# Congress to vote on delay March 27, 2014



## jlm

Wanted to share this article so all can contact their state representatives:
Congress to Vote on ICD-10 Delay Tomorrow, AHIMA Calls for Action to Stop Bill Today 

Mar 26, 2014 11:04 am    |    posted by Chris Dimick   |    Coding & reimbursement &  ICD-10
A new bill has been quietly introduced into the US House and Senate that features a section calling for the delay ICD-10-CM/PCS implementation until 2015.

The bill, which would adjust the Sustainable Growth Rate (SGR) and amend the Social Security Act to extend Medicare payments to physicians and change other provisions of the Medicare and Medicaid programs, also includes a seven line section that would delay ICD-10 to October 1, 2015.

This bill was negotiated at the leadership level in the House and Senate, and it is expected that there will be no debate before calling the bill to vote. The bill states: ?The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD?10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d?2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.?

This bill is expected to go to the House floor on Thursday, March 27 for a vote.

AHIMA Calls on Members to Request Removal of Delay Provision
AHIMA has put out a call to members and other stakeholders to contact their representatives in Congress and ask them to take the ICD-10 provision out of the SGR bill.

When contacting Congressional members, AHIMA has instructed callers to state that their representatives/senators:

?Oppose the specific language in the SGR patch legislation
?Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill
AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ?This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,? AHIMA wrote in a statement. ?Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished?  Let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district.?

Contacting Your Congressional Representatives
For more information on contacting your representatives and senators in Congress, visit AHIMA?s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/. For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy


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## MnTwins29

Thanks for sharing this.  I was going to do so, but was beaten to the punch!   Regardless of your stance (IMO, it's time to stop the games and get it done), reaching out to your Congressional representatives is what you should do if you care at all about ICD-10.


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## ABonnell CPC

Thank you for posting.  Would you please continue to do so in this thread if you find out the outcome?  Thank you!


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## monopoly222

*Called my Congress Woman and Wrote My Doctor's Congressman*

I just got off the phone with Congress woman, Kuster......was on the phone for at least 5 mins explaining to the poor girl that answered the phone....about how important ICD10CM coding is and that the US needs to get on the stick and come up to speed!!

Call, E-mail, whatever....contact your Congress now, tonight!!!



jlm said:


> Wanted to share this article so all can contact their state representatives:
> Congress to Vote on ICD-10 Delay Tomorrow, AHIMA Calls for Action to Stop Bill Today
> 
> Mar 26, 2014 11:04 am    |    posted by Chris Dimick   |    Coding & reimbursement &  ICD-10
> A new bill has been quietly introduced into the US House and Senate that features a section calling for the delay ICD-10-CM/PCS implementation until 2015.
> 
> The bill, which would adjust the Sustainable Growth Rate (SGR) and amend the Social Security Act to extend Medicare payments to physicians and change other provisions of the Medicare and Medicaid programs, also includes a seven line section that would delay ICD-10 to October 1, 2015.
> 
> This bill was negotiated at the leadership level in the House and Senate, and it is expected that there will be no debate before calling the bill to vote. The bill states: ?The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD?10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d?2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.?
> 
> This bill is expected to go to the House floor on Thursday, March 27 for a vote.
> 
> AHIMA Calls on Members to Request Removal of Delay Provision
> AHIMA has put out a call to members and other stakeholders to contact their representatives in Congress and ask them to take the ICD-10 provision out of the SGR bill.
> 
> When contacting Congressional members, AHIMA has instructed callers to state that their representatives/senators:
> 
> ?Oppose the specific language in the SGR patch legislation
> ?Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill
> AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.
> 
> CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ?This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,? AHIMA wrote in a statement. ?Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished?  Let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district.?
> 
> Contacting Your Congressional Representatives
> For more information on contacting your representatives and senators in Congress, visit AHIMA?s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/. For more information on AHIMA ICD-10 advocacy, visit http://www.ahima.org/about/advocacy


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## 2Labradors

*ICD 10 Delay proposed again by Congress*

The Bill is HR4302 being called  ??Protecting Access to Medicare Act of 2014??. Hidden is "Sec. 212. Delay in transition from ICD?9 TO ICD?10 code sets. "
Congress is voting on the entire group of proposals without a discussion on Thursday 3/27.  
Funny as I checked the A.M.A. web site they are pushing this delay again, but the blog of many of their own physicians actually support the current October 2014 start.
We have been using ICD 9 since 1975. Medical procedures drugs and care have changed since then. The World Health Organization (WHO) implemented ICD 10 coding world wide in 1994.
Just as interesting to me was "Sec. 213. Elimination of limitation on deductibles for employer-sponsored health plans. "Guess this is what happens while we are not watching congress. (wonder who could be behind this idea? you got it!)  I did call congress and left my professional opinion with several of them as well as my local Senator. They all have VMs and web sites.


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## mitchellde

I am saddened and sick of this kind of underhanded tactic.  I wonder how many of those voting even understand the significance of the seven lines pertaining to ICD-10 CM.  All of the prep and hard work that all of us have invested on this only to be tabled yet another year??!!!  We were promised, yes promised last year that there would be no further delay and it would not even be considered.   I cannot even imagine what these people are so afraid of.  This sytem works better and more clear and is easier than ICD-9.  I shake my head and worry about the future of health care in the US!


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## MnTwins29

Debra, not last year - just last MONTH, Secertary Sebellis said no more delays.   I have not only written email to my House Representative (Rep. Chris Gibson) and two Senators (Kirsten Gillibrand and Chuck Schumer) but also to House Speaker Bohener and Senate Majority Leader Reid.   Sure, maybe it falls on deaf ears but we all need to do our part to make our views heard.   

I am not optimistic - with the MGMA and AMA complaining loudly, I am sure that Congressmen don't want to hear about more healthcare issues a month before the mid-term elections.   Like you said, all our work to get ready for this is now being delayed again.  ARRRGGGHHH!!!


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## wryder

*Delay for ICD-10*

Good morning

When we received the word yesterday on this, they stated in the AHIMA letter that this could cost between $1 billion-$6.6 billion dollars if this is delayed from CMS.  I read the bill and it is 121 pages long.  If you go to section 212 under Title II-Other Health Provisions on page 19.  The entire bill is to amend the Social Security Act to extend Medicare payments to physicians and other provisions of the Medicare and Medicaid programs, and for other purposes. *It mentions Delay in transition from ICD-9 TO ICD-110 code sets.  It is a very small paragraph.  *

Since I have been working on ICD-10 for the past 6 months, we would feel that all the work that has been done with only 6 months left until implementation would be detrimental to physicians, coders, hospitals, etc.... across the nation.    

Please help stop this motion.


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## SVarney

The House just passed the bill, the Senate is scheduled to vote tomorrow...
http://www.healthitoutcomes.com/doc/house-passes-sgr-repeal-bill-now-what-0001


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## AprilSueMadison

SVarney, they are voting today.  I've read that it will probably be around noon that they vote.


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## MnTwins29

This article is dated yesterday - bill voted on is maybe an earlier version?


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## Lynda Wetter

It's time for ICD-10!!!
We are as prepared as we are going to be.  And whoever wrote that more education needs to be given to those passing these bills is absolutely correct. ICD-9 was supose to be temporary.  It is time we catch up to the other countries already using I-10.


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## ABridgman

I agree, we need to go ahead with this thing...but my primary worry is that some of the PAYERS are not going to be ready in time...that's the feedback I am getting from a few payer reps (I won't name names)

That could result in serious delays in processing claims which would negatively impact our income that way.

So it would seem we are danged if we do and danged if we don't....but I'll put in a call to add my voice to the "go ahead with this thing already" crowd.

As an aside:  This is one main reason I have delayed getting ICD-10 certified.  It doesn't do me much good if they delay implementation yet again...and you end up not using your new knowledge for a whole year and then wind up forgetting most of what you learned, because you're not USING it.

I don't believe the basic rules of coding are actually changing as much as the codes themselves...the same basic E/M rules are not changing.


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## MnTwins29

ABridgman said:


> I agree, we need to go ahead with this thing...but my primary worry is that some of the PAYERS are not going to be ready in time...that's the feedback I am getting from a few payer reps (I won't name names)
> 
> That could result in serious delays in processing claims which would negatively impact our income that way.
> 
> So it would seem we are danged if we do and danged if we don't....but I'll put in a call to add my voice to the "go ahead with this thing already" crowd.
> 
> As an aside:  This is one main reason I have delayed getting ICD-10 certified.  It doesn't do me much good if they delay implementation yet again...and you end up not using your new knowledge for a whole year and then wind up forgetting most of what you learned, because you're not USING it.
> 
> I don't believe the basic rules of coding are actually changing as much as the codes themselves...the same basic E/M rules are not changing.



