August 3, 2011

CMS Plants the Seeds of Change on National ICD-10 Call


“Embrace it; don’t postpone it.” That’s one key piece of advice that Dr. Daniel Duvall, medical officer for the hospital and ambulatory policy group at the Center for Medicare, gave to those who listened to an August 3 national provider call sponsored by the Centers for Medicare & Medicaid Services.

The presentation by Duvall and others from CMS, entitled ICD-10 Implementation Strategies for Physicians, seemed to be designed as a way to replace providers’ fears about the new system with information about what they need to do to get ready for the October 1, 2013, implementation date.


Even though implementation is still more than two years away, Duvall said it’s time now for physicians and others to get “emotionally ready” for the switch and to not fool themselves into thinking that CMS will postpone it. As he said, it’s “inevitable” and “CMS is committed to meeting the deadline and expects the industry to do so as well.” Other take-home messages included his opinion that work for physicians will be “neglible” and costs for some offices may be small.

Developing a Plan

Where should providers start? Duvall encourages them to follow CMS’s example and adopt a conversion-strategy framework, which involves thinking about general approaches to problems as well as to patient care. CMS is using the traditional documentation method called the SOAP note—an acronym with the following steps:

Subjective: Define problem and issues.

Objective: Collect and process information.

Assessment: Evaluate options.

Plan: Determine your response.

Duvall stated very plainly that switching to ICD-10 is a “headache” for all involved (physicians; billing agencies; hospitals; health insurance plans; and the government, primarily CMS). As the complexity of an organization increases so does the level of its headache.

For example, ICD-10 will create a “tension” headache (level 1) for physicians and their office staff. Hospitals will have a “cluster” headache (level 3), and CMS and other government agencies involved will suffer from “encephalitis” (level 5). In the end, the headaches will be worth it because the new coding system will make several things better, although the benefits are as varied as the headache levels. The primary benefit for physician is one that their specialty societies requested: the opportunity to assign diagnoses that more closely and accurately match their patients’ conditions.

Physician Impact

Returning again to the conversion-strategy framework mentioned above, Duvall discussed the primary steps that physicians will need to take when the time comes, which are listed below.

- Obtain an ICD-10 diagnosis code book, and review the way the system and codes are organized, particularly the alphabetical index, which physicians should use.

- Record all of the diagnoses they now assign for patients seen in one week or two, including the most common ones and those that are atypical. Cross off atypical ones at the end of the recording period.

- List the most commonly used diagnoses in alphabetical order, and find the codes in the alphabetical index.

- Update the office superbill or job aid (the “cheat sheet”), listing the top I-10 diagnosis codes—a task that CMS estimates will take no more than eight hours.

In reality, the end goal for physicians personally is to learn to choose the right diagnosis code, although those with their own offices or clinics also must address system changes needed and must be sure the coders get the education they need to code from the new system.

Very large clinics will need to update proprietary software, which is already being forced by the conversion to 5010 (set for January 1, 2012). An update of billing software will be required for medium clinics, while small clinics that use billing agencies may simply need to update code books and forms used.

The last piece of advice is an important piece. Duvall recommends that physicians who are planning to adopt the electronic medical record should wait until they can bring the ICD-10 codes into the system instead of using ICD-9 codes.

Practicing a little patience will reduce costs and minimize refitting the system.

Read 1 times Updated on March 16, 2016
Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for and; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.