ICD-10 Implementation Postponed … Again: What Does This Mean …

icd10The race to replace the International Classification of Diseases, 9th Edition (ICD-9) with the 10th edition, ICD-10, appears to be going in circles. For years healthcare companies have been preparing to move to ICD-10, a longer coding system that will be used to report diagnoses and procedures and to enable patients to accurately pay for services. Industry expectations had been set by legislative bodies for the shift to take place on Oct. 1, 2014, but the Senate voted on May 31 to delay the implementation to Oct. 1, 2015.

The Centers for Medicare & Medicaid Services website only specified the following reason for the delay: “On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.”

The cutover to ICD-10 codes does not come without its challenges, which is why the field has been busily preparing for this implementation for months. For example, there are eight times the number of ICD-10 codes than ICD-9 codes. Under ICD-9, for instance, an angioplasty was represented by one code but under ICD-10, an angioplasty could be represented with one of 854 codes. Moreover, such a monumental change means U.S healthcare organizations will have to trade about 14,000 codes for about 69,000 codes.

The delay in execution has caused much frustration, as the healthcare industry has been upgrading its systems to handle this change—aggressively performance testing to make sure their new systems can properly handle the same volume of transactions as before. But such a delay does not mean healthcare officials can put performance testing on the backburner. Conversely, now is the time for these companies to step it up a notch so they are ready for the new go-live date. Here are a few things they should be considering:

• Leverage Professionals Who Do This Everyday: The switch to ICD-10 comes with complications, especially since healthcare companies will be handling much more data, which always comes with risks of failure. Leveraging a company with the expertise shifts the burden of production performance from the healthcare company to focus on what really matters—serving patients.
• Maintaining Training: At this point, your team is probably knee-deep in training, reassessing implementation processes and company readiness. Now is not the time to cut training cold turkey. Doing so will halt all the progress you have already made. Instead, keep charging forward with regular team meetings; continue to determine the operational risks associated with the cutover, and focus on testing and training to mitigate risk.
• Identify Your Shortcomings: Is your team slacking when it comes to testing the types of cases you will actually be treating and submitting for reimbursement with ICD-10 implementation? Is dual coding holding up your IT staff? In the coming months, identify your company’s shortcomings and make sure you onboard the experts needed to get you through the transition without hiccups.

Whether you are happy to have more time to prepare for the cutover—or are lambasting the Senate for more delays—ICD-10 is on its way and will fundamentally rock the industry. The best course of action is for companies to keep their head in the game and remain committed to a seamless, efficient implementation.

As AHIMA officials explained in a press release addressing the ICD-10 delay, “We know that the industry has already invested considerable time and money in implementation. We have long advocated for a coding system that offers flexibility and specificity, enables us to properly assess healthcare services, understand public health needs, and get the best rate of return from our national investment in EHRs and meaningful use. All along, AHIMA has urged our members to ‘stay the course’ of preparing for implementation.”



The Importance of Updating Technology for the ICD-10 Transition …

The Importance of Updating Technology for the ICD-10 Transition

By Ken Bradley

In sports, a time-out stops the clock for a relatively brief time, but this break can entirely change the outcome of a game. Who could ever forget the effect the blackout had on last year’s Super Bowl game? It’s a time for regrouping on strategy and critical decisions.

While the countdown to ICD-10 marches on, the industry recently received the equivalent of a time-out. Without a doubt, healthcare leaders are using this extra time wisely, but as outlined in step five of the guide, “ICD-10: 8 Steps to Ensure Transition Success,” the task of updating technology will require a great deal of advance planning. It encompasses big picture items such as supporting evolving processes and transactions – both within and among organizations – as well as painstaking details such as coding and integration. That’s why it’s a great time to regroup, think strategically and ask the right questions of your technology vendors.

These questions include: What is the timeline for software updates to support compliance? How did they handle 5010? Just as necessary are specifics such as whether the software can identify diagnosis codes by varied criteria such as frequent use, payer and revenue impact.

Asking these questions now can entirely change your organization’s outcome in October 2015. Obtaining and implementing technology updates well in advance of the ICD-10 transition permits adequate testing and staff training, and enables practices to participate in end-to-end testing opportunities as well as consider advanced implementation techniques like dual-coding. Are there specific questions you have for vendors? Let us know in the comment box below.