Agree with your logic in not going too far ahead with certified - I have done the same thing for the same reason.  I have been skeptical it would happen until I actually saw it on Oct. 1 - this is the government after all.    Also, if you are comfortable with an ICD-9 book and looking up codes in the alphabetic index and then in the tabular - ICD-10-CM is pretty much the same.  Yes, more detailed, but you still arrive at the correct code in the same way.  

ICD-10-PCS, now, that's another ball game....


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## hillard90

*Live feed for vote*

Here is a link for the live feed for the discussion and vote. They are on recess right now: http://clerk.house.gov/floorsummary/floor.aspx


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## mitchellde

I do not see that is has passed, itlooks like it has been tabled, no vote was taken.  Am I reading this correct?


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## MsGarner69

mitchellde said:


> I do not see that is has passed, itlooks like it has been tabled, no vote was taken.  Am I reading this correct?



that was before they went to break. The bill was just passed if I'm hearing them correctly.


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## AprilSueMadison

http://www.healthcareitnews.com/news/house-delays-vote-sgr-icd-10

It looks like it was delayed.

http://talkingpointsmemo.com/livewire/house-gop-doc-fix-in-limbo < another article about what happened today.


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## mitchellde

Thank you April !  I was trying to watch this live and i missed this when i left the room for a second.   So this bill has been tabled for now. I have communicated with my representative and my senator.  I also sent an e-mail to Rep Pitts. He is the sponsor of this hill., i requested that he eliminate this section pertaining to ICD-10 and I will then encourage my representative to vote for the bill.  We have a little time to work with so we need all of use to get involved and contact your representative and senator and help to get this done.


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## Ellacott

It passed by a voice vote:


*In voice vote, House approves Medicare ?doc f*ix?

By Wesley Lowery, Updated: March 27 at 12:42 pm 

The House quickly approved another so-called "doc fix" bill early Thursday afternoon that serves as a temporary solution to an ongoing structural problem in the formula used to determine Medicare funding levels.

After hours of uncertainty over whether the bill have sufficient support to pass, House Republican leaders moved quickly to approve the measure by voice vote.

The bill, which is also expected to be taken up and passed by the Senate later Thursday, prevents a 24 percent cut in reimbursements to physicians under Medicare.

House Democrats criticized the bill -- insisting that Congress should have voted on a permanent fix to the Sustainable Growth Rate model.

"This is a band-aid," declared House Minority Leader Nancy Pelosi (D-Calif.) during a speech before the vote. " There are so many things that are wrong with this bill, but the simple fact is that the clock is ticking and on March 31, it's bad news for our seniors and the doctors that treat them."

The "doc fix" is the latest incarnation of a bill passed frequently by the House -- sometimes multiple times per year -- that avoids a sharp drop-off in Medicare payments.

In 1997, Congress created the Sustainable Growth Rate, a system that pegged the amount of money budgeted for Medicare payments to projected growth of the economy. However, within a few years, health-care costs far outpaced economic growth -- creating a multibillion dollar shortfall in funding for Medicare payments.

Since 2003, Congress has approved "doc fix" bills that appropriate more money to Medicare funding in order to avoid cuts in Medicare reimburse rates for doctors.

The last doc fix bill expires on March 31, forcing Congress to either pass another doc fix, pass a bill overhauling Medicare payments, or see skyrocketing costs of doctors who treat Medicare patients.

This year's legislation, also includes a new delay to Medicaid cuts to hospitals serving low-income patients that were ordered by the Affordable Care Act.

"We need to fix this permanently, not patch it every year." said Rep. Steny Hoyer, (D-Md.), the House Minority Whip. "It's a fraud and both sides have committed that fraud. We have to fix this."

? The Washington Post Company

http://www.washingtonpost.com/blogs...n-voice-vote-house-approves-medicare-doc-fix/


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## mitchellde

So one source says it passed and the other says it was postponed so which is it??   If it was voted on even a voice vote we should be able to see who voted which way.  I at the other bill voted on and there is a detailed accounting of the yeas and nays.  There is nothing on this one.  But it does not look good.


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## cwpierce

March 27, 2014
House Votes to Delay ICD-10 Implementation 
By Chuck Buck
The fix is in.
The U.S. House of Representatives voted today to extend the deadline for implementing ICD-10 by one year, pushing the mandatory compliance date to October 2015. The Senate is expected to vote tomorrow.
The provision for extending the delay was tucked into the House bill to extend the Sustainable Growth Rate (SGR) formula for another 12 months rather than finding a permanent solution to the 1997 Balanced Budget Act, which attempted to rein in Medicare reimbursement to physicians. Annual "doc fixes" to temporarily repeal the SGR have become an existential rite of spring, as Congress has continued to forestall a scheduled 24-percent reduction to physician reimbursement that would have kicked in April 1. 
Read more?


Exclusive ?What-if? Series 
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Join Chuck Buck, Talk Ten Tuesdays program host, and Kim Charland, senior vice president of clinical consulting for Panacea Healthcare Solutions, for the first of a two-part series that begins on Tuesday, April 1 on clinical documentation improvement. Much has been written about CDI and ICD-10. In Tuesday?s broadcast you will learn how to ensure that your facility?s board of directors, senior executives and physicians are ready for ICD-10. Part two continues on Tuesday, April 8. All this and more when our second of three broadcasts originates live from the HCCA 2014 Compliance Institute in San Diego, California.
Featured on the broadcast?
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## MnTwins29

http://clerk.house.gov/floorsummary/floor.aspx gives the official trasncript - it was passed by voice vote.  This is the excerpt from that site for the bill:

12:08:20 P.M.  H.R. 4302 Considered as unfinished business. H.R. 4302 ? "To amend the Social Security Act to extend Medicare payments to physicians and other provisions of the Medicare and Medicaid programs, and for other purposes."  

12:09:00 P.M.  H.R. 4302 On motion to suspend the rules and pass the bill Agreed to by voice vote


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## MnTwins29

mitchellde said:


> So one source says it passed and the other says it was postponed so which is it??   If it was voted on even a voice vote we should be able to see who voted which way.  I at the other bill voted on and there is a detailed accounting of the yeas and nays.  There is nothing on this one.  But it does not look good.



I don't think you would know individual votes on a voice vote alone.  If there is a question of whether there are more yays than nays, then the Speaker would call for individual votes, but if one side is much louder than the other when the vote is cast, then the bill would pass or die without having to count individual votes.   So, best guess would be this was a resounding yes vote.


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## rgunwall

http://thehill.com/blogs/floor-action/votes/201932-house-approves-doc-fix-in-voice-vote


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## mitchellde

I was so afraid of that.  We can only hope that with a democratic majority Senate this will not pass.  But with this week being spring break in many areas how many of our representatives and senators are even present.  This is very bad for our industry.  To be saddled with an outdated code set for yet another year when the majority of us have invest valuable time and money into the learning and mastery of this new code set.


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## MnTwins29

rgunwall said:


> http://thehill.com/blogs/floor-action/votes/201932-house-approves-doc-fix-in-voice-vote



Great article and it just goes to illustrate that our government leaders really have no clue just what we are doing regarding physician pay or ICD-10 (if any of them even knew about that seven-line sentence).


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## treichman

House passed the bill it now moves to Senate for vote


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## Dawn Marie

*ICD-10 Moved to 10/2015 House of Representatives PASSED the Bill*

It passed!! *(pending Senate approval on 03/31/14-CALL YOUR SENATOR*)!! 

American Institute of Healthcare Compliance 
Alert Update
Thursday March 27, 2014

House of Representatives PASSED the Bill to amend the Social Security Act on important health care issues

Check out this link:
http://campaign.r20.constantcontact...WAg52G9xY4zByjnCbH11FvT6RDm20lpEIGjuuxTyvUvc=


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## monopoly222

*I agree!!*




MnTwins29 said:


> Great article and it just goes to illustrate that our government leaders really have no clue just what we are doing regarding physician pay or ICD-10 (if any of them even knew about that seven-line sentence).


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## ABridgman

MnTwins29 said:


> Agree with your logic in not going too far ahead with certified - I have done the same thing for the same reason.  I have been skeptical it would happen until I actually saw it on Oct. 1 - this is the government after all.    Also, if you are comfortable with an ICD-9 book and looking up codes in the alphabetic index and then in the tabular - ICD-10-CM is pretty much the same.  Yes, more detailed, but you still arrive at the correct code in the same way.
> 
> ICD-10-PCS, now, that's another ball game....



