HIPAA Compliance

ICD-10 Implementation on Hold Until 2015

ICD-10 delays increase training costs and frustrations, but implementation will pay off.
By: | May 2, 2014

Workers’ comp payers that have invested in the impending new diagnostic codes are being forced to regroup. A law signed by President Obama delays implementation until October 2015, at least.

The International Classification of Diseases 10th edition was scheduled to take effect this October. But legislation that addresses the Medicare sustainable growth rate includes a provision that prohibits the Department of Health and Human Services from implementing the updated coding for another year.

“We’re all walking around here not really sure if this is going to happen. I’m confident it will, whether it is ICD-10 or 11. We have to change,” said Michele Hibbert-Iacobacci, vice president of information and support for Mitchell International.

Hibbert-Iacobacci spoke to Workers’ Compensation Report from Washington, D.C., where she was attending the American Health Information Management Association’s ICD-10/Procedure Coding System and Computer-assisted Coding Summit, which had been planned before the delay was announced. According to the association’s website, panelists at one of the early sessions referred to the code set’s delay as “ICD When.”

Even though workers’ comp is not a covered entity under HIPAA and therefore not required to transition to ICD-10, experts such as Hibbert-Iacobacci have strongly advised payers to do so. As she explained, it is in the best interests of workers’ comp stakeholders to comply.

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“The fact of the matter is the doctors do [have to comply]. Providers are covered under HIPAA regardless whether they bill for comp or general health,” she said. “It would be the most ridiculous thing [for them] to speak two different languages.”

Many providers’ offices had already begun the expensive transition from ICD-9 to ICD-10. “The small practice, which is what we see a lot of in workers’ comp, is truly affected,” Hibbert-Iacobacci said. “Many of them switched.”

Some providers have been using dual systems in preparation for the change. Switching from one coding system to another costs an estimated billions of dollars, especially for training.

“Training was set for three months leading up to the [implementation] date,” Hibbert-Iacobacci said. “Some have started preliminary training. They will lose that information. They will have to do it over again or revisit it somehow.”

Hibbert-Iacobacci said annual updates to the ICD-9 codes were not done this year due to the anticipated implementation of ICD-10. Now those code sets will need to be updated.

With workers’ comp regulated at the state level, many jurisdictions have adopted  legislative or administrative changes to allow for the transition from ICD-9 to ICD-10 codes. They are now in a wait-and-see mode.

Despite the costs and frustrations imposed by the delay, Hibbert-Iacobacci believes the change is inevitable and will be highly beneficial. For one thing, she says the new codes may help determine causation.

“There are encounter codes added to the injury codes, [including] the initial, subsequent, or sequela migration of injury,” Hibbert-Iacobacci said. “In workers’ comp we have to pay for things related to accidents … you should not see a ‘subsequent’ for an accident or it means there is a preexisting injury.”

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]