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Discussion of ICD-10 Will Open AHIMA's LTPAC Health IT Summit …

Long-term and post-acute care (LTPAC) providers—unlike much of AHIMA’s membership—welcomed the delay of ICD-10-CM this spring, according AHIMA LTPAC Summit presenter Mary Ann P. Leonard, RHIA, CRM, RAC-CT. Leonard’s session, which opens the Summit, will attempt to respond to ongoing concerns about the code set from LTPAC providers.

“Long-term care has a history of making changes only when they have to,” Leonard explains. “They don’t usually prepare too far ahead for anything. If it isn’t mandated and/or identified in survey (planned and unplanned inspections by state regulators) it isn’t a priority. Part of that is the flat hierarchy—there aren’t a lot of knowledgeable management heads or hands to do the work. Part of it is financial.”

Leonard’s presentation, “Preparing LTPAC for ICD-10-CM: Technology, Documentation, Workforce and Pysician Engagement,” will be Sunday, June 22, at 3:30 p.m. ET, in Baltimore, at AHIMA’s 10th Annual LTPAC Health IT Summit. She will be joined by two co-presenters: Nick Dobrzelecki, RN, BSN, of The Corridor Group, and Jeanne Doherty, MD, Magee Rehabilitation Hospital.

Leonard says her session is principally an overview of the ICD-10-CM coding system and differences between ICD-10 and ICD-9.

“In addition it [the presentation] provides questions for the administrator to ask the vendor, management, etc. to assist in preparing for the implementation process,” Leonard says. “Most of the questions actually came from the materials on the CMS ICD-10-CM website. [LTPAC facility] administrators usually will ask the vendor if they will be ready and take them (and others) at their word that they will be. They don’t ask the additional questions, such as, ‘Can we dual code? When can we dual code? How long will ICD-9 stay in the system, etc.’”

Overall, ICD-9 and ICD-10 coding in LTPAC settings is less complicated than in hospital, physician, and ambulatory clinics because nursing home and rehab facility residents more often have the same diagnoses, such as chronic obstructive pulmonary disorder, chronic heart failure, hip fractures, and so forth.

For LTPAC, Leonard says the difficulty with implementing and using ICD-10 is “how to access the codes and interpreting which is the appropriate code to assign,” not the sheer number of new codes to learn.

“I can guarantee that once they latch on to a code that is close and goes through the system it will be used over and over. I suspect that there will be a lot of non-specific codes from LTC [long term care providers],” she adds.




SNOMED, ICD-11 Not Feasible Alternatives to ICD-10-CM/PCS …

As the US healthcare industry faces yet another delay in ICD-10-CM/PCS implementation, with a new compliance date of October 1, 2015, questions continue to arise as to whether there are any alternatives for replacement of ICD-9-CM other than implementation of ICD-10-CM/PCS. In particular, use of SNOMED CT or waiting for ICD-11 are both alternatives that have received attention. This article addresses why neither of these approaches is a reasonable alternative to implementing ICD-10-CM/PCS, and why the US must remain fully committed to transitioning smoothly to ICD-10-CM/PCS on October 1, 2015 while leveraging the exciting opportunities presented by this transition.


SNOMED CT and ICD-10: Complementary—not Competing—Systems

SNOMED CT and ICD are designed for different purposes. ICD’s focus is statistical, whereas SNOMED CT is clinically-based and focused on capturing the information needed for clinical care.1

A clinical terminology such as SNOMED CT is an “input” system designed for the primary documentation of clinical care.2 It is the global clinical terminology that adds processable meaning to the EHR.3 When implemented in software applications, SNOMED CT can be used to represent clinically relevant information consistently, reliably, and comprehensively as an integral part of producing EHRs.4

The International Classification of Diseases (ICD) is the international standard diagnostic classification that organizes content into meaningful standardized criteria and enables the storage and retrieval of diagnostic information for epidemiological and research purposes.5

ICD is the foundation for the identification of health trends and statistics globally. The ICD defines the universe of diseases, disorders, injuries, and other related health conditions. It organizes information into standard groupings of diseases, which allows for:

  • Easy storage, retrieval, and analysis of health information for evidenced-based decision-making
  • Sharing and comparing health information between hospitals, regions, settings, and countries
  • Data comparisons in the same location across different time periods6


