As the U.S. House of Representatives inked the latest episode in the sustainable growth rate saga, many eyes of the industry were watching to see whether anything related to ICD-10 landed among that bill’s pages.

A collective sigh of relief followed the House’s passage of the Medicare Access and CHIP Reauthorization Act this past week when that alphanumeric acronym was nowhere to be found. Instead, the House bill promises to finally fix the looming 21 percent reduction in what Medicare pays doctors.

But make no mistake: Just because it’s not in the House bill doesn't mean ICD-10 is entirely safe from further delay. 

Here are three potential ways Congress could postpone the code set conversion all over again.

1. Senate rejection. Currently on a break, the U.S. Senate is slated to vote on the SGR bill during the week of April 12, and while the legislation sailed through the House, the fact that the Senate held off on voting could prove to be telling. A spokesperson for Senate Majority Leader Mitch McConnell (R-KY) told The Hill that the Senate’s vote was delayed because there was at least one objection on the Republican side. Should the Senate reject the bill and kick it back to the House, who knows whether ICD-10 would find its way into another attempt. If that sounds like an impossibly long shot, consider that almost no one saw provision 212 in the Protecting Access to Medicare Act of 2014 coming; 212 is the brief mention prohibiting Health and Human Services from enforcing the compliance deadline prior to Oct. 1, 2015.

2. Resurrection. The Protecting Access to Medicare Act was hardly the first bill guilty of attempting to stall the code set conversion. Before that was the Cutting Costly Codes Act of 2013, sponsored by Sen. Tom Coburn (R-OK), who also tried to weave an amendment into the farm bill, dubbed the Agriculture Reform, Food, and Jobs Act of 2013, of all places. Senator Coburn retired at 2014’s end, but a loose coalition of Congress members including Sen. Rand Paul (R-KY), Sen. John Barasso (R-WY), Sen. John Boozman (R-AR) and Rep. Ted Poe (R-TX), among others, have been outspoken against ICD-10 and any one of them could potentially try to stop it from happening whether by resurrecting the Costly Codes Act, slipping a provision into an ostensibly unrelated piece of legislation, or a completely fresh approach.

3. A new surprise twist. It would be an understatement to suggest that many jaws dropped in startled amazement when Rep. Joe Pitts (R-PA) included the now-notorious provision 212 in the Protecting Access to Medicare Act and both the House and Senate subsequently passed it without so much as a single verbal mention of ICD-10. What remains unclear a year later is exactly how provision 212 landed there in the first place. Was it the Centers for Medicare and Medicaid Services? That was perhaps the most intriguing rumor swirling 12 months ago, but not the only one. Another was that Pitts was acting as a lone wolf on behalf of one or more of the specialty medical societies that were 16 of Pitts' top 20 published donors at the time. We may never really know the truth. But the more substantive lesson is that something could happen again – as quickly and as oddly as it all occurred last year.

Granted, this time around the groups in favor of ICD-10 are organized better, more vocal and are proactively monitoring Congress in ways they were not last year, while industry opponents – most notably the American Medical Association and, to a lesser extent, the Medical Group Management Association – are considerably quieter in their dissent. And the House Energy and Commerce Subcommittee on Health, which Pitts chairs, gave just about every indication in a hearing earlier this year that it will not push back ICD-10 again.

But with the SGR matter not yet settled, other proposed bills lurking on the House and Senate floors, and even a few politicians outspoken against ICD-10, it’s simply unwise to think that ICD-10 proponents are insulated from another out-of-the-blue surprise.

What's a hopsital or health system to do? How do you keep moving toward the Oct. 1, 2015 compliance deadline knowing that Congress could change it again? Comment below.