U.S. House Introduces ICD-10 Dual Coding Bill

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U.S. House Introduces ICD-10 Dual Coding Bill

Some physicians are still resisting ICD-10 implementation due to negative effects it may have on smaller practices revenue stream. Both EHR vendors and consumers need to both push for upgrades in order to comply with the looming deadline.

ICD-10 Bill Introduced to U.S. House of Representatives

Last Friday, July 10th, yet another ICD-10 bill was introduced in the U.S. House of Representatives, this time by Reps. Marsha Blackburn (R-Tennessee) & Tom E. Price (R-Georgia).

As we all know by now, starting October 1st, 2015, ICD-9 codes will no longer be accepted and all providers are expected to begin using ICD-10 codes. H.R. 3018 a.k.a. the Coding Flexibility in Healthcare Act of 2015 a.k.a. Code-FLEX, if passed, will allow dual coding for up to six months after the transition deadline. Dual coding refers to using either ICD-9 or ICD-10 codes for billing and is intended to ease the transition period as physicians begin adjusting to the new diagnostic system.

Proponents of Code-FLEX assert that the bill does not call for a delay in ICD-10, but rather a grace period to avoid the sudden change. The Medical Group Management Association (MGMA) is in full support of the legislation. Robert Tennant, Senior Policy Advisor at MGMA, said, “The Code-FLEX act would give physician practices much-needed flexibility and provides a window of time to address inevitable system issues.” (ICD-10 Monitor) Some are under the impression that the bill provides too much leniency for those who are just inadequately prepared for the shift. Others feel that dual coding will only lead to further delays. The Coalition for ICD-10 believes the solution will have a negative impact on patient care if labs, pharmacies, clearinghouses, etc. are all using different codes. Considering that interoperability is already a substantial issue in health IT, this would only serve to complicate things further.

The American Health Information Management Association (AHIMA), a member of the Coalition, is strongly against allowing dual coding after the deadline, stating that it will require major changes that are “not practical or feasible.” Forcing claims processers to accept both types of codes will cause too much confusion and inevitable delays. AHIMA also mentions that many health plans including that of the Centers for Medicare and Medicaid Services (CMS) “are unable to process claims for both ICD-9 and ICD-10 codes submitted for the same dates of service.”

Dual coding is by no means a new notion; the idea has been around for a few years, back since ICD-10 was first supposed to be implemented. In April 2015, ICD-10 Watch Editor Carl Natale suggested physicians begin dual coding now, before the deadline, as a method of training. Despite the extra costs and effort they will be forced to put in, dual coding in preparation will pay off in the long run.

Though AHIMA does not approve of dual coding after the ICD-10 transition has been made, they do agree that, for those with ICD-10 ready EHR systems, dual coding is a good practice to better understand and adapt to the new codes.

While it remains to be seen whether the bill will pass, last week’s CMS announcement indicates that they are attempting to assuage fears and make concessions. Working with the American Medical Association, CMS declared that it would not penalize providers for the first year of ICD-10 based solely on the specificity of the codes, as long as a relevant code has been used. Hopefully, there is room for further compromise to pacify everyone involved.

How do you feel about dual coding? Do you think it will help or hurt the ICD-10 transition?


PrognoCIS EMR is already ICD-10 compliant and prepared for users. With a simple two-step process, users can click on the ICD-9 code in the PrognoCIS interface, quickly find the correlating ICD-10 code, and easily populate it into the patient chart. If an ICD-10 code is not filled in, the software will prompt users to add them in with an alert. All lab & radiology tests, as well as e-prescriptions, will include ICD-10 codes. To learn more about our ICD-10 solution, click here to schedule a live demonstration with one of our experts: PrognoCIS Demo.

Author: Apoorva Anupindi

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