ICD allows the counting of deaths as well as diseases, injuries, symptoms, reasons for encounter, factors that influence health status, and external causes of disease. It is the diagnostic classification standard for clinical and research purposes. These include monitoring of the incidence and prevalence of diseases, observing reimbursements and resource allocation trends, and keeping track of safety and quality guidelines.7

The International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) is a US version of the World Health Organization’s ICD-10 and was developed for use in reporting morbidity data in all healthcare settings. The International Classification of Diseases 10th Revision Procedure Coding System (ICD-10-PCS) has been developed as a replacement for Volume 3 of the International Classification of Diseases 9th Revision (ICD-9-CM).

The standard vocabulary afforded by SNOMED CT supports meaningful information exchange to meet clinical requirements. ICD-10-CM and ICD-10-PCS, with their classification structure and conventions and reporting rules, are useful for classifying healthcare data for administrative purposes, including reimbursement claims, health statistics, and other uses where data aggregation is advantageous.

Information captured in SNOMED CT can be re-purposed through linkage to ICD. Classification systems allow granular clinical concepts captured by a terminology to be aggregated into manageable categories for secondary data purposes.8 Clinical data “input” into EHR systems can be transformed by ICD into “output” governed by reporting rules and guidelines for use. The benefits of using SNOMED CT increase exponentially if it is linked to modern, standard classification systems for the purpose of generating health information necessary for secondary uses such as statistical and epidemiological analyses, external reporting requirements, measuring quality of care, monitoring resource utilization, and processing claims for reimbursement.9

To maximize the value of health information, classifications and terminologies should be used appropriately according to their purpose(s) and design. Together, terminologies and classifications provide the common medical language necessary for interoperability and the effective sharing of clinical data.10 Linked together, ICD and SNOMED CT support better data collection, more efficient reporting, data interoperability, and reliable information exchange in health information systems. Healthcare systems will benefit from better data while reducing data capture and reporting costs. ICD-10-CM/PCS and SNOMED CT can both contribute to the improvement of the quality and safety of healthcare and provide effective access to information required for decision support and consistent reporting and analysis.11


ICD-11? US Can’t Afford to Wait That Long

Based on the World Health Organization’s current schedule, ICD-11 is expected to be finalized and released in 2017.12 For the US, that date is the beginning, not the end, of the process toward adoption of ICD-11. Regardless of the benefits of ICD-11, the US would still need to evaluate the code set for national use and likely develop a national version to allow for the annual updating demanded by Congress and US stakeholders.13 Also, since ICD-11 does not include a procedure classification system, a procedure coding system for use in the US would need to be developed.

The process of evaluating ICD-11 for use in the US, developing a national modification to meet US information needs, and developing a procedure coding system would take at least a decade, followed by the rulemaking process to adopt ICD-11 as a HIPAA code set standard. In the case of ICD-10, it took eight years to develop a US modification of ICD-10 and a procedure coding system, and nineteen years until a final rule for the adoption of ICD-10-CM/PCS to replace ICD-9-CM to be published. Five years after publication of this final rule, and twenty-four years after the World Health Assembly endorsed ICD-10, the US has still not implemented ICD-10-CM/PCS.

The US cannot wait another 10-25 years to replace the ICD-9-CM code sets. Replacement of ICD-9-CM is long overdue. There is a cost and danger to using the outdated ICD-9-CM coding system. ICD-9-CM is obsolete and no longer reflects current clinical knowledge, contemporary medical terminology, or the modern practice of medicine, and its limited structural design lacks the flexibility to keep pace with changes in medical practice and technology. The longer ICD-9-CM is in use, the more the quality of healthcare data will decline, leading to faulty decisions based on inaccurate or imprecise data.14 With ICD-9-CM, healthcare providers often don’t know precisely what was wrong with patients or what treatments they received.

