ICD-10 Dual Coding Proposed in Code-Flex Act

ICD-1o and ICD-9 dual coding has been proposed in H.R. 3018 so called the Coding Flexibility in Healthcare Act of 2015 (Code-Flex) which aims to provide for a safe harbor period for the transition from  ICD–9 to ICD–10 by allowing dual coding for six months after the ICD-10 transition deadline. The bill was introduced by Representatives Marsha Blackburn (R-TN) and Tom E. Price (R-NC).

Code-FLEX defines the duration of the safe harbor period as follows:

“The transition period under subsection (a) shall begin on the first day in which the Secretary adopts such ICD–10 code sets as the standard for codes sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and end 180 days after such date.”

Code-FLEX, if enacted, requires HHS to report to Congress 90 days after implementation of ICD-10 on the impacts the new codes are having on providers, patients and other stakeholders.

The bill has support from the Medical Group Management Association (MGMA) but we wonder how health plans who have prepared to retire ICD-9 centric systems and processes will respond.  Many including Medicare’s CMS adjudication systems are not designed to support ICD-9 after October 1, 2015.

 

 

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

Leave a Reply