too far.”

Addressing cost, most of the healthcare experts said conversion has not been as expensive as feared.

“It wasn’t hard, it wasn’t expensive, and it wasn’t time-consuming,” said Dr. Edward Burke of Beyer Medical Group.

Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association, said data released Tuesday by PAHCOM shows the cost and burden to be less than predicted.

Averill said free software and training are available.

“The biggest factor is uncertainty,” Averill said. “Do you want to spend on ICD-10 dollars when it may not occur? Get it out there and let the industry move forward.”

Twitter: @SusanMorseHFN