Waiting until ICD-11 is ready for implementation in the US is not a viable option, as waiting that long to replace the ICD-9-CM code sets would seriously jeopardize the country’s ability to evaluate quality and control healthcare costs.15 US healthcare data is being allowed to deteriorate at the same time demands are increasing for high-quality data that can support new healthcare initiatives such as the “meaningful use” EHR Incentive Program, value-based purchasing, and other initiatives aimed at improving quality and decreasing costs.16

In a 2013 report on the feasibility of skipping ICD-10 and going right to ICD-11, the American Medical Association Board of Trustees recommended against skipping ICD-10 and moving directly to ICD-11, as this approach is fraught with its own pitfalls.17

Concerns cited in this report included:

  • ICD-9 is outdated today and continuing to use the outdated codes limits the ability to use diagnosis codes to advance the understanding of diseases and treatments, identify quality care, drive better treatments for populations of patients, and develop new payment delivery models.
  • The market will miss out on the improvements in the ICD-10 codes that align with today’s diagnosis coding needs, including the addition of laterality, updated medical terminology, greater specificity of the information in a single code, and flexibility to add more codes.
  • Skipping ICD-10 will impede the ability of the industry to build on their knowledge and experience of ICD-10, which is expected to be needed for ICD-11. Learning the medical concepts, training efforts, and overall implementation efforts for ICD-11 will be more challenging if ICD-10 is not implemented first.
  • Implementing ICD-10 is expected to reduce payers’ reliance on requesting additional information, known as “attachments,” which could reduce burdens on physicians, but this opportunity will be delayed until ICD-11 is implemented.
  • The timeframe to have ICD-11 fully implemented could be as extended as 20 years, unless there is a strong commitment by the industry to implement it faster.18


Implementing ICD-10-CM/PCS is an important step on the pathway to ICD-11. ICD-10-CM has informed ICD-11 development, as updated clinical knowledge and additional detail considered important for use cases such as quality and patient safety monitoring have been incorporated into the US code sets.19 Transitioning to ICD-10-CM/PCS in 2015 will provide an easier and smoother transition to ICD-11 at some point in the future.

By preparing information systems now to accommodate ICD-10-CM/PCS, they will be better able to accommodate the transition to ICD-11.20 And just as modifications to ICD-10 have been incorporated into ICD-10-CM through the annual update cycles, it is anticipated that content additions in ICD-11 that are not already included in ICD-10-CM will be incorporated into ICD-10-CM over time, which will facilitate the transition to ICD-11. Due to the structural limitations and obsolescence of ICD-9-CM, modifications to ICD-9-CM to reflect changes in the World Health Organization version of ICD would be impossible, complicating and disrupting a future transition to ICD-11 if the ICD-10-CM/PCS code sets are not implemented first.21



1. Kin Wah Fung. “How the SNOMED-CT to ICD-10 Map facilitated the map to a national extension of ICD-10.” National Library of Medicine. http://ihtsdo.org/fileadmin/user_upload/doc/slides/Ihtsdo_Showcase2012_MappingNationalExtensionICD10.pdf.

2. Bowman, Sue. “Coordinating SNOMED-CT and ICD-10: Getting the Most out of Electronic Health Record Systems.” Journal of AHIMA 76, no.7 (July-August 2005): 60-61.

3. International Health Terminology Standards Development Organisation. “SNOMED-CT – Adding Value to Electronic Health Records.” February 2014. http://ihtsdo.org/fileadmin/user_upload/Docs_01/Publications/SNOMED_CT/SnomedCt_Benefits_20140219.pdf.

4. International Health Terminology Standards Development Organisation. “About SNOMED CT.” http://www.ihtsdo.org/snomed-ct/snomed-ct0/.

5. WHO-FIC. “International Classification of Diseases (ICD) and Standard Clinical Reference Terminologies: A 21st Century Informatics Solution.” May 2013. http://www.cdc.gov/nchs/data/icd/Class_Term_InfoShee_May2013.pdf.

6. World Health Organization. “International Classification of Diseases (ICD) Information Sheet.” http://www.who.int/classifications/icd/factsheet/en/.

7. Ibid.

8. Bowman, Sue. “Coordination of SNOMED-CT and ICD-10: Getting the Most out of Electronic Health Record Systems.”

9. Ibid.

10. Ibid.

11. WHO-FIC. “International Classification of Diseases (ICD) and Standard Clinical Reference Terminologies: A 21st Century Informatics Solution.”

12. Ibid.

13. Averill, Richard and Sue Bowman. “There Are Critical Reasons for Not Further Delaying the Implementation of the New ICD-10 Coding System.” Journal of AHIMA 83, no.7 (July 2012): 42-48.

