With 3.5 months to go for the implementation deadline, new bills in the house trying to delay it once more. Calling it the “safe harbor” supporters are asking for a transition period for up to 2 years during which time, providers using the codes wouldn’t be panelized for their errors.
Detractors argue that the bills are really based on some incorrect assumptions. First, payments aren’t determined with the ICD codes; these codes are for diagnoses. CPT code are used to describe services. Secondly, ICD-10 details aren’t readily available in the record. The record should include all of the information to determine the ICD code. The argument that payments will be delayed has been put to rest by actual claim processing results tested by the Centers for Medicare & Medicaid Services (CMS). Their results show that only 2% of the test claims submitted were denied based on coding errors.
The bills claim that the code switch will place an undue burden. However, the magnified detail includes, for example, the body part(s) affected in the injury or disease process, all of which information is available in the record.
The Coalition for ICD-10 arguing against the safe harbor bills on the fraud and abuse issues says that if the coding errors were accepted by CMS without fear of audit, the agency could see a rise in deliberate reporting of incorrect information.
The bills also fail to address all payers, that is would the safe harbor provisions only relate to CMS or to all insurance companies.
Bottom line, virtually everybody in the healthcare industry that understands and works with codes and reimbursement agrees that it is important to move forward with the implementation and stop worrying about the allegedly dire consequences. After all, the rest of the civilized world has been using it for years.