The Hill - Citing Turkeys, House Republican Seeks to Change Medicare Policy

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By Molly K. Hooper

A Texas Republican is seeking to change a new Medicare reimbursement system that has different payment categories for a turkey bite and a turkey peck.

An international coding system, which medical professionals must adopt by October of next year, has at least nine reimbursement codes for treating "turkey contact" injuries.

For the past three decades physicians' offices have billed the federal government for Medicare and Medicaid reimbursement using nearly 13,000 different procedure and diagnosis codes. But as part of the Health Insurance Portability and Accountability law, the codes will increase by a factor of more than five next year.

Backers of the new system -- which is not related to anything in ObamaCare -- say there needs to be more specificity in treatment codes.

Rep. Ted Poe (R-Texas) says the new system is absurd.

In a floor speech earlier this year, Poe said, "Let's say I take...one of my grandsons, Jackson, to go hunting, but he happens to get assaulted by a wild turkey. We go to the doctor, and the doctor says, 'Hey, I've got to know exactly how you were hurt by that turkey because there is a code for being assaulted by a turkey for the first time. There is a code for being assaulted by the turkey a second time. There is a different code for being pecked by a turkey rather than being bitten by a turkey.' There are nine codes. The doctor must get the right code or he is in violation of the law about being assaulted by that turkey. It seems nine codes for a turkey assault is a bit silly."

Poe's "Cutting Costly Codes Act of 2013" -- and an identical version sponsored by Oklahoma GOP Sen. Tom Coburn in the upper chamber -- would delay "until further notice" the October, 2014 deadline.

Poe learned of the problem facing medical providers from the Harris County Medical Association who came to him for help, he said in an interview.

Updating the current codes -- known as ICD-9 -- to the mandated ICD-10 (10th Revision) could cost medical providers hundreds of thousands of dollars, all to satisfy "statisticians" Poe contends.

"It could cost a sole practitioner $80,000 to just implement the code…if you have two or three or four or five doctors working together it's going to cost them as a group about $250,000 to set it up for a small practice...and it's an expense that they're not reimbursed for that will be passed on to the patient and it's all is for getting statistics to the federal government," Poe explained.

The American Medical Association (AMA) has endorsed Poe's bill that would mandate a Government Accountability Office (GAO) to "identify steps that can be taken to mitigate the disruption on health care providers resulting from a replacement of ICD-9 as such a standard."

Thus far, the billing code overhaul deadline has generated stories focused on the more arcane codes such as the turkey encounters, which extends to a number of domestic and wild fowl including ducks, geese, parrots, macaws, chicken, psittacines and "other birds."

In a letter of support for the Poe and Coburn bills, AMA Executive Vice President Dr. James Madara wrote of the burden facing physicians with "the prospect of the tremendous administrative and financial burdens of transitioning to the ICD-10 diagnosis code set with its 68,000 codes --a five-fold increase from the approximately 13,000 diagnosis codes currently in ICD-9."

"Implementation will not only affect physician claims submission, it will impact most business processes within a physician's practice, including verifying patient eligibility, obtaining pre-authorization for services, documentation of the patient's visit, research activities, public health reporting, and quality reporting," Madara wrote in a late April letter of support.

Still, the Centers for Medicare and Medicaid Services (CMS) counter charges that "increased number of codes in ICD-10-CM/PCS will make the new coding system impossible to use."

"Just as an increase in the number of words in a dictionary doesn't make it more difficult to use, the great number of codes...doesn't necessarily make it more complex to use," the CMS states in a six-page "Myths and Facts" sheet posted on the CMS website.

Since introducing his bill (H.R. 1701) earlier this year, Poe has garnered 18 co-sponsors, including a key endorsement from Rep. Tom Price (R-Ga.).

Price sits on the powerful Ways and Means Committee, one of the committees of jurisdiction on the bill. Both Price and Coburn are physicians.

Poe hopes that with Price's support, the committee will consider the legislation before the end of the year.

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