July 9, 2013

A Fable, Just for Us

By

Once upon a time, not too long ago, and actually in this galaxy, there lived two children, brother and sister, named Issy and Carla Dover (or “ICD” for short). They were both 9, as it happens.

Issy and Carla loved walking in the woods with their dogs, Moribund and Algernon. In fact, they used to go there every single day, because it was the only way they could know for sure that life was good. You see, they had a very poor father and no mum, and walking in the woods let them forget about everything they didn’t have, at least for a short while.

One day, Issy and Carla (remember, both 9, or ICD-9, if you will) stumbled upon a house deep in the darkest part of the forest: a place they’d never been before. They stared at it, marveling at how big it was; it was the biggest house they had ever seen. In time, their surprise was replaced by curiosity, and they found themselves creeping ever closer to the monstrous house, although they still really could not wrap their minds around how big it was.

As they drew very near to it, they realized it wasn’t a house at all, but a huge tent – bigger than any army officer’s tent, bigger even than a circus tent (and those were the biggest they’d ever seen before.) And suddenly, they realized: This was no ordinary tent, no, no!  This was an…ICD-Tent!They went inside, and discovered that as big as the tent seemed on the outside, it was even bigger inside! How could that be? As they explored this wondrous place, a place they never could have imagined, they found room after room after room: nearly 150,000 of them in all, they guessed, and every one had from three to seven walls. It was the most massive, complex, incomprehensible thing they had ever seen. They looked at each other with big eyes, filled with fright, turned slowly, and ran!

But it was too late! For the owner of this monstrosity had arrived, and her name was Connie Mavis Simpson (or “CMS” to her friends).Though truthfully, she had no real friends, for Connie Mavis Simpson was a witch, and the worst kind. She offered the children presents, candy, soda and cake, but when they stopped eating to catch a breath, they realized they truly were trapped. You see, they had followed crumbs and completely lost their way. Yet what they didn’t know was that there was no way out!

And thus, ICD-9 never were heard from again. The End.

OK, so that’s not really “the end,” but it is quite enough, I think. Now it’s time for the secret message embedded in this fairy tale. At least some of you reading this probably had a secret decoder ring as a child, and many others will admit to having some other type of secret all their own.

I am a fan of ICD-10-CM/PCS in spite of its complexity, its proliferation of silly and overly complex designations, and its cost to implement. But I don’t subscribe to the argument that ICD-10 is all good, all the time, for all people. I doubt that’s true of anything, and it certainly is not true of an over-thought coding system brought to us by a government that apparently equates “improved” with “incomprehensible.” I know we need something to replace the ICD-9 dinosaur, but I always hoped the “something” would be better in most respects. Alas, it’s better in only a few, and it is irresponsible of anyone to suggest that ICD-10-CM/PCS is exactly what it should have been.

So, the question becomes: “Why do you support ICD-10-CM/PCS, Bill?”

And the answer is shockingly simple: “Because it’s the ONLY bridge to ICD-11.”

That’s it.

ICD-10-CM/PCS is a grade-B, poorly conceived, administrative nightmare. But it also is the epitome of the term “necessary evil” – like that witch, CMS – if we ever hope to get to ICD-11. ICD-11 is different, and in my opinion, markedly better. To a great extent, it will integrate coding and documentation, a good outcome, but I suspect the real required documentation (in the medical record) probably will drive 38.7 percent of physicians out of practice (source: 52.6 percent of statistics are just made up.)

Still, there is good news: ICD-11 is being released by the World Health Organization (WHO) next year or the year after, so we presumably won’t need to worry about ICD-11-CM/PCS until at least 2035 or so.

Until next time…

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

Contact the Author

To comment on this article please go to

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Billy Richburg, M.S., FHFMA

Billy K. Richburg, MS, FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the University of Alaska, Anchorage and earned his MS in Health Care Administration from Trinity University, San Antonio, Tex. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Senior Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.