PCS only matters if you're doing Institutional claims, not Professional Claims.
So no worries for me, yet, regarding ICD-10 PCS.  But it might be a good idea to get a general working knowledge of it...once they actually implement it!


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## MnTwins29

*Inpatient, outpatient and professional*

I audit inpatient and outpatient records as well as professional claims, so I have had to go through PCS training as well.  That was just starting - now I wonder if it will be on hold if the Senate passes this as well!


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## ABridgman

MnTwins29 said:


> Great article and it just goes to illustrate that our government leaders really have no clue just what we are doing regarding physician pay or ICD-10 (if any of them even knew about that seven-line sentence).



Our government leaders have no clue about ANYTHING regular folks like you or I do at all.  They have the Beltway Syndrome...they exist in a bubble where the rest of us do not, and they lose touch with us as a result.

We could explain to them WHY this is important to us and they likely would not care.  Their Job Number One anymore is to get re-elected.  And they believe that "he who has the most cash wins" in any election, so they are going to listen to whomever comes to them with the most money.

Oh, they'll TELL you that they care, but the truth is they are clueless and don't care to get a clue, either.

Not that this should stop any of us from still calling our Senators.  My calls to Casey and Toomey go out today.  Too late for Cartwright.

P.S. - As someone who has some experience as a citizen lobbyist, it is always a good idea to let them know exactly what you're talking about...to that end, the Senate Bill is S 2157.
The House Bill which passed was HR 4302.

Me, I intend to express concern to my Senators over the passage of the HR....and urge striking the implementation delay from S 2157.

If JUST the Senate passes a bill that strikes ICD-10 implementation delay, then what happens is a conference committee to coordinate the bills, so that they match.  That is our best chance.  We need to get the Senate to pass the bill, but strike the delay of ICD-10 from it.

Because this bill DOES need to pass, else we could see Medicare payments drop precipitously, which would also create problems.

So be specific, that we want the bill to pass, but WITHOUT the ICD-10 implementation delay.

Hopefully, then, it will go to Conference Committee.  This is mind, it would not be a bad idea to still call House Members about this.


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## KCady

*Better 'brand' a VETO on this if it does pass the Senate*

So if we are all ready- why can't we talk to our vendors and CMS and go through with the original deadline since the ones making these decisions have no idea what* we *have all gone through to get to this level.    Who is standing in our way? 
As a member of a 'small rural hospital'-  we are ready and don't like that the blame is being shifted in our direction.  I am quite sure that all the members of 'Small Rural Hospitals' in Montana are ready so I don't believe they polled us.  What about the other states with 'small rural hospitals'?  I know you're ready- the pride for these facilities we all have, makes me optimistic that we are prepared but getting the blame for the delay.  Don't believe it.  Call your Senators.  Or maybe we can have former Montana Gov. Schweitzer drop off his 'Veto' Branding iron off with the President.


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## ABridgman

Cady,
As far as I can tell, there is nothing that would prevent anyone from going ahead with ICD-10 with any PRIVATE PAYER.  However, the bill's language specifically forbids CMS from taking any action without Congressional approval.  Meaning that, even if we are ready and they are ready...the implementation would be delayed and CMS cannot over-ride that delay.

I have calls in to both my Senators, Pat Toomey and Bob Casey.  Have not yet heard back from their Legislative Assistants on this yet (and by the way folks...when you call, THAT is who you want to talk to...a Legislative Assistant)

I did, however, speak with Congressman Matt Cartwright's office, and left a message for his Legislative Assistant to get back to me...and in this case, since I had a knowledgeable person on the line, I attempted to outline for them what my strategy is.

Folks: I don't mean to speak for anyone but myself, but, I think it is in ALL of our best interests that the overall bill DOES pass - otherwise we will all see provider payments from Medicare drop very badly.  Bad enough we have to deal with Sequestration cuts!!  However, we don't want the delay of ICD-10 to happen.

That is why the absolute best strategy we can do right now, in my opinion...is to call Senators and encourage them to pass the bill...but WITHOUT the ICD-10 implementation delay.  That will cause two different versions of the bill to be passed, thus they will have to have a Conference Committee between the two Chambers to iron out the differences.

What we DON'T want is identical bills to pass the Senate and House...because then we have virtually zero chance.

Meanwhile, we should be calling our House Members (the ones who already passed the bill) and explain our position concerning ICD-10.  Hopefully, we can get a few allies on our side in Conference Committee...and get this particular part taken out of the final bill which would then go to Obama for signature or veto.

I sincerely doubt that...even if implementation delay is passed...that Obama would veto this bill...so our best chance is to amend it at the Senate level now...and then have the final bill coming out of Conference Committee to not include the implementation delay.

THAT, I believe, is where we all should be on this legislation, and it is best if we are presenting a unified voice in this matter.  This serves everything we DO want...and nothing we DON'T want.

This allows for the Medicare payments to providers to remain at current levels...while also not delaying ICD-10 implementation.

Although, in my not so humble opinion...Steny Hoyer of MD has it right...we need to fix this thing right and not have a SGR bill every year, just slapping a band-aid on the problem...which goes all the way back to 1997.


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## mitchellde

ABridgman said:


> Our government leaders have no clue about ANYTHING regular folks like you or I do at all.  They have the Beltway Syndrome...they exist in a bubble where the rest of us do not, and they lose touch with us as a result.
> 
> We could explain to them WHY this is important to us and they likely would not care.  Their Job Number One anymore is to get re-elected.  And they believe that "he who has the most cash wins" in any election, so they are going to listen to whomever comes to them with the most money.
> 
> Oh, they'll TELL you that they care, but the truth is they are clueless and don't care to get a clue, either.
> 
> Not that this should stop any of us from still calling our Senators.  My calls to Casey and Toomey go out today.  Too late for Cartwright.
> 
> P.S. - As someone who has some experience as a citizen lobbyist, it is always a good idea to let them know exactly what you're talking about...to that end, the Senate Bill is S 2157.
> The House Bill which passed was HR 4302.
> 
> Me, I intend to express concern to my Senators over the passage of the HR....and urge striking the implementation delay from S 2157.
> 
> If JUST the Senate passes a bill that strikes ICD-10 implementation delay, then what happens is a conference committee to coordinate the bills, so that they match.  That is our best chance.  We need to get the Senate to pass the bill, but strike the delay of ICD-10 from it.
> 
> Because this bill DOES need to pass, else we could see Medicare payments drop precipitously, which would also create problems.
> 
> So be specific, that we want the bill to pass, but WITHOUT the ICD-10 implementation delay.
> 
> Hopefully, then, it will go to Conference Committee.  This is mind, it would not be a bad idea to still call House Members about this.


Correct the bill number now changes and I spok with my daughter who is an attorney for Heath and Human services in DC, she did say there is time to contact your senator and request that the ICD-10 CM provision be removed, the bill does need to pass with that exception.  She stated then if they do amend it the house has to consider that amendment and then if they pass it it goes to the President who can pass or veto.  Nancy Pelosi was not please with the manner this done but did get behind the bill since the rest of it is necessary.  Most of the senators and representatives have no idea what ICD-10 CM even is much less how much work has gone into preparation.  Therefore if you get behiund the bill and request only that portion removed we have a better chance for success.


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## mjs1974

It passed. Now it goes to obama to sign or veto. We need to get him to veto this bill!!!!!!!!


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## mitchellde

I did not think the senate would get it until tomorrow?
It passed the house today.


----------



## ABridgman

mjs1974 said:


> It passed. Now it goes to obama to sign or veto. We need to get him to veto this bill!!!!!!!!



Wrong.

Veto would result in Medicare payments to providers being cut by as much as 24 percent.  The overall bill needs to pass.
Just not the part about delay of implementation.

If it passed the House but not yet the Senate, then we still have a chance.

If it passes the Senate with the delay intact...then we are in trouble.  In which case, given a choice between a year delay of ICD-10...or 24 percent cut in payments, I'll take the delay.

Besides, I am reasonably sure that there's no way in all the seven hells that Obama is going to veto this one.  Even as a lame duck President, he isn't going to.  This would be spun by the muckrakers and pundits as cutting funding to Medicare and used against the entire Democratic Party in upcoming mid-term and 2016 Presidential elections.

Just telling you how things really work in Washington.  As a person with experience in citizen lobbying, I am telling you our best chance is to go for the Senate...get them to pass the bill WITHOUT the implementation delay...and then get the final bill out of Conference Committee to not include the implementation delay.

ADDENDUM:  Thus, if we are successful in getting the Senate to drop implementation delay from the Senate bill...we still need allies in the House to get that to carry thru to the final bill which would then go to Obama.

