CMS Reconsidering Testing of ICD 10 Considering the Issues that Came up from Healthcare.gov

by | Last updated May 17, 2023 | Published on Dec 19, 2013 | Medical Coding

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MedPage Today reported on November 8, 2013 that the Centers for Medicare and Medicaid Services (CMS) said it might reconsider external, end-to-end ICD-10 testing during a stakeholder meeting. Earlier, CMS had claimed that it was confident regarding its current testing and would not do such testing for ICD-10 code system. The MGMA (Medical Group Management Association) and other organizations had publicly called for such testing. The latest news is that the agency announced that Medicare Administrative Contractors (MACs) must give the opportunity for both providers and suppliers to submit their ICD-10 test claims during the testing week scheduled for March 3-7, 2014. The main aim of this testing week is to identify the potential problems associated with ICD-10, the revolutionary change to the medical coding system before its implementation.

Of course, there were rumors that the agency has no plans for end-to-end testing with outside organizations for ICD-10 claims. The CMS officials seemed confident with the ICD-10 transition though the United States Department of Health and Human Services (HHS) delayed the implementation date from October 1, 2013 to October 1, 2014. However, the problematic launch of HealthCare.gov with the following issues has made CMS re-think this matter.

  • Around 20 minutes of wait time
  • A system shutdown
  • Redirecting to a waiting page with a view to limit the number of consumers using the website at the same time
  • Unable to enter the information in the username and password fields

CMS has already admitted in the MedPage Today report that it didn’t test the site properly before making it active on October 1, 2013. Hence, it will surely want to avoid any chance of mistakes with medical billing based on ICD-10 codes.

Healthcare organizations in the United States have already started working for the transition from ICD-9 to ICD-10 code sets. Both healthcare providers and insurers find it a cumbersome task to switch from 14,000 codes to around 69,000 codes. Physicians are also aggrieved at the increase in the complexity of the new coding system as it requires greater detail regarding the location, cause and type of the ailments and their complications or manifestations compared to ICD-9. For example, there is only one ICD-9 code for diabetes with neurological manifestations, type II or unspecified type, uncontrolled (250.62) where the exact condition is not defined. ICD-10 code sets constitute two codes to specify this ailment – E11.40 for Type 2 diabetes mellitus with diabetic neuropathy, unspecified and E11.65 for Type 2 diabetes mellitus with hyperglycemia.

According to a survey published in MedPage Today, nearly two-third of physicians’ clinical documentation lacks sufficient information for coders to use for billing based on ICD-10 codes. Numerous calls are being made to delay the implementation date further than current date. In such a scenario where healthcare providers are struggling to understand the new code sets and implement compatible medical billing software, this testing week is a relief as they may get some practical solutions for their problems.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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