Last issue, we reported on the status of health information technology legislation currently moving through Congress. After going to press, we received additional details from the American Chiropractic Association (ACA) regarding the status of the legislation, along with the steps being taken by the ACA to ensure doctors of chiropractic are adequately prepared and protected.
According to the ACA, the House and Senate are working to resolve the differences between their respective versions of the legislation. The House passed H.R.4157, the Health Information Technology Promotion Act, on July 27, 2006; the Senate passed S.1418, the Wired for Health Care Quality Act, on Nov. 18, 2005. The intent of both bills is to advance health information technology.
The ACA and others are most concerned about a provision in the House bill that mandates implementation of the ICD-10 coding system no later than Oct. 1, 2010. This provision is not included in the Senate bill. Conversion to ICD-10 is significant and will impact chiropractic offices. While the current ICD-9 code set has 24,000 codes in a five-digit numeric series, the proposed ICD-10 code set will be substantially more complex, with more than 200,000 codes in an alphanumeric seven-digit series. Because of this, the ACA and others have requested that an Oct. 1, 2012 date be included in a final version of the bill.
Concern regarding the ICD-10 implementation date is not exclusive to chiropractic: On Sept. 19, 2006, the American Medical Association sent a letter, signed by nearly 80 medical specialty organizations and state associations, to Sen. Michael B. Enzi (R-Wy.), chair of the Senate Committee on Health, Education, Labor and Pensions. The letter states, in part:
"The undersigned physician and state medical associations are concerned with the feasibility of a rapid transition from ICD-9 to ICD-10. Recent action at the AMA House of Delegates called for 'delayed implementation of a simplified, modified ICD-10-CM coding system which is less burdensome on practicing physicians, hospitals, and the health insurance industry.' We therefore urge that provisions requiring implementation by a date certain, or at least prior to 2012, not be included in a conference report promoting health information technology.
"In addition to the costs and challenges associated with implementing new clinical information technology systems, physician offices could face the equally costly prospect of upgrading or replacing practice management systems for billing and coding and the necessity of retraining their billing and coding staff. Private payers and others, including the federal government, would also have to upgrade their own payment processing and data management systems to accommodate the significantly larger body of data generated by the transition."
Despite negotiations between House and Senate leaders to reconcile the differences and bring a final bill to both chambers for passage before Congress adjourned, no action had been taken as of press time. Sources close to the ACA suggest this bill will be on the agenda during the lame duck session (week of Nov. 13) and that congressional staff will continue to negotiate during the election recess. The ACA continues to lobby for adoption of the 2012 implementation date. Doctors of chiropractic are encouraged to voice their concerns to members of Congress by calling the Capitol switchboard at 202-224-3121.
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