14. Bowman, Sue. “Why We Can’t Skip ICD-10.” Journal of AHIMA. http://journal.ahima.org/2012/04/05/why-we-cant-skip-icd-10/.

15. Averill, Richard and Sue Bowman. “There Are Critical Reasons for Not Further Delaying the Implementation of the New ICD-10 Coding System.”

16. Bowman, Sue. “Why We Can’t Skip ICD-10.”

17. AMA Board of Trustees. “Evaluation of ICD-11 as a New Diagnostic Coding System.” http://www.ama-assn.org/assets/meeting/2013a/a13-bot-25.pdf.

18. Ibid.

19. Bowman, Sue. “Why We Can’t Skip ICD-10.”

20. Averill, Richard and Sue Bowman. “There Are Critical Reasons for Not Further Delaying the Implementation of the New ICD-10 Coding System.”

21. Bowman, Sue. “Why We Can’t Skip ICD-10.”





Making a Case for Dual Coding | ICD-10 Online

Making a Case for Dual Coding

For providers seeking to reduce productivity challenges associated with ICD-10, they should look to benefits of dual coding. This approach can help lessen the risks associated with an ICD-10 implementation, including operational and financial impacts. It’s an effective strategy for organizations already dealing with coder shortages, education and training needs, and budget issues, particularly in light of the recent delay.

On the path to ICD-10, dual coding can help healthcare organizations:

·       Identify critical areas for clinical documentation improvement

·       Target areas for increased training and education

·       Improve workflow and prepare technologies

·       Reduce financial risk and pinpoint areas for improved financial outcomes

·       Support predictive modeling for future financial forecasts

Clinical documentation improvement: As we know, the number of codes that providers will need to document drastically increases in under the complexity of an ICD-10 environment. This includes a jump from 13,000 to 68,000 diagnosis codes, as well as an increase of nearly 85,000 procedure codes. With this expanded volume and level of granularity, it’s critical that providers use the ICD-10 delay to develop practice opportunities for their coders.

Training and education: In identifying areas for improvement through CDI, dual coding also presents greater opportunities for targeted education efforts. Under ICD-10, physicians will be required to newly capture or modify a range of classifications that could spell trouble for accurately pinpointing reimbursement. These  conditions include diabetes mellitus, pregnancy, injuries characterized by encounter type, the addition of underdosing and expanded codes for musculoskeletal conditions.

Improve workflow and preparing technologies: With the complexity of CDI programs, the potential addition of coding resources and more, the move to ICD-10 will undoubtedly require change management initiatives for effective workflow strategies. In addition, providers will need to ensure the proper steps are taken to ensure that their internal and external technology systems supporting ICD-10.

Reducing financial risk and predictive modeling: Dual coding can help give healthcare organizations a more accurate view into how the move from ICD-9 to ICD-10 will impact their financial future. By identifying reimbursement differences in grouped MS-DRGs, providers should have a better idea of how ICD-10 will challenge, or possible reward, their budgets.

CAC implementation for ICD-10 – Nalashaa Solutions

Computer Assisted Coding or CAC has gained importance with the ICD-10 implementation road map underway at most healthcare providers. The CAC software will help preserve accounts receivable and accounts payable resulting in accurate, compliant medical coding and reimbursements.

Traditionally this process was performed by coders, but with the recent changes in the coding standards, and going ahead with ICD-11 coming up in a few years, it is beneficial to invest in a CAC software and have most routine coding work to be performed by the software. Coders can take up more complex issues, and further assist in audit of the CAC system output. The CAC software uses Natural Language Processing (NLP) to suggest codes and then prompting the user to agree or disagree with the suggested codes.

When implementing CAC

  1. There needs to be an assessment on the best mode of implementation. One method is an enterprise wide implementation, or the other is where each department implements an instance specific to them.
  2. Regardless of the nature of implementation, the current state coding workflow and the current state data workflow need to be identified.
  3. Mapping of data flow to show the data types, and this will contain specific data for each patient class type within each system. The data mapping helps in defining test plans.
  4. Understand which are the systems in which the documents reside, and can the outputs all interface with the CAC system

When testing CAC

  1. Unit and functional testing is usually taken up by the technology partner to ensure that the product complies to requirements prior to implementation
  2. Integration testing: Review test scripts and test those which are affected by the change/ build.
  3. Operational Readiness Testing (ORT): CAC systems require document input from various systems, an also interfaces with various EHR systems. This requires ORT to ensure workflow completion and correct billing processes

The ultimate goal of a CAC system is to create a centralized space where coders have access to all documentation needed during the coding course—i.e to accept or reject codes thrown up by the NLP engine with confidence. When that is achieved, organizations can code more effectively and thus create a faster, smoother transition to ICD-10.

