Congress has delayed by at least one year the requirement that certain HIPAA-covered entities implement ICD-10, the code sets for coding diagnoses and inpatient hospital procedures. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of Health and Human Services to adopt transaction standards and data elements for electronic health information exchange. Among those standards are “code sets” for coding diagnoses and procedures. Currently, health plans, health data clearinghouses, and health care providers transmitting health information electronically must use an older version of the “International Classification of Diseases,” ICD-9. However, ICD-9 is over thirty years old and has an insufficient number of procedure and diagnosis codes. In contrast, the ICD-10 code sets are more up to date, include more possible codes, and allow for greater detail within the codes.
HHS finalized regulations in January 2009 requiring providers and plans to transition from ICD-9 to ICD-10 by October 1, 2013, but later extended the deadline by one year. Although many providers and plans, as well as HHS itself, have said they would be ready for an October 2014 transition, concerns have been raised that some providers could be ill-prepared.
Congress has now legislatively extended the compliance deadline as part of the Protecting Access to Medicare Act of 2014, which averts a scheduled Medicare physician pay reduction. Section 212 of the bill prohibits the Secretary from adopting the ICD-10 code sets before October 1, 2015. Provider groups are split over the advisability of the measure with some worrying about the uncertainty surrounding the extension as well as the repeated delays of ICD-10 implementation. Many providers had already made significant investments into training programs and other transitions measures. Providers may now need to repeat training programs and other investments before a new deadline. Additionally, HHS will need to decide whether to require compliance by October 1, 2015, a decision that may be complicated by the fact that the revised ICD-11 is scheduled to be released less than two years later.