So don't forget to also still call House Members...even if they supported the original HB 4302.

I believe the Senate votes on 2157 tomorrow.


----------



## ABridgman

By the way...

here is a link to follow the progress of the bill.

http://beta.congress.gov/bill/113th-congress/senate-bill/2157


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## ABridgman

OK, folks....

Just got off the phone with John, a Legislative Aide with Senator Bob Casey's office...and he was able to give me the straight dope, and it doesn't look good...

S 2157 is a bill sponsored by Senator Wyden of Oregon.  It is set to be voted on on Monday, 3/31.  While Casey does support this bill, John indicated to me he does not believe it likely to pass. (2157, by the way...is the solution Steny Hoyer-MD, indicated he would have preferred over what in fact came out of the House)

Now...here's where this gets tricky, so I'll try to lay it out for you as best I can in layman's terms:

S 2157 calls for the repeal and replacement of the Sustainable Growth Rate.  This is a problem that goes all the way back to 1997...and every year, the Congress has slapped a band-aid on the issue, passing extensions to this.

THAT is what the vote on HB 4302 was about.  And this was a "patch" which was negotiated within the House and then passed.  That bill includes the ICD-10 implementation delay. 

(I am not clear on how the implementation delay came to be a part of this patch, but I can advance a few guesses - as I had indicated before, I had gotten wind from some of my Provider Reps with some of my Payers...that some of the payers would not be ready for ICD-10 in time for October 2014...and my guess is that some of these payers are political campaign contributors - reference my earlier posts about this...and you can do the math)

S 2157, however, does NOT include an implementation delay.  Senator Casey, incidentally, supports 2157 and supports 2014 implementation of ICD-10.

The thing is, as it looks now, 2157 is not going to have enough support to pass.  Which means that the Senate will then vote on 4302 instead.

(My guess on the reasons for this is - quite simply, some payers are pushing against 2157...and pushing for 4302 - if you want to know why things happen as they do in Washington, the best way is to follow the money trail)

AND THERE IS NO WAY TO REMOVE THE IMPLEMENTATION DELAY FROM 4302 FOR PURPOSES OF THE SENATE...they will have to vote on it as is.  And if it passes, it goes to Obama - who will sign it...I explained why he will NEVER veto this one in an earlier post.

A lot can happen tomorrow and over the weekend, but as it looks now, 2157 won't pass, and the Senate will instead vote on 4302, and then that will go to Obama to be signed, and we will have delay of ICD-10.

Unless, of course, miracles happen, and 2157 actually passes.

The upshot of all this is:  There is NO WAY that either the D's or the R's are going to allow it to get hung on them, in an election year...that they supported any cuts to Medicare (which is what a no/veto vote would get spun as being...even though it isn't)  which means ONE of these two bills are going to get passed, and get signed by the President.

If 2157 makes it...no delay to ICD-10 implementation, and no cuts to provider payments.

If 4302 makes it...ICD-10 gets delayed, and no cuts to provider payments.

If neither one makes it, or if, against all logic, Obama DOES veto it (and he won't) then ICD-10 may still be on track, but be prepared to see provider payments cut by almost 25%.

That said, for me, given my choice, if I have to take a delay or payment cuts...I'll take the delay.

Ideally, we want 2157 to pass.  So that is what you want to be pushing your Senators for on your calls...if what you want is on-time implementation AND no payment cuts.


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## Saedron

mitchellde said:


> I was so afraid of that.  We can only hope that with a democratic majority Senate this will not pass.  But with this week being spring break in many areas how many of our representatives and senators are even present.  This is very bad for our industry.  To be saddled with an outdated code set for yet another year when the majority of us have invest valuable time and money into the learning and mastery of this new code set.




Agreed. We'd been promised that 2014 was THE year and nothing was going to stop it. We've all invested so much money and time into this and now to be told, "just kidding" is horrible.

Also, to tie the ICD-10 delay into a bill that discusses the Medicare SRG reimbursement issue is just wrong.


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## ABridgman

Saedron said:


> Agreed. We'd been promised that 2014 was THE year and nothing was going to stop it. We've all invested so much money and time into this and now to be told, "just kidding" is horrible.
> 
> Also, to tie the ICD-10 delay into a bill that discusses the Medicare SRG reimbursement issue is just wrong.



Welcome to the smoky, back-room dealing that is Washington.

As I said above, my own guess as to how this delay in implementation of ICD-10 came to be in the bill:

Some payers were said to possibly not be ready for ICD-10 in time for 2014.  This is the kind of bill (SRG reimbursement issue) is one that is likely to actually pass.
It is often a tactic to put onerous items on someone's wish list (items which would never stand on their own) into bills that are all but guaranteed to pass.

My guess is that this delay in ICD-10 implementation was on the wish list of one or more insurance carriers who feared they would not be ready, or who were not going to be ready.  These insurance companies likely are campaign contributors.  Follow the money from that point.

And I hate to say...collectively, our voice is not likely to have much sway against the power of campaign contributions from entities who wish to delay implementation.

Not supposed to be any quid-pro-quo in our government, of course, but we all either know better or should know better.

At any rate, I suspect this is why S 2157 will not have enough support to pass, and we're gonna get stuck with HB 4302.

Whichever bill DOES get passed, it will go to Obama, and he will sign it.  A veto is not going to happen on this bill...whichever one makes it to the President's desk.  There is, alas, no way to get the Senate to craft a 4302 bill that removes the delay to ICD-10, thus no way to get a disputed bill into a Conference Committee - which would have been my first and preferred strategy.

At this point, the calls to Senators should indicate support for S 2157 - since that one DOES NOT include the ICD-10 implementation delay.  However, if S 2157 is not possible, we should still want HB 4302 to go forward (if neither bill goes to the President...we go over our industry's equivalent of the "fiscal cliff" and our providers will all see payment reductions up to 24 percent from Medicare.)

At this point, there's three possible outcomes...I'll list them in order of my personal preference - and, I believe, the preference of most of us in this industry:

1. Passage of S 2157
Result: No payment cuts to providers and no delay of ICD-10 implementation.

2. Passage of HB 4302 by the Senate (It has passed the House)
Result: No payment cuts to providers.  ICD-10 implementation is delayed.

3. Neither bill passes...or Presidential veto
Result: ICD-10 implementation may not be delayed (unless they try to slide that into yet a different bill) - however, this option also carries with it a drastic reduction to provider reimbursements from Medicare - up to 24 percent.  Which is a serious income deficit for all affected.  It is the equivalent of the fiscal cliff - but only for our industry.

And that is the straight dope.

So call your Senators!!  We have till Monday's vote!!  Try to push for support for S 2157!!

P.S. Sen. Wyden of Oregon crafted, sponsored, and introduced S 2157, thus he is definitely a supporter.  I have Bob Casey of Pennsylvania on record supporting S 2157 and on-time implementation of ICD-10.  We need to get the current non-supporters on board.

That said, it would still be good to call Sens. Wyden and Casey, thanking them for supporting S 2157 - and giving them some talking points on why we would support 2157 (what a negative impact a delay of ICD-10 would have on us) - and ask them to speak with their colleagues in the Senate on these talking points, and hopefully try to sway some of their colleagues to support S 2157.

If you're calling Senators other than Wyden or Casey, then it is best to support S 2157 and again, give them the talking points about the negative impact of a delay to implementation of ICD-10.

The problem is this:  S 2157 deals with doing away with SRG.  It goes WAY beyond the scope of HB 4302.
S 2157 is NOT "just HB 4302 without ICD-10 delay" (which is how many of us here might see it...as this would be the main issue on OUR radar)

S 2157 would get rid of the every-year having to extend SRG (Steny Hoyer in the House voiced support for this approach)  But it is far more comprehensive of a "doc fix" and this is a main reason for many non-supporters.  It is also why I personally believe we are more likely to get stuck with HB 4302 (small change is easier to make than sweeping change...and 4302 basically keeps the status quo - except, of course, for our purposes...)

The possible outcomes I listed above, in order of most likely to actually happen...are #2, #1, #3.
So we want to try to do what we can to support #1...that is...if what we want is no cuts to providers AND no delay in ICD-10.

Option #3 is only acceptable if you are willing to accept a 24 percent cut in payments - this is why arguing for an Obama veto is not a good idea, in my estimation (and I don't think such a veto would be forthcoming anyway)


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## Ellacott

Excellent summation.  Thanks.


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## Ellacott

The AMA has been pushing for a delay in ICD 10 implementation.  That's a pretty big group.

