Six takeaways from the CMS teleconference on ICD-10 implementation

Carl Natale
by Carl Natale

I just finished listening in on the ICD-10 Implementation Strategies for Physicians National Provider Call by staff members at the Centers for Medicare & Medicaid Services (CMS). (Post updated 08/04/2011)

[Download the slide presentation (809KB PDF)]

[See also: CMS Plants the Seeds of Change on National ICD-10 Call (]

Daniel Duvall, medical officer for the CMS Hospital and Ambulatory Policy Group, got most of the time to discuss ICD-10 implementation. Here are some takeaways from the conference call:

You asked for this so don't blame the government

Duvall wanted to make sure everyone knew that the reason there is so much detail in ICD-10 codes is that private organizations and physicians wanted it. They asked for a code set that recognized specific diagnoses for their reporting and tracking.

This is no big deal for physicians

In light of this information, I probably should shut down the site. Because nothing really changes. Duvall gives three reasons for this conclusion:

  1. ICD-10 is not changing diseases, diagnoses and treatments. Physicians need to do their work the same way they always do it. (Look for a slight disagreement on this point later.) It's just the labels (medical codes) that are different. Your office just needs to learn new labels.
  2. You don't have that many ICD-9 codes memorized anyway. No one is going to need to remember 70,000 codes. You're just going to have to learn the ones you need.
  3. This is a tension headache for physicians. The billing agencies, hospitals, payers and federal government have much bigger challenges and headaches. This is a bit like telling your doctor about your aches and pains. The doctor tells you well there are people dieing out there so you don't have it so bad.

OK, I'm not buying this point. Neither did a coder who challenged Duvall on this point. She emphasized how hard it will be to get physicians to give enough detail to assign ICD-10 codes. (I assume reminding physicians that "they" asked for this won't help much.) Duvall says that's a symptom of poor documentation practices that exist now. And they need to be fixed now just as much as they do after Oct. 1, 2013.

Prepare diagnosis codes now

This goes back to the relatively few diagnoses you work with now. Translate the common ones now into ICD-10 codes and record them. Duvall even recommends building the ICD-10 version of your superbill. Then look up the rarely used ones when you encounter them. This is pretty much a ICD-10 implementation strategy that's been given a lot of attention.

But that may be a bit too simplistic according to Jen Searfoss, an attorney  and consultant, who represents individual and group health care providers and integrated health systems. She also worked for the Government Affairs Department of the Medical Group Management Association (MGMA) and lobbied against implementing ICD-10.

"I don't have that position," said Searfoss. "Unless you can make the superbill really, really long... Nobody' s going to be able to find [the code]." ICD-10 gives medical coders so many options, Searfoss wonders if only the high level codes will make it on the sheet.

Which leads to the big problem.

"Today Down Syndrome is called Mongolism and it's one code. It's going into 21 codes," said Searfoss. So how does a medical coder figure out today which ICD-10 code is the right one for Down Syndrome?  "Unless that information is in the medical record for that point of service in time or some reference is made in the transcription, it's going to be more difficult."

Yes, figuring that out now - which probably will require communication with physicians - will save time later. But don't underestimate how long that will take.

This may not cost as much as you think

Duvall is speaking to small practices on this point. He bases this on two assumptions:

  1. Your medical coders already are using resources for continuing education courses. ICD-10 training may end up costing just a bit more time and money than usually budgeted.
  2. Small offices are likely to be be using billing agencies anyway. They need to worry about the coding. Of course that's assuming that they don't pass the costs of their bigger headache on to clients.

Don't convert to EMRs yet

Duvall suggests waiting until after ICD-10 implementation so you don't have to worry about upgrading your ICD-9-only system. At this point, I would think you would be able to buy ICD-9 and ICD-10 compliant EMR systems. And hopefully the EMR would force physicians to provide enough information to make an ICD-10 code.

Code books might be better than GEMs

Maddy Hue, a health insurance specialist, says small offices with not so many different diagnoses might do better looking up ICD-10 codes in code books.

What do you think of the information presented by the CMS during Wednesday's conference call?