We had previously detailed a complete implementation and testing strategy for ICD-10 transition, and now along with CAC systems, the process of transition will be made smoother. The coder training and educating will be still required, but the scope for error can be reduced, and the coding process quickened.

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Myths About ICD-10 Delay | HealthWorks Collective

icd-10 delayThe process of switching over to ICD-10 has caused a lot of stress in healthcare circles even before many companies begin to make the change.  While the repeated delays in the mandate to convert record-keeping processes bring a relief to some, they also cause more confusion. These delays have generated a number of myths that need to be dispelled so that coders and billers can get on with the real work involved in moving on to ICD-10.

Four Myths About the ICD-10 Delay

  • The New Law Mandates A 10/01/2015 Implementation Date

The truth about the new law, signed by the President on April 1, is that it does not mandate an implementation date.  This new law simply states that ICD-10 will not be put into effect before October 1st, 2015.  It does not actually say that ICD-10 will be put into effect then.  CMS, however, has stated that it has every intention of doing so. 

  • The New Compliance Date Is A Flexible Date

There have been many delays already.  October 2014 was seemingly set as a hard and inflexible date for compliance with ICD-10.  Nevertheless, that date was pushed back to 2015.  A lot of people in the healthcare business are beginning to look at the new date as just another date on the calendar.  They fear that they are losing a sense of urgency with regard to the conversion to ICD-10.

Some people may feel that the new date for compliance will not be exact.  In other words, that healthcare facilities and providers will be allowed to simply be in transition at that time, rather than in full compliance.  Perhaps the several delays already put in place have led some people to think that the government will not take this final date very seriously.

However, there is nothing suggesting any such a thing.  Every indication is that CMS will require full implementation on Oct. 1, 2015.  Any thinking that there will be flexibility, risks legal and financial consequences for those involved.

  • Most Healthcare Organizations Are Relieved About The Delay

Given the great difficulty that many organizations have already encountered in dealing with conversion to ICD-10, some people assume that there is widespread and shared relief over the most recent delay.  In fact, one national physician group rejoiced publicly about this delay.

However, polls actually show that 58% of the organizations required to make this change are upset with the delays.  These groups have already made considerable effort to be prepared and are afraid of losing momentum and focus.

  • ICD-10 Is Now So Old That It Is Out Of Date

Healthcare and medical treatments are always changing.  New procedures arise, and technology is updated to assist in examinations and treatments.  Delay after delay has led many people to think that ICD-10, which was developed a few years ago, will be hopelessly out of date by October 2015.  In fact,  some may think that CMS should bypass ICD-10 and skip to implementing ICD-11 instead.

Actually, the delays have not hurt the usefulness of ICD-10.  Behind the scenes, developers have been continuing to update the codes.  When ICD-10 finally becomes effective on October 1, 2015, it will be absolutely relevant and efficient.

The delays have provided breathing room for healthcare organizations.  They have not caused ICD-10 to become obsolete before its time.

With these myths dispelled, people can focus on implementing the coding changes and avoid kicking the can down the road.  Early 2015 would be the best time to conduct full testing of the new codes.

The Coding Institute Releases ICD-9-CM 2014 Multispecialty Guide …

The Coding Institute’s new 2014 ICD-9-CM Multispecialty Quick-Reference Guide makes it simple for healthcare providers to focus on diagnosis coding accuracy. Many providers have been concentrating on ICD-10 training, rather than ICD-9, expecting ICD-10 to replace ICD-9 in October 2014. But on April 1, 2014, President Obama officially signed the controversial H.R. 4302 (also called the “Doc-Fix” bill) that includes a provision to delay the ICD-10 implementation deadline until at least October 1, 2015.

The delay has the industry searching for answers, with billions of dollars already spent by providers on products/services to assist their ICD-10 transition — and CMS estimates the delay will create an additional $1 billion to $6.6 billion in costs to the industry! To help physicians and other healthcare providers safeguard their payments until the nation moves to ICD-10, The Coding Institute (TCI), a healthcare education and information company, has released the 2014 ICD-9-CM Multispecialty Quick-Reference Guide,    a comprehensive resource organized into 26 specialty sections.

