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Medical Coding News Archives

Final Rule Confirms ICD-10 Delay

September 21, 2012:

Karen Adkins, Clinical/Technical Editor

On September 5, 2012, the Federal Register officially confirmed the one-year delay in the compliance date for ICD-10-CM and ICD-10-PCS. While it was widely expected that the effective date for implementation of ICD-10 would be postponed from October 1, 2013, to October 1, 2014, the announcement established that no further delays would be forthcoming.

The Department of Health and Human Services secretary identified three issues as deciding factors in delaying implementation: an ineffective transition to version 5010 claims, provider concern over the taxing of resources by other statutory initiatives, and finally, widespread polls and surveys that showed that many health care providers were not ready to transition to ICD-10.

Version 5010 issues included:

  • Vendor delays in delivering/installing version 5010-compliant software, thus creating testing delays with trading partners
  • Errata issued due to typographical errors and maintenance issues identified during internal testing of 5010 standards
  • Discrepancies between “provider billing address” and “pay to” address fields that negatively affected crossover claims processing
  • Conflicting payer interpretation of 5010 standard requirements at the front end of systems, resulting in claim rejections; other technical and standard misinterpretation issues
  • Failure to provide adequate notice of test mode edits made after claims went into production
  • Inadequate end-to-end testing with full scope edits and business rules that would have ensured a smooth transition to full production

Statutory initiatives issues included:

  • Electronic health records incentive program
  • Physician Quality Reporting System (PQRS)
  • Electronic prescribing (eRx) incentive program

Lack of readiness issues included:

  • Obstacles in transitioning to version 5010
  • Workgroup for Electronic Data Interchange (WEDI) Readiness Survey:
    • 50 percent of respondents could not give completion date for impact assessment
    • 33 percent of respondents did not anticipate starting external testing in 2013
    • 50 percent could not say when external testing would even occur
    • Majority of health plans not expected to begin external testing until 2013
    • 50 percent of vendors are not yet halfway through developing ICD-10 products
    • Vendor delays in product development have resulted in payer/provider delays


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