Prior to passage of the Protecting Access to Medicare Act of 2014, covered entities throughout the United States were working furiously to meet the October 1, 2014, deadline for implementation of the latest edition of the International Statistical Classification of Diseases and Related Health Problems, ICD-10.

Devised by the World Health Organization, the ICD-10 coding system is already in use throughout the world to track the incidence of disease and help nations guide the allocation of healthcare resources. Implementation of the system this year, after many previous postponements, would have brought the United States into conformity with leading industrialized nations and many other countries where the system is in use.

But the Protecting Access to Medicare Act incorporated another postponement—until October 1, 2015—leaving many covered entities wondering how best to proceed.

In the United States, ICD-10 consists of two code sets: the diagnostic coding set that is in wide international use, and a procedural coding set (ICD-10 PCS) that is not used in other countries. When used for claims processing, the diagnostic codes are linked to procedure codes for services delivered to patients in all sites—physicians’ offices, hospital inpatient and outpatient settings, ambulatory surgery centers, and clinical labs.

According to Judy Rosenbloom, president of reimbursement consultancy JR Associates, the ICD-10 diagnostic codes are broader and allow for greater differential diagnoses than the ICD-9 CM coding set now in use. It will yield better information about why a patient may undergo a test and whether the correct test is being used.

Postponement of the implementation date for ICD-10 PCS will have little effect on clinical labs, since that coding set is used to report hospital inpatient procedures. But the effects of postponing implementation of the ICD-10 diagnostic coding set are less certain.

According to Xifin vice president Rina Wolfe, the delay could be a positive for labs, allowing more time for physicians to become comfortable with test orders under the new system. “One of the struggles that many laboratories have is to get appropriate ICD-9 codes from ordering physicians, resulting in a lot of resources expended to contact clients, and delays in being able to submit claims,” she says. “This could be exacerbated in the early days of ICD-10 implementation, due to the lack of familiarity both physicians and labs would have with this widely expanded code base.”

But for many labs the delay may result in sunk money lost, with no corresponding task having been completed. “The new legislation provides labs with a reprieve for 1 year,” notes Rosenbloom, “but since most major labs were prepared to implement this October, it is a costly delay.”