ICD-10 and the Five Stages of Grief

An interesting thing happens every time I am on the road speaking to physician groups about ICD-10. During the course of my lecture, I always demonstrate the difference between ICD-9 and ICD-10 by citing the number of codes in each for fracture of the patella. ICD-9? Two codes. ICD-10? Four hundred and eighty codes.

As soon as the ICD-10 slide with that latter figure appears, the resulting gasps, guffaws and outbursts are loud, no matter the location of the seminar. I am particularly struck by the similarity of these responses as they pertain to the Kubler-Ross model, perhaps better known as the “Five Stages of Grief.” While manifestations of grief and other responses to emotional trauma are as individual as a fingerprint, and therefore not uniform, ICD-10 nonetheless inevitably evokes these kinds of uniformly strong emotions in even the most jaded physicians. So in this article we’ll take a closer look at how reactions triggered by the ICD-10 mandate correspond to the various stages of grief.


Denial is a conscious or unconscious refusal to accept facts, information, reality, etc. relating to a certain situation. In the case of ICD-10, there existed (and still exists, if truth be told) many providers who refused to believe that ICD-10 would actually be implemented. Many still believe a “skip” to ICD-11 will happen, but this conclusion is reached without taking into account the years it will take to develop clinical modifications necessary to make ICD-11 feasible under our country’s payer model. Let’s be clear: the government’s mishandling of the announcement that ICD-10 implementation will be delayed didn’t help. ICD-10 is the “law,” and it literally would take an act of Congress to derail us from the path we’re currently on. Being in denial isn’t going to make this go away.


Anger can manifest itself in many different ways. With ICD-10, anger seems to be directed at those who “ are shoving this ridiculous waste of time and resources down our throats.” At my workshops I routinely hear such comments as “well, I now know my retirement date,” or “this is yet another instance of government intrusion” or “I don’t care what they say; I’m not going to do it.” Again, ICD-10 is the law. No matter how angry you get, it ain’t going away.


Once it became clear that ICD-10 implementation seemed inevitable, bargaining came about through numerous requests from various entities pleading for or demanding delays. Don’t forget, ICD-10 already was delayed by two years before recently being delayed by yet another year. Expect the bargaining to continue. Unfortunately, bargaining rarely provides a sustainable solution, especially if the outcome is inevitable anyway.


This phase of the grief cycle is the most dangerous, in my opinion. Now that it appears ICD-10 is truly inevitable, what becomes “depressed” is the will to heed the call to prepare. This inaction will lead many providers to “wait and see” until the switch is thrown (on what looks to be Oct. 1, 2014). Experts and early implementers agree: there will be a significant drop in both productivity and revenue for even the well-prepared practice.


The rate at which acceptance of ICD-10 is reached is key. The sooner a provider understands and accepts that ICD-10 demands a concerted effort to navigate, the better. When emotional detachment and objectivity are reached, solid work can be achieved.

So how do we mitigate these five phases of the grief cycle? It certainly helps if you take an emotionally detached, objective look at what ICD-10 is really all about. Think back to the fracture-of-the-patella example I used earlier. Simply adding laterality drops the number of ICD-10 codes to 160. Looking at the X-ray and knowing, for example, that it is a “transverse” fracture reduces the results to 32. Adding the type of visit, in this case let’s say “initial,” drops the number of results to only six.

I urge everyone to take a closer look at what ICD-10 truly means. A physician wouldn’t pronounce a diagnosis without performing a thorough exam on a patient. Taking such an objective view of ICD-10 will help mitigate and reduce the need for having to endure the five stages of grief. The sooner the “acceptance” stage is reached, the sooner productive work can occur.

About the Author

Denny is the president of Complete Practice Resources, a health care education, consulting, and software company headquartered in Slidell, Louisiana. He formerly served as the CEO of a large, multi-specialty physician group, full service MSO and was certified as a CPC through AAPC. He has authored or co-authored numerous “common sense” practice management books and implementation manuals. He is an award-winning, nationally known consultant, speaker, and educator bringing his expertise to making the complex “simple.” He currently serves on the editorial board of ICD10 Monitor.

Educated at the United States Air Force Academy, Denny had a distinguished career as an Air Force pilot and has a long history of commitment to excellence and dedication to his clients’ success.

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