*****************
*ICD-10 implementation costs ?much more disruptive?: New study*

Posted at 2/12/2014 9:02 AM CST  

New estimates of costs to implement the federally mandated ICD-10 code set by Oct. 1 are in some cases nearly three times more than previously estimated, according to a new AMA study.


Costs associated with ICD-10 implementation include training, vendor and software upgrades, testing and payment disruption. Compared to a similar study completed in 2008, these costs could be as much as $8 million for a typical large physician practice. For a small practice, implementation costs could be more than $225,000. The move is expected to be ?much more disruptive for physicians? than previous mandates.





?The markedly higher implementation costs for ICD-10 place a crushing burden on physicians, straining vital resources needed to invest in new health care delivery models and well-developed technology that promotes care coordination with real value to patients,? AMA President Ardis Dee Hoven, MD, said in a news release. 


?Continuing to compel physicians to adopt this new coding structure threatens to disrupt innovations by diverting resources away from areas that are expected to help lower costs and improve the quality of care,? Dr. Hoven said.


Current cost estimates are higher now ?due to the need for testing, and the potential for increased payment disruption,? the study reports. ?A major element in cost is clearly the vendor/software upgrade category.?


The study notes specialty practices will see the highest ICD-10 implementation costs, especially in productivity losses and payment disruptions, because of their higher revenues and per hour rates.


The study estimates both pre- and post-ICD-10 implementation costs for average small, medium and large physician practices. While conservative cost estimates fall slightly below 2008 estimates, the range of expenses is much higher than the AMA?s 2008 analysis, and many practices are expected to fall into the higher ranges.


?Because of variability in the size and specialty of practices, there is no ?one size fits all? implementation process for practices to follow,? the study said. 


The AMA has been able to keep ICD-10 at bay for more than a decade and continues to urge lawmakers to stop implementation of the code set. Physicians can ask their members of Congress to co-sponsor legislation to stop ICD-10 implementation, known as the Cutting Costly Codes Act of 2013, by sending an email through the AMA?s Physician Grassroots Network.


As the AMA works to halt ICD-10, physicians should continue to prepare for the new code set. Access free educational resources from the AMA for practical insight into the preparation process, or visit the AMA Store for additional training opportunities and products.


These numbers are too important to ignore. Share on social media, and help us #StopICD10.

http://www.ama-assn.org/ama/pub/ama...mmentKey:99d4dca7-a285-4b0e-8bd7-27c225d65183


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## mjs1974

These numbers are too important to ignore. Share on social media, and help us #StopICD10.

http://www.ama-assn.org/ama/pub/ama-...7-27c225d65183
__________________
Renee, CPC
The Best Things in Life Aren't Things

So it is better for us not to have the new coding system which will ultimately have fewer rejections and denials and to be the last country not to have this system because the physicians say it will be to costly? 

THAT IS JUST BULL. It is better for the industry. it will make the physicians more money. have less denials. which means less time for billers arguing with insurance companies about why they are not paying. the physicians from what i have seen are the ones that dont want it. the medical billers and coders do. we are the one that do the work to get the money in. getting the codes. sending out the claims correctly. posting the money into the doctors bank account. let the coders and billers be the ones to decide. not the physicians.


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## ABridgman

Well, the argument can be made that we coders and billers are not the ones footing the bill for this implementation (except of course what we spend on our own continuing education...which I could only hope would result in an appreciable ROI)

I, personally am on the fence about this only because many doctors are not documenting the level of specificity demanded by ICD-10.  Another year delay may not be a bad thing in order to get the physicians some more training and more into the habit of documenting according to the new standards.

Yes, doctors SHOULD be being very specific in their documentation already...but the ideal world and the real world are two different things, and many doctors that are used to ICD-9 are going to need to develop new habits.

If ICD-10 IS delayed (and I am beginning to think it will be, now that I am aware the AMA is behind the push to delay this) we would do well to use the extra time to get our respective physicians in the habit of better documentation.

As I said in my previous posts, I already had a good idea that the reality appears to be that ICD-10 is going to get delayed...the new information that the AMA is pushing for delay...only serves to confirm for me...the eventual outcome will be delay.

Obviously, the majority view here, and among coders is that we do not want delay...but we should be prepared for that eventuality, and, as I said, use the extra time to develop better documentation habits in the physicians we serve.


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## mitchellde

The reason the providers are against ICD-10 is mainly due to the EMR. The EMR forces the provider to supply the codes befor the record can be signed out.   Why have they never fought a change in the code set before?  From ICD-8 to ICD-9, there was no fuss or discussion.  Because the provider never had to use the numeric codes.  We need to retool this industry and go back to a earlier version.  It is best if the provider does not assign the code.  It is best if they do not use templets for documentation.  If the provider never had to worry about learning the codes and code assignment then they would not care which code set is in play.   Then all they would need is knowledgeable coding staff.


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## mitchellde

here is the latest.  Notice they stipulate that come monday, there will be no amendments to the bill and it will be a roll call vote.  Basically it looks like they have agreed to pass this as a last act on Monday and send it to the President , they need this to pass befor midnight to meet the April 1 deadline.  So do you really think the president will veto this??

The Senate has reached an agreement to vote on passage of the SGR bill on Monday, March 31, with a 60-affirmative vote point of order. We expect a Republican to raise a Budget point of order against the bill prior to the vote on passage.



As a result of this agreement beginning at 5:30pm on Monday, March 31, there would be 3 roll call votes and 1 voice vote. Those would be on the following:



-          Confirmation of Executive Calendar #573, John B. Owens, of CA, to be US Circuit Judge for the Ninth Circuit (majority vote threshold);

-          Motion to waive applicable budget points of order with respect to H.R.4302, Protecting Access to Medicare Act of 2014 (SGR/Doc Fix) (60-vote threshold);

-          Passage of H.R.4302,  Protecting Access to Medicare Act of 2014 (SGR/Doc Fix) (60-vote threshold); and

-          Adoption of the motion to proceed to H.R.3979, the legislative vehicle for the Unemployment Insurance extension (voice vote expected)



The agreement is as follows:



Following Leader remarks on Monday, March 31st, the Senate proceed to the consideration of H.R.4302, which was received from the House and is at the desk; that there be no amendments or motions in order to the bill with the exception of budget points of order and the applicable motions to waive; that the time until 5pm be equally divided between the two Leaders, or their designees, for debate on the bill; that notwithstanding the previous order, following the vote on confirmation of the Owens nomination on Monday, March 31st, the Senate resume consideration of H.R.4302, the bill be read a third time and the Senate proceed to vote on passage of the bill; that the bill be subject to a 60 affirmative vote threshold; finally, that upon disposition of H.R.4302, the Senate proceed to vote on the motion to proceed to H.R.3979, as provided under the previous order.


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## Petlorilea

ABridgman said:


> Yes, doctors SHOULD be being very specific in their documentation already...but the ideal world and the real world are two different things, and many doctors that are used to ICD-9 are going to need to develop new habits.
> 
> Obviously, the majority view here, and among coders is that we do not want delay...but we should be prepared for that eventuality, and, as I said, use the extra time to develop better documentation habits in the physicians we serve.



I have 48 providers; about 1/3 of them simply will NOT document specifically now because ICD9 does not encourage it. (See 729.5) My ever present thorn in the side is diabetic manifestations.... 250.60 is not diabetic peripheral neuropathy,  Dr.! 
I believe that ICD10 actually will help providers in their selection of specific codes; we just won't have that benefit for 18 MORE months at least


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## Wanda Elizabeth Thomason

*ICD-10 implementation*

I think that they should delay this for another year.  I don't really think a lot of us is ready for this.  Especially VA facilities.


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## mitchellde

The real question is why isn't everyone ready?  This has been planned for several years now.  The code set has been available in code books since 2010. That is 4 years of real prep time.  This code set has not changed at all since 2011 except for one code that was deleted.   What is one more year going to add?  You will never have 100% readiness no matter what the issue is.  One more year is not going to assure that everyone is prepared any better than they are right now.  We need to just pull this trigger and do it.  That is when everyone will he ready and not a day sooner.  Most will wait until the last minute no matter what.


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## espressoguy

Exactly right, Debra. The hospital where my wife works would have been ready for the Oct 2013 implentation had it not been delayed. We started training last fall and were scheduled to start dual coding on April 7. Wednesday, before management became aware of the pending legislation, they decided to delay dual coding until April 14. I'm not sure what's going to happen now, but I would rather just get it over with.


