Medicare Compliance & Reimbursement

Reps say IPPS and implementation of ICD-10 unrelated.

You’re not alone if you have questions about the ICD-10 delay. You have plenty of company waiting for answers from CMS, as was evident during CMS’s May 13 Open Door Forum. 

“On April 1, 2014, the Protecting Access to Medicare Act of 2014 was enacted, and it says that the secretary may not adopt ICD-10 prior to Oct. 1, 2015,” said the Centers for Medicare and Medicaid Services’ Chris Ritter during the call. “Accordingly, the US Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through Sept. 30, 2015.”

When a caller asked whether that Final Rule will be issued on Aug. 1 (which is when the Inpatient Prospective Payment Final rule is due to be issued), CMS reps declined to answer. “Actually, the handling of ICD-10 is a separate issue,” Ritter said. “The proposed IPPS rule does simply indicate that the recent legislation does delay ICD-10, and the secretary will be issuing a rule separately, but there will be a separate final rule for ICD-10. You can keep your eyes out for that.”

When a caller asked whether the ICD-9 code freeze will stay in effect or whether new ICD-9 codes will be released in the wake of the ICD-10 delay, CMS’s Diane Kovach responded that the answer has not yet been determined and that CMS will speak on that at a later date.

Another caller asked for rationale regarding the cancellation of ICD-10 end-to-end testing, but CMS stressed that “the agency has committed to end-to-end testing” and that it will happen in 2015. “Like everyone else that has done a lot of work to prepare for ICD-10 for the Oct. 1, 2014 date, we now have to turn our attention to reverting back to ICD-9 codes, so we’ll be doing that for the coming months, and as soon as we have information available, which we hope will be in the not too distant future, we’ll have information to you on end-to-end testing for next year,” Kovach added.

Here’s What You Can Do

Take the extra year to get to know the ICD-10 manual, if you haven’t already studied it. Each ICD-10 code begins with a letter and these letters indicate the tabular chapter from which the code comes. Use this list to begin familiarizing yourself with ICD-10’s organization.

• A & B – Certain Infectious and Parasitic Diseases
• C – Neoplasms
• D – Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism
• E – Endocrine, Nutritional, and Metabolic Diseases
• F – Mental, Behavioral and Neurodevelopmental Disorders
• G – Diseases of the Nervous System
• H – Diseases of the Eye and Adnexa, Ear and Mastoid Process
• I – Diseases of the Circulatory System
• J – Diseases of the Respiratory System
• K – Diseases of the Digestive System
• L – Diseases of the Skin and Subcutaneous Tissue
• M – Diseases of the Musculoskeletal System and Connective Tissue
• N – Diseases of the Genitourinary System
• O – Pregnancy, Childbirth and the Puerperium
• P – Certain Conditions Originating in the Perinatal Period
• Q – Congenital Malformations, Deformations and Chromosomal Abnormalities
• R – Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified
• S & T – Injury, Poisoning and Certain Other Consequences of External Causes
• V, W, X, Y – External Causes of Morbidity
• Z – Factors Influencing Health Status and Contact with Health Services.