“Most healthcare providers have not updated their ICD-9-CM resources in several years due to the planned ICD-10 implementation. However, it’s essential that providers have the latest ICD-9 resources to safeguard payments, steer clear of audit troubles, and comply with HIPAA regulations,” says Mary Compton, PhD, CPC®, Editorial Director & Publisher, The Coding Institute.

The Coding Institute’s just-released 2014 ICD-9-CM Multispecialty Quick-Reference Guide offers a comprehensive and instant solution to ICD-9 coding needs for 26 specialties. “Specialist-drafted codesets organized by specialty ensure more accuracy and efficiency than other charts/books on the market,” adds Compton.

The Coding Institute also offers these ICD-9-CM resources that will assist providers in boosting reimbursement during the transition period:

2014 ICD-9-CM Quick-Reference Charts (26 specialties) for physicians and other healthcare providers

2014 ICD-9-CM Pocket Guide (26 specialties) for physicians and other healthcare providers

2014 Legacy ICD-9-CM Expert for Physicians.

These ICD-9-CM 2014 products are available in various formats including:


Laminated charts.

About The Coding Institute:

The Coding Institute has provided healthcare education and information for more than 60 years, with roots going back to 1947. The company is primarily focused on providing specialty-specific content, codesets, continuing education opportunities, consulting services, and a supportive community of healthcare professionals and experts. For more information on TCI’s product offerings, visit http://www.codinginstitute.com/.


With 14,000 medical codes, the old collection of codes – the ICD-9- seems puny by comparison. The new manual for ICD-10 explodes that code set to 68,000 much more granular and detailed terms to define — very exactly what health problems can occur.

The ICD-10 manual is thick, about the size of a phone book. Printed in minuscule type on newsprint-thin paper, it weighs five pounds and includes more than 1,100 pages of medical procedures and ailments. The index alone — the guide to figuring out where to find the right code — is 421 pages.

The ICD-10 manual is big. Really big. (Carla Broyles)

Two key factors help explain the explosion in medical codes. First, ICD-10 adds in the ability to differentiate between left and right sides of the body. This can help insurers, for example, to root out fraud. A hip replacement on both the left and right side might not raise any red flags — but two hip replacements on the left side probably would.

Second, the new codes categorize whether a trip to the hospital was the first round of treatment or a subsequent encounter. This is important for reimbursement purposes, as first visits to the doctor tend to require more resources.

Whether this specificity improves the medical system is a subject of fierce debate in health technology circles. Opponents argue that the new larger set will slow productivity, making it more difficult for veteran billers to find the right code in a sea of parrot injuries and turkey bites.

Most other industrialized nations transitioned to ICD-10, which the World Health Organization published in 1992, more than a decade ago. The switch can take years because most countries come up with a slightly modified version of the code set that best suits their needs.

When Canada adopted ICD-10 in 2001, one study of a Toronto hospital system showed that productivity fell by half. Before ICD-10, medical coders could get through 4.62 charts in an hour. Right after the transition, that fell to 2.15 charts per hour. One year later, productivity had partially rebounded to 3.75 charts per hour.

“If you look at Canada’s transition, there were some longer term cost impacts that went well beyond the transition itself,” said Michael Nolte, chief operating officer of technology firm MedAssets. “There’s some evidence that there will be a long-term effect.”

One study funded by the American Medical Association estimated that it could cost doctors’ offices $56,000 to $8 million to transition to ICD-10, depending on the size of the practice. The AMA, one of the larger groups opposed the switch, is still petitioning the federal government to reverse course.

“Adopting ICD-10, while it may provide benefits to others in the health-care system, is unlikely to improve the care physicians provide their patients and takes valuable resources away from implementing delivery reforms and health information technology,” the trade group wrote in a Feb. 12 letter to Health and Human Services Secretary Kathleen Sebelius.

Others contend that the change in productivity won’t be as dramatic — that opthalmology coders could just stick to the ophthalmology section, for example, and don’t have any reason to get bogged down in codes about parrots. Health insurers don’t care if a bite came from a parrot or a turkey — they just want to know what type of medicine they’re paying for when the hospital treats it.