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## ABridgman

Petlorilea said:


> I have 48 providers; about 1/3 of them simply will NOT document specifically now because ICD9 does not encourage it. (See 729.5) My ever present thorn in the side is diabetic manifestations.... 250.60 is not diabetic peripheral neuropathy,  Dr.!
> I believe that ICD10 actually will help providers in their selection of specific codes; we just won't have that benefit for 18 MORE months at least



So you know EXACTLY what I am talking about.
The provider I currently work for is also bad about specificity in documentation...and again, this is because ICD-9 does not encourage or even really require it.

ICD-10 is going to FORCE this specificity.

The way I'm looking at this is that I now have another year to train my providers to document in the manner needed.

Just today, I showed my doctor how Gout, which has about 11 codes in ICD-9 is going to have about 340 codes in ICD-10.

And I showed him the level of specificity needed.

For the example of Gout, we need

First, is it Chronic or not?
Second, if Chronic, is it with or without tophus?
Third, is it idiopathic, lead-induced, drug-induced, due to renal impairment, or other secondary gout?
Fourth, need to know which body part is affected - foot/ankle, knee, hip, hand, wrist, elbow, shoulder, vertebrae...and then
Fifth, if applicable, need to know if it is right-side or left-side.

ICD-9 lets you get away with 274.9 - Gout, NOS.
Not so, ICD-10.

So, getting providers up to - and in the habit of - precise documentation...is a very important part of ICD-10.
Me, I could care less if my provider knows the code numbers...frankly, that's my job anyway.
But it IS his job to give me the information I need in order to code correctly.


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## ABridgman

mitchellde said:


> The real question is why isn't everyone ready?  This has been planned for several years now.  The code set has been available in code books since 2010. That is 4 years of real prep time.  This code set has not changed at all since 2011 except for one code that was deleted.   What is one more year going to add?  You will never have 100% readiness no matter what the issue is.  One more year is not going to assure that everyone is prepared any better than they are right now.  We need to just pull this trigger and do it.  That is when everyone will he ready and not a day sooner.  Most will wait until the last minute no matter what.




True, but now I am glad I held off on all the expensive training.
Since the actual coding rules, the E/M rules, etc are not actually changing...just the codes themselves are changing...why spend hundreds of dollars to get certified in the new code set when you can't even use it yet....and now they are going to delay it yet another year.

The problem is that this is like learning a second language...if you don't use it, you lose it.

So I have tried my best to coordinate any formal training I will take...to coincide with implementation, so that my training will complete right around the time implementation happens, thus I do not have a long time to wait before using it, risking losing too much of the knowledge due to lack of use.

I mean, let's face it this training isn't cheap.  So who wants to go through it...only to have a delay happen...and then have to pay more money for a refresher course later on....and possibly have the thing get delayed yet again?

So...I'm on the fence about implementation, really.

On one hand, I'd like to see them pull the trigger and go forward, thus I could then start my formal training and have it fresh when the implementation happens.

On the other hand...another year to hammer home to my providers about the need to get into the habit of specificity in documentation might not be such a bad thing.

Not sure what EMR's actually are requiring doctors to actually know the codes...I do not think Practice Fusion actually requires them to know it...I think they can type in the name of the diagnosis and get a list of codes to choose from...and once that diagnosis is in the Patient History, it stays there, so the doctor can pull it back any time he needs to...no need for him to know or memorize the codes.

Though, since I, myself, do not generate SOAP Notes within PF, I am not sure how that aspect of it works for the provider.  But I know I can find all the patient's diagnostic history within the patient's chart on PF.


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## MedCodeNet

*Consider both ramp up and implementation*

It's important to consider not only all that iss involved with implementing and launching ICD-10 but what happens when it?s implemented. I don't hear much discussion about the initial rush of denials and confusion that will certainly occur. Thousands of new, more specific codes will give insurance companies new opportunities to deny claims and in some instances, it will come down to who knows ICD-10 the best ? payer or payee. With payers, physicians, coders, billers and other HIM workers all having a different level of training and expertise in ICD-10, it will be a bumpy ride for a while. I hope ICD-10 is not delayed but if it is, I hope the issues above will be more closely examined.


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## ABridgman

MedCodeNet said:


> It's important to consider not only all that iss involved with implementing and launching ICD-10 but what happens when it?s implemented. I don't hear much discussion about the initial rush of denials and confusion that will certainly occur. Thousands of new, more specific codes will give insurance companies new opportunities to deny claims and in some instances, it will come down to who knows ICD-10 the best ? payer or payee. With payers, physicians, coders, billers and other HIM workers all having a different level of training and expertise in ICD-10, it will be a bumpy ride for a while. I hope ICD-10 is not delayed but if it is, I hope the issues above will be more closely examined.



That is my biggest concern with ICD-10.  It gives insurance companies more reasons to deny claims.  And I am of the belief that insurance companies do their level best to delay, pend, and deny claims, because they don't really WANT to pay.  I have been self-training myself in ICD-10 ever since 2013...and waiting on formal training and certification until it appears that implementation is really going to happen...and trying to time it such that the formal education/certification is completed very shortly before actual implementation...thus there is little time where the new knowledge is not used, thus retention remains high.

If I am gong to invest money in further education, I want to do it at a time where I will get the most benefit from it - and that means not having too much time between the end of the education...and actually USING the new knowledge.

This is like a second language, and if you are not using it, then you're going to lose it.  Training in ICD-10 is not cheap, not anywhere.


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## jimbo1231

*2015?*

I have my doubts about ICD-10 ever happening, or at least for a long time. There is nothing to stop congress from voting annually for an ICD-10 delay the way they do the SGR fix every year. The reality is that the lobbyists including AMA are more powerful than anything we have.

Since I've been writing about ICD-10, I'v learned it pretty well. And it is far superior to ICD-9 on many levels. And it isn't that hard. Maybe it would have resulted in more payor denials initially. But the specificity in the long run would have prevented denials (I think, no excuse for the payor to put in medical review).

But the worst part is the hypocricy of the medical community. And physicians who had learned anything about ICD-10 know it's a better system for tracking trends in disease, linking trends to outcomes and treatment etc. Hell, right now with ICD-9 a specific finger injury can't be tracked.

I do agree that pretty much the only stakeholder in ICD-10 that would have been ready on 10/1 is our industry. And coders being ready if providers, IT and payors weren't really would have been a mess. But I have no confidence they will be ready next year since skepticism will set in about this ever happening.


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## ABridgman

Oh, I think it may eventually happen, but when...who can say.

My OWN take would be they should slowly transition this in...in other words, have an overlap period of a year or two in which both reporting in ICD-9 OR ICD-10 would be acceptable.

This would possibly allow for more time to use it and get used to it...because we could actually USE what we are learning in ongoing education - instead of having the education in place...no place to use it...and then risk losing a lot of that knowledge to lack of use.

This would also give us some time to show our physicians we serve...the differences in the coding, thus the changes they will need to adapt to in their documentation.  I know many doctors really hate documentation - they rightly see it as bureaucratic stuff that eats up time they could be in the examining room.   But they are the only ones who can do that documentation...they need to document what they are doing so that we can code properly.

When I showed my doctor the differences just in coding Gout, for example...he was shaking his head.

The way you'd work a transitionary shift to ICD-10...would be to extend it over a three-year period, perhaps...allowing both code sets to be used.  The first two years, you'd get a bonus in payments FOR using ICD-10 versus ICD-9.  The third year, you'd be penalized for NOT using ICD-10.  The fourth year, ICD-10 ONLY would be acceptable.

This way, you give them an incentive to do these things.  Why not?  This is how they have phased in Meaningful Use, right?  The first couple years, the HITECH Act gave physicians incentives for using EMR systems, as long as they met MU criteria...and starting 2015, will begin penalizing doctors who do not meet and report MU.

So why could we not do the same with ICD-10?

Start with an incentive...allowing both code sets to be used...then move to a penalty for not using...then just phase out ICD-9.  Most doctors will WANT the incentive...and will certainly wish to avoid the penalty.

This way, those of us who do coding...will have opportunity to become accustomed to ICD-10, to USE the knowledge we are spending lots of money in obtaining...and the physicians will have an incentive to go along with it.

By the time we get to the penalty phase, ICD-9 would probably just about wither on the vine, as it were...and we'd have a successful transition.

This would also allow payers to have a time period with which to ramp up...and experience in dealing with ICD-10...this could provide a less bumpy path forward.  

On the payer end...they could assign certain agents only...ones who have knowledge...to handle incoming ICD-10 claims...while others handle the ICD-9.  Then you begin educating those agents still doing ICD-9 into ICD-10, and then let them work under the wings of the ones already handling ICD-10...and so on...thus insuring everyone gets properly educated, and has plenty of time to slowly transition.

