AHIMA launches fight against ICD-10 grace period

The American Health Information Management Association (AHIMA) has launched a campaign opposing the Protecting Patients and Physicians Against Coding Act.

Introduced by Rep. Gary Palmer (R-Ala.), the bill would establish a two-year “grace period” for accepting codes submitted after the Oct. 1 ICD-10 implementation deadline and prevent providers from being denied Medicare/Medicaid payments because of coding errors. AHIMA is urging its members to contact their legislators to “let them know you oppose any legislative efforts to reduce the accuracy of medical coding.”

The proposed grace period “goes too far” and has the potential to lead to waste, fraud and abuse, according to the professional medical coders association. “With no official repercussions for inaccurate coding the door is wide open for both improperly paid claims at best and rampant fraud at worst-since proper payment of claims depends on accurate coding. Coverage determinations and validation of medical necessity of healthcare services depend on codes submitted on claims for reimbursement; this bill is written in a manner that leaves the door open for up coding and possibly outright fraud.”  

AHIMA also says the bill is unnecessary because medical coding allows for less specific codes when necessary and appropriate. There are unspecified codes in both ICD-9 and ICD-10 and unspecified ICD-9 codes already are allowed in Medicare fee-for-service payment systems. There also  are default codes when there is no unspecified option. 

AHIMA also says the bill is unnecessary since just two percent of claims were rejected for ICD-10 coding errors during the most recent end-to-end testing conducted by the Centers for Medicare & Medicaid Services (CMS), which is “actually lower than the number of claims, 3 percent, currently rejected by CMS after annual ICD-9-CM code updates.”