ICD-10 Transition to Proceed Even if Government Shuts Down

ICD-10 Transition to Proceed Even if Government Shuts Down

By Kerry Young, CQ Roll Call

A nationwide changeover to a new set of medical billing codes will proceed on Oct. 1 even if Congress triggers a partial government shutdown that day by missing an appropriations deadline, according to a top federal official.

The Centers for Medicare and Medicaid Services already is establishing contingency plans for managing the transition to ICD-10 codes against the potential disruption of a shutdown, said Patrick H. Conway, principal deputy administrator of the agency, on a Thursday call with reporters. Managing the switch from the older ICD-9 codes is among the top priorities for the agency, and CMS has some flexibility in its staffing that can be used to keep the work on track in case of a shutdown, he said.

“Our goal is to have a smooth transition to ICD-10, both from a payment perspective and from the service around that payment," Conway said.

CMS is at the helm of a conversion of a system that underpins billing for services delivered in virtually every field of American medicine. ICD-10 is a more complex set of billing codes, which is expected to generate detailed information about medical practice to aid in future research on health care. Doctors and other health professionals have complained about the complexity of the new system, which contains about 72,000 procedures codes, compared to the roughly 4,000 used in ICD-9.

The deadline for the change from the older ICD-9 codes happens to fall at the same time as the start of fiscal 2016. Congress has not yet completed work on any new spending bills. GOP bids to defund Planned Parenthood are complicating efforts to get a routine stopgap continuing resolution in place to fund the federal government in the early months of fiscal 2016, in lieu of a completed appropriations measure.

Even without the complication of a potential government shutdown, CMS has been readying for expected glitches with the conversion to the ICD-10 system.

Conway said on the call that it may take a few weeks before any issues becomes known, due to the nature of payment cycles. CMS, the largest buyer of health care in the United States, earlier this year told Congress that there will be increased demand on its call centers for most of fiscal 2016 due to the conversion. CMS said it expects more inquiries from medical care providers seeking additional instruction on how to bill correctly, as well as calls from people enrolled in federal health plans who may be incorrectly billed due to invalid coding.

Insurance firms, hospital chains and makers of certain medical products also have warned their investors about the potential for payment s and additional costs related to the transition. Lawmakers including Rep. Diane Black, R-Tenn., and Rep. Tom Price, R-Ga., will be watching the transition, and mayact to seek further help for doctors who struggle to adapt to the new codes.