Why can't we use ICD-9 and ICD-10 codes after Oct. 1?

Carl Natale
by Carl Natale
Why can't we use ICD-9 and ICD-10 codes after Oct. 1?

When the U.S. House Energy & Commerce Subcommittee on Health held its hearing "Examining ICD-10 Implementation" last month, dual coding came up.

No not the kind of dual coding that allows healthcare providers to practice ICD-10 codes until Oct. 1. But politicians kept asking why ICD-9 codes and ICD-10 codes couldn't be used at the same time.

And none of the witnesses could answer the question. You could hear the screaming across town coming from the Department of Health and Human Services (DHHS) building.

I could understand the reluctance of everyone who did not want to speak for the Centers for Medicare and Medicaid Services (CMS). But for Pete's sake, they're already there to sing the praises of ICD-10 coding. Why couldn't someone try to explain that the differences between assigning ICD-9 codes and ICD-10 codes is not the same as choosing between a Blackberry or iPhone?

CMS tried to explain it in a revised guidance statement last week:

"No, CMS will not allow for dual processing of ICD-9 and ICD-10 codes after ICD-10 implementation on October 1, 2015. Many providers and payers, including Medicare have
already coded their systems to only allow ICD-10 codes beginning October 1, 2015. The scope of systems changes and testing needed to allow for dual processing would require significant resources and could not be accomplished by the October 1, 2015, implementation date. "

Except the committee noticed that depending on dates of services, ICD-9 codes will need to be used after Oct. 1. That kind of makes me wonder too. Makes me wonder if healthcare payers are going to be able to handle a few days of ICD-9 codes.

But we get a little closer to the problem here:

"Should CMS allow for dual processing, it would force all entities with which we share data, including our trading partners, to also allow for dual processing. In addition, having a mix of ICD-9 and ICD-10 codes in the same year would have major ramifications for CMS quality, demonstration, and risk adjustment programs."

There's the rub. Things will be crazy enough not being able to compare ICD-9 years to ICD-10 years. But mixing both code sets in the same year will make data analysis about useless.

And if healthcare providers figure out that reimbursement rates are different for an ICD-9 code compared to an ICD-10 code, they're going to choose the higher paying code for medical claims.

Would it be possible for healthcare payers to deny an ICD-10 claim if they can offer lower rates for ICD-9 claims?

No, CMS wants to rip off the bandage quickly Sept. 30. It's may sting Oct. 1. But it's going to hurt worse if they try to pull it off a tiny bit at a time.