I think the main reason for the hesitation and delay in using the new code set involves the fact that this is NOT just an update to the code set, like ICD-8 to ICD-9 was...this is a complete overhaul...and it has some powerful people resisting it because it is such a radical change.

MY own opinion is that radical change is best accomplished slowly...by implementing it a piece at a time.  But just my $.02 worth...


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## lorrpb

The Senate is voting Monday.


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## jimbo1231

*Transitional Approach*

I also think some type of transitional approach could work. Those of us who have been around a few decades remember the RBRVS transition in the early 90s. Initially it was going to be a hard date implmentation from the old UCR reimbursement method to RBRVS. But after a lot of commotion similar to ICD-10, feds went to a 5 year transition. Hell, they are still transitioning and refining...SGR
But something making sense and politics and lobbying don't always jive. The medical provider industry is lined up against this ever happening. And Obama doesn't ever want Obamacare roll out deja vu. But maybe our industry could learn from Obamacare's errors. They initially did a poor job communicating the value of it to young people. Now you see movie stars and mega star athletes (Lebron included) selling it to young people. I don't know if it's possible but if high level physicians who do research, people like Jesse Pines in the ED industry, started publishing about the positives of ICD-10 for medicine, that might turn the tide. 
But I'm not holding my breath. So years more of E-Codes since ICD-9 can't identify a freakin puncture wound, and multiple diabetes codes because ICD-9 never heard of combination codes, and no tracking which finger was injured or if it was left or right.


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## ABridgman

jimbo1231 said:


> I also think some type of transitional approach could work. Those of us who have been around a few decades remember the RBRVS transition in the early 90s. Initially it was going to be a hard date implmentation from the old UCR reimbursement method to RBRVS. But after a lot of commotion similar to ICD-10, feds went to a 5 year transition. Hell, they are still transitioning and refining...SGR
> But something making sense and politics and lobbying don't always jive. The medical provider industry is lined up against this ever happening. And Obama doesn't ever want Obamacare roll out deja vu. But maybe our industry could learn from Obamacare's errors. They initially did a poor job communicating the value of it to young people. Now you see movie stars and mega star athletes (Lebron included) selling it to young people. I don't know if it's possible but if high level physicians who do research, people like Jesse Pines in the ED industry, started publishing about the positives of ICD-10 for medicine, that might turn the tide.
> But I'm not holding my breath. So years more of E-Codes since ICD-9 can't identify a freakin puncture wound, and multiple diabetes codes because ICD-9 never heard of combination codes, and no tracking which finger was injured or if it was left or right.



Pretty much.
But I like the idea of a transitional approach...one which makes it more "voluntary" - and to do it, you start off incentivizing early adopters...then you start penalizing those who don't jump on-board...then you give them no choice.

The point is...if you get some early adopters jumping on - to get the incentives (same way MU was done with EHR/EMR) then you get some people out there USING ICD-10...who can then say...look, it works for us...this isn't so bad, the sky is NOT falling, Chicken Little!!

On the other hand...supposing it starts out a royal disaster.  OK, so you can STILL go back to ICD-9 while the problems are worked out - and you have REAL PEOPLE doing REAL CLAIMS in the REAL WORLD...using ICD-10...and so you get a better idea where the problems are and how to fix them.

The transitional approach would thusly reward those who adopt it early...later, penalize those who don't jump on-board...and then, finally, give them no choice.  But the transitional approach, I think, would meet with far less resistance.


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## darfale1

I would love to hear the outcome of this.    Thanks for posting


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## Ellacott

The Senate is adjourned until 2pm today.  They are expected to vote on the bill around 5:30 pm.


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## continuum2013

I also am waiting to hear the outcome of the vote


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## cjhalk@yahoo.com

Voting in progress - but vote is currently 62 yes and 35 no. The bill passes for a delay of ICD-10. 60 needed to pass. Now onto the president for signature or veto.


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## AlaskanCoder

Has anyone heard anything more?


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## cjhalk@yahoo.com

Final voting has passed for a delay of ICD-10.


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## sjenkins0070

It's official...ICD-10 is delayed until October 2015.


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## cjhalk@yahoo.com

sjenkins0070 said:


> It's official...ICD-10 is delayed until October 2015.



Well, not offical - the president can still veto. I don't think anyone thinks he will do that, but he still has to sign it for it to become "offical."


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## ABridgman

Official count in Senate 

64 Yea
35 Nay

Has bi-partisan support and averts the fiscal cliff" for doctors...you might as well call this thing signed.

I can't find any official word as yet whether Obama has signed it but I believe it is a foregone conclusion.


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## mitchellde

He had to sign it by midnite or the whole thing is for naught.  The bill is all about the SGR and truely had nothing to do with ICD-10.  However this is much like the whole APC thing back in 2000.  Same thing we get ready and then congress pushed it back.  Then when no one was looking the last meeting before congress recessed for the summer, they passed the APC for facility outpatient to be effective in a 2 week time frame.  It was so quick and no one was ready because of the constant delays.  I see this same thing happening here, we will get a 2 week notice and go. 
Obama will not veto this bill, it would be a huge mistake for him to do that.  But this is not yet dead.


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## Ellacott

I don't think he has a choice whether to sign it.  If he doesn't sign it there will be a 24% reduction in Medicare reimbursement.


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## skeen

*Presidental Signature*

Does anyone know if President Obama signed HR 4302?  Can he do a line item veto and just strike implementation of ICD-10 from the bill leaving it with an effective date of 10/14?


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## Aperring

The President is not allowed a line item veto. And even is he dosen't sign the bill today it will take effect retroactivly, when he does sign it. CMS has already stopped processing claims until April 10th so they can make necessary adjustments.


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## pathfinder57

*ICD10 and Politics*

Poli = many (we knew that)
Tic(k) = blood-sucking parasite (we knew that, too)
Politics = many blood-sucking parasites.....we know this for sure everyday


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## lisbat

Ok, so I'm not crazy. I thought Sebelius had, "put her foot down" on that recently. I can't believe this might be happening. What's wrong with these people?!?


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## Ellacott

The President has signed the bill.  The AMA and other physician groups were in favor of the delay.  I subscribe to the Medscape newsletter and they had an article about the delay.  I was really surprised by the comments.  The overwhelming majority of doctors are opposed to ICD 10 because they think it will be more work for them and be something that the insurance companies will use to deny payment.  

The AMA was also against this bill(the doc fox) because it provided a temporary patch to Medicare Reimbursement and they wanted a permanent fix.  It's been speculated that the ICD 10 delay was inserted to placate the medical community since they didn't pass legislation for the permanent fix.


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## ABridgman

pathfinder57 said:


> Poli = many (we knew that)
> Tic(k) = blood-sucking parasite (we knew that, too)
> Politics = many blood-sucking parasites.....we know this for sure everyday




If "PRO" is the opposite of "CON"

What is the opposite of PROGRESS??

Think about it.


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## ABridgman

Ellacott said:


> The President has signed the bill.  The AMA and other physician groups were in favor of the delay.  I subscribe to the Medscape newsletter and they had an article about the delay.  I was really surprised by the comments.  The overwhelming majority of doctors are opposed to ICD 10 because they think it will be more work for them and be something that the insurance companies will use to deny payment.
> 
> The AMA was also against this bill(the doc fox) because it provided a temporary patch to Medicare Reimbursement and they wanted a permanent fix.  It's been speculated that the ICD 10 delay was inserted to placate the medical community since they didn't pass legislation for the permanent fix.



I suspect you're right about why docs are opposed to ICD-10.  They think it will be more work for them...AND they believe insurance companies will use it to nitpick things and increase denials, and pended claims.

I know my doctor HATES the documentation end of his work - most doctors do.  They just want to heal people, and get paid for doing so.

It's OUR job...to make this transition as painless as possible for the clients we serve.  To that end, I have been doing everything I can to find ways to minimize the extra work that will be required by my doctor.

I have also switched billing vendors to a vendor who was able to prove they were more than ready for ICD-10 when it came - they have been ready for over a year.  And with the claimscrubbing features, I anticipate little to no increase in rejected/pended/denied claims.

I think part of the problem may be a lack of communication - we need to communicate to the medical professionals that we serve...what we are doing to insure a smooth transition to ICD-10.

We can only hope our voices...and our personal relationships with the professionals we serve...will be louder than the voices of the AMA and the insurance lobby.


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## Pam Brooks

If you've been in healthcare as long as I have, you know that things change, nothing stays the same, and in a regulated industry such as this, our government has the potential to influence us every day.  

Frankly, I am OK with the delay, and from what I've heard from colleagues and consultants across the country, my organization was actually one of those who is very well prepared--so we've spent a lot of money on training, education and upgrades at this point. 

