The latest trend in the ICD-10 saga appears to be introducing bills that would allow for a grace period or safe harbor surrounding the Oct. 1 implementation date. One such bill was introduced in May by Rep. Diane Black (R-Tenn.). A grace period would ensure physicians aren't denied claims due to an unspecified or inaccurate ICD-10 code. However, the Coalition for ICD-10 says these bills are based on two key assumptions, both of which are false.
The first assumption, according to the Coalition for ICD-10, is that ICD-10 diagnoses directly impact physician payment. In a blog post, the coalition indicates, "the amount paid to physicians is not impacted by the assignment of ICD-10 diagnosis codes. The amount paid is determined by the reported CPT codes." According to Health Fusion, ICD codes focus on the diagnosis, while CPT codes identify services provided. Payers use CPT codes to determine service delivered, and therefore how much to pay physicians.
The second false assumption is that ICD-10 diagnosis coding will be burdensome for physicians. The coalition writes the expanded detail in ICD-10 is basic information that should be in the EHR. Additionally, the coalition says nearly half of the new codes simply identify what side of the body is affected.
What's more, the coalition writes CPT codes are heavily detailed — and require recording the side of the body that is affected — yet nobody is concerned about the burden CPT codes produce. And, physicians are unlikely to use all ICD-10 codes, "but will only use the subset of codes applicable to his/her specialty and patient population."
The Coalition for ICD-10 presents three negative consequences that may come about if the grace period were invoked.
1. The safe harbor would undermine care quality. "Under the safe harbor provisions, physicians would be exempt from providing the data necessary for Medicare to determine if the services being delivered are covered under Medicare guidelines, meet medical necessity standards and are of high quality," according to the coalition. "Thus, a safe harbor has no impact on physician payment, but would severely restrict Medicare's ability to determine coverage, medical necessity and quality of care."
2. The safe harbor undermines Medicare's responsibility to accurately ensure proper payment. Allowing for "unspecified or inaccurate" codes would prevent Medicare from properly validating medical necessity and coverage, as there is no proper recording of the care encounter.
3. The safe harbor draws concerns of fraud and abuse. As written, the safe harbors don't account for intentional errors, according to the coalition. "If a broken finger was reported as a broken neck, Medicare would have no choice but to accept that the services delivered were covered and met medical necessity standards."
4. The safe harbor diminishes care quality. Assigning accurate codes is important to understand patient care and outcomes, according to the coalition, so not documenting proper information evokes a care quality issue.
5. The safe harbor would disrupt all levels of the system. According to the coalition, it is unclear if the safe harbor would only be applicable to Medicare or if it were applicable to all payers. If only applicable to Medicare, systems will be functioning on non-standardized, inconsistent reporting.
6. The safe harbor is just another ICD-10 delay. Factoring in the previous two ICD-10 delays, the healthcare industry has had five years to prepare for the transition date, according to the coalition. A safe harbor would likely lead to another delay. "It can be predicted with virtual certainty that at the end of the safe harbor, there will be new demands for a reprieve from ICD-10 because there hasn't been enough time to prepare."
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