“No individual has to use the whole thing,” said Martin Libicki, a researcher at RAND Corporation. “If you’re working with an eye doctor, God knows why you’d learn the codes for broken legs. But if someone showed up with a broken leg, you would just look it up.”

Libicki authored a major RAND Corporation study in 2004 — when the Bush administration was first studying the transition — that estimated the potential benefits of switching to ICD-10 outweighed the costs by as much as $4.5 billion.

Much of this comes from increased specificity in coding, which both makes it easier to accurately pay hospitals for the care they provide — and reduces opportunity for fraudulent billing.

“If you have ICD-10, you have an enormous increase in precision,” said Richard Averill, senior vice president of clinical and economic research at 3M Health Information Systems, recalled. He has worked in the medical coding world for decades, and his company has a key federal contract to help run the ICD-10 transition. “Yes, there’s an adjustment, but two years later you’ve gotten rid of a lot of that paper chase.”

In a more precise coding system, researchers see the potential to better track the quality of medical care that patients receive. Billers can denote whether a visit to the hospital is a first, second or later trip — which could indicate the severity of the condition.

Nearly everyone agrees that there is at least one compelling reason to switch to ICD-10: As new medical technologies have come online and demanded new codes, ICD-9 has run out of space. The capacity for noting cardiology procedures (assigned, in ICD-9, by codes that begin with “37”) was exhausted in the early 2000s. That created a patchwork scenario, where new cardiology codes show up elsewhere in the code set, with little rhyme or reason.

“The consequence is very disruptive,” said Christopher Chute, a professor at the Mayo Clinic and expert on medical classification. “It’s like they’re renovating a city, and assigning addresses at random. That makes it a lot more difficult to find the right house.”

In 2012, Chute wrote an article in the journal Health Affairs advocating for delaying the ICD-10 implementation. He has serious doubts about whether the new codes will improve the medical system. But he also doesn’t see any better option right now: The code set the country currently uses has no space left to grow.

“It’s now equally important for private payers, in terms of a backbone of how bills get paid,” Michael Nolte said, chief operating officer of technology firm MedAssets. “It’s just as fundamental.”

When the Centers for Medicare and Medicaid Services first explored a move to ICD-10 more than a decade ago, health insurance plans began diligently preparing. Medical billing trainers started developing their her ICD-10 curriculum. No one imagined they would still be getting ready a full decade later.

Flipping the switch

Nobody in the medical community is quite sure what will happen on Oct. 1, when the US federal government flips the switch on this new system.

“I think it will be a non-event in the same way Y2K was,” Gordon, the woman with the workplace stress pin, said. “I have such confidence in our health-care providers. They’re not going to enjoy it, but they’ll be ready.”

Others aren’t quite as sanguine.

“The difference is Y2K was only a technical issue,” Nolte, of MedAssets, said. “You didn’t have to ask anybody to do anything different. But here you have a culture change, where you’re teaching thousands of people to do something that’s somewhat foreign to them.”

The federal government has undergone a massive data mapping project, figuring out which codes from ICD-10 will replace each and every code from ICD-9. Technology firm 3M, where Averill works, has one of the major contracts to complete that process.

This month the agency announced it would hold a testing week in March, where hospitals can check if their new ICD-10 claims make it to the federal government. While those are the only testing plans in place for the moment, the agency says it’s confident that it will be able to handle the new codes come October. More of the concern tends to center on smaller, private health insurance plans, who which don’t have the resources of the federal government to prepare.

Regardless what happens this year, even more change is in the works: In 2007, Chute, at the Mayo Clinic, began leading the World Health Organization’s efforts to develop the Eleventh Edition of the International Classification of Diseases, or ICD-11. He expects that to come into use in the United States sometime around 2022.

“I think we’ve had about tens of thousands of person hours put into this already,” Chute said. The effort relies on hundreds of committees with thousands of doctors around the world, each leading experts in their medical specialities.

Reolubin made it through the San Francisco training. It’s nearly certain she won’t be around for the next ICD upgrade — and she says, only partially joking, she thinks sometimes about skipping this one, too.

“I keep telling my boss, ‘I’ll just retire,’ ” she says, as she highlights her new, ICD-10 code book. “I’ve done this for long enough.”