Still, there's always room for improvement.  

So we will continue to dual-code, to train providers and to keep tabs on the Coding Clinic updates so that when the ICD-10 transition takes place, we'll be that much more efficient and prepared.  

Lemonade from lemons, people.


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## MarcusM

The US Senate has voted for a 1-year "doc fix" preventing a 24% pay cut for physicians who treat Medicare patients, while also delaying by 1 year the implementation of the nationwide conversion to the International Classification of Diseases, 10th Revision (ICD-10), set of diagnostic and procedural codes that was scheduled to occur on October 1.

The bill now awaits President Obama's signature.


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## RebeccaCross*

*From: Modern Healthcare*

Healthcare Business News 

*Obama signs 'doc-fix' bill*
By Associated Press 

Posted: April 2, 2014 - 9:45 am ET
Tags: Associated Press (AP), Barack Obama, ICD-10, Medicare, Payers, Physicians, Reimbursement


President Barack Obama Tuesday signed into law legislation to give doctors temporary relief from a flawed Medicare payment formula that threatened them with a 24% cut in their fees.

A 64-35 Senate vote Monday cleared the measure through Congress. The law also delays nationwide implementation of the ICD-10 diagnostic codes until 2015.


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## maddismom

What Pam said.  I was personally very surprised by this and willing to move forward with ICD-10, but I can't say all of our independents (mom/pops) were.  

Am looking forward to more/better education for myself and ways to assist them.

Lemonade indeed.............


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## continuum2013

Where did you find this information? I looked at the AP and checked the Medicare news and couldnt find the article that talks about it.
Thanks



RebeccaCross* said:


> Healthcare Business News
> 
> *Obama signs 'doc-fix' bill*
> By Associated Press
> 
> Posted: April 2, 2014 - 9:45 am ET
> Tags: Associated Press (AP), Barack Obama, ICD-10, Medicare, Payers, Physicians, Reimbursement
> 
> 
> President Barack Obama Tuesday signed into law legislation to give doctors temporary relief from a flawed Medicare payment formula that threatened them with a 24% cut in their fees.
> 
> A 64-35 Senate vote Monday cleared the measure through Congress. The law also delays nationwide implementation of the ICD-10 diagnostic codes until 2015.


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## mhstrauss

continuum2013 said:


> Where did you find this information? I looked at the AP and checked the Medicare news and couldnt find the article that talks about it.
> Thanks




This AP article shows that he signed yesterday...I hadn't come across this before either    It appears to be the same that Rebecca posted from above.

http://abcnews.go.com/Health/wireStory/obama-bill-giving-docs-temporary-medicare-fix-23137934


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## second to none 

*study for ICD-11*

Hi Everybody!
Nobody needs to study for ICD-10 because France and India will adopt the ICD-11 in the begging of 2017. So, we need to study for ICD-11 together including our providers.


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## ABridgman

This says it all...only a coder could appreciate this.
By the way, I made it.  My idea.


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## RebeccaCross*

Ha!  What a HOOT!  What an imagination!


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## ABridgman

RebeccaCross* said:


> Ha!  What a HOOT!  What an imagination!



Thanks.

By the way...DO we have an ICD-10 code for Borg Implants?
Something in the External Causes of Morbidity codes, maybe??


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## Aperring

Yes it would be multiple codes from Z96 series for presence of implanted devices


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## ABridgman

Aperring said:


> Yes it would be multiple codes from Z96 series for presence of implanted devices



Love it!!

Thanks!!


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## Ellacott

ABridgman said:


> This says it all...only a coder could appreciate this.
> By the way, I made it.  My idea.




This is so great!!


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## Cherish79

*Eh*

I have to say I am of two minds about this. However, not two weeks before this all came about I was saying to one of my coworkers that I was hoping it would be delayed one more year. Oops. Sorry! 

However, I have not been doing physician coding for very long, maybe 5 years (I did 911 Ambulance billing and then DME/Oxygen billing before that), so until I got to my current job, I knew nothing really about any ICD10 stuff, or that it would be something in the future. (Amazing how much more you learn when you are working instead of in school!) With this new delay, I'm not too confident that it will ever happen now. If we are to change, I'm sort of with those who say forget ICD10 and lets just moved to ICD11. What's the point? So we can get ICD10 and do it for the next 40 years while everyone else moves on to ICD11?  

Anyway, here's to another year to prepare, and possibly another 4 or 5 if it keeps going this way! Cheers!


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## K_Schwacha

*What will happen next year?*



Ellacott said:


> This is so great!!



I love Jean-Luc as the Borg!  However, the caption "resistance is futile" is now kind of a joke.  Whether it is insurance companies or doctors that pushed for the delay, the ones who are being penalized are the ones who prepared for the change like they were supposed to.  
I guess 6 billion dollars is not considered a lot of money to waste.  In any case, it will all have to be respent again when some new version does go into effect.  I find it interesting that other than "not being ready", there is no real rationale for the delay - and really there is no excuse to not be ready at this point.
Will ICD-10 re-emerge in a modified form that will make everyone happy?  We shall see.


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## Ellacott

K_Schwacha said:


> I love Jean-Luc as the Borg!  However, the caption "resistance is futile" is now kind of a joke.  Whether it is insurance companies or doctors that pushed for the delay, the ones who are being penalized are the ones who prepared for the change like they were supposed to.
> I guess 6 billion dollars is not considered a lot of money to waste.  In any case, it will all have to be respent again when some new version does go into effect.  I find it interesting that other than "not being ready", there is no real rationale for the delay - and really there is no excuse to not be ready at this point.
> Will ICD-10 re-emerge in a modified form that will make everyone happy?  We shall see.



I've been comments on a newletter I receive from Medscape.  I'm really surprised at the amount of physician resistance.  They want to change at all.  They don't want ICD 10 or ICD 11.  They feel it would increase their time on clerical things like picking a more specified code and take away from time that could be spent on patient care.  They also feel it would give insurers more incentive to deny the claim if the code selected is not specific enough.  

There is definitely a divide between the physicians and the coders.  The AMA is a much bigger and more powerful lobbying group than AAPC of AHIMA.  The lawmakers probably have no idea about coding.

This will be a huge financial hit for people in our profession.  Many of the new coders have been trained exclusively on ICD 10 and will now need training in ICD 9.

I have my doubts if we will ever change.  It will be just like the metric system.  People felt it was too big of a change.


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## erjones147

Sarreenah said:


> I have to say I am of two minds about this. However, not two weeks before this all came about I was saying to one of my coworkers that I was hoping it would be delayed one more year. Oops. Sorry!
> 
> It's all your fault!!!


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## ABridgman

I tend to agree on the source of the resistance is coming from providers.

Recently I saw results of a survey about ICD-10 and the overall results of the survey were pretty negative...and it seemed a large amount of the survey pool was providers...although some coders, myself among them, were in the pool.

The biggest concern...and one I share...is that insurance companies will use this to deny/reject/pend more claims.  and it will also slow down their processing of claims until THEY become more familiar with the new coding.  This will create revenue stream problems, and remains MY biggest concern regarding ICD-10.

This is why I still believe a transitional approach, where implementation is done over a period of a few years, would be the best approach.  Let's face it...this is NOT a tweaking of the codes, like ICD-8 to ICD-9 was...this is a major overhaul!  This IS very much like converting from standard American measurement units into Metric.

I can do it...but most Americans can't.  And even though I can do it...still...a mile means something to me...something I can visualize without a lot of thought.  A kilometer doesn't do that for me (although I know a mile is 1.62 kilometers...and therefore a kilometer is just about 6/10 of a mile (a little over that, really, if you wanted me to break out a calculator)

For my part, I have been doing everything I can to educate the provider I serve about what documentation changes he will need to be making...and TRYING to get him in the habit of doing it NOW...rather than when (or if) implementation occurs.  To that end, I am also doing everything I can to minimize the amount of extra work that will be required.

Most of us serve professionals who just want to do medicine and hate the bureaucratic side of it...and really don't care for the documentation all that much, either.  From THEIR point of view, it takes time from them...time they could be in the examining room.

And I don't know if the majority of coders out here feel as I do...but it isn't the doctor's job to pick out a more specific code...that is our job.  It is HIS job to give us the level of documentation we need in order to select the best possible code.  And so that is where I am focusing my efforts.  Educating my provider as to the level of specificity I need in his documentation.  Trying to get him in the habit of doing it now, rather than only when it is required.

And that is all WE can really do at this point.  Keep ourselves educated and sharp, and try to ease the transition as much as possible for the professionals we serve.


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