Orthopedic Coding Alert

So far, Congress appears to support Oct. 1 implementation date.

You may be furiously prepping for the ICD-10 conversion, but your specialty societies are still looking for answers to their burning questions.

The American Association of Orthopaedic Surgeons (AAOS) and the American Medical Association were among medical 100 groups that wrote to CMS on March 4 seeking answers about ICD-10 that they believe have not been appropriately addressed.

Although the groups didn’t go so far as to request a delay to the Oct. 1 implementation date, they did express strong concerns about the transition in the seven-page letter to Acting CMS Administrator Andrew Slavitt.

Chief among the issues were the results of CMS’s end-to-end testing periods, which revealed claim acceptance rates in the 76 to 89 percent range. This range clashes significantly with the standard Medicare acceptance rate of 95 to 98 percent, the letter stated. Because only a small number of practices participated in the testing, the groups worry that when all Medicare practices start submitting claims, that percentage rate will extrapolate out to the community at large, causing massive denials.

“The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices,” said AMA President Robert M. Wah, MD in a March 4 statement. “Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care.”

The most recent CMS end-to-end testing period (Jan. 26 to Feb. 3) resulted in an 81 percent success rate, the agency said. The remaining claims were rejected for three main reasons, as follows, according to the most recent statistics released by CMS:

• Invalid submission of ICD-9 codes (seen in three percent of rejected claims)
• Invalid submission of ICD-10 codes (as demonstrated by another three percent of claims that didn’t pass through the system)
• Errors unrelated to ICD-10, such as using an incorrect NPI, an invalid date, the wrong place of service or an incorrect HCPCS code (seen in 13 percent of rejected claims).

Congress Sticking to Guns—for Now

The letter comes on the heels of a Congressional hearing that seemed to solidify the Oct. 1 ICD-10 implementation date.

On Feb. 11, the House Energy and Commerce Committee held a hearing in which healthcare experts urged Congress to ensure that the Oct. 1 deadline stays put. Only one witness, a physician from Alabama, asked for a reprieve from the October requirement, but members of Congress did not appear to be sympathetic. Representative Kathy Castor of Florida urged the panel to stop delaying the transition to ICD-10, which was echoed by other members of Congress.

Keep an eye on Orthopedic Coding Alert for more on the ICD-10 implementation date as the situation unfolds.