August 18, 2011

ICD-10: The Rubik’s Cube of Healthcare

By

Editor’s Note: On a recent Talk-Ten-Tuesday podcast, the ever-popular Billy K. Richburg used the Rubik’s Cube as an analogy for ICD-10 compliance. His segment is transcribed below.

Rubik’s Cube is a puzzle invented by a Hungarian engineer and teacher in 1974. Subsequently it was marketed worldwide beginning in 1980 by Ideal Toy Corporation.

When you buy a (Rubik’s) Cube, it’s “solved.” That is, each face is all one color and you mess it up by twisting the layers. Once the colors are mixed on each face, you then solve it – making the faces a solid color again – by twisting the layers around the central core. Sounds simple enough … until you actually try it.

How difficult is it to solve? Well, there are 43.25 quintillion possible solutions, unless you take it apart. … To put that in perspective, 43.25 quintillion Rubik’s Cubes – which are roughly 2-1/4 inches on each side – would cover the earth to a depth of 52 feet – roughly 5 stories.

The current record time for solving the cube is 5.66 seconds, set by Feliks Zemdegs in Melbourne just this year. Feliks also holds the record for “average solution times,” at 7.64 seconds.

“So what’s your point,” you ask? Glad you asked!

The process of preparing for ICD-10 actually has a lot in common with (solving a) Rubik’s Cube.

If each diagnosis code could be used with any procedure code and vice-versa – which is not the case, but stay with me here – then there are approximately 5-1/2 billion combinations, and that’s only using one procedure code and one diagnosis code at a time.

And how many ways are there to implement ICD-10 in your organization – hospital, payer, clearinghouse, or vendor? Actually, the number probably is infinite, because each individual involved in the process will influence how it is done, and let’s be honest: we each think our way is best.

There is a grand irony in all this.

In the final analysis, and with apologies to Carl Sagan, there are “billions and billions” of ways to implement ICD-10, but – like the Cube – there is only one correct implementation. No matter how you approach the problem, your implementation of ICD-10 has to look pretty much like every other one.

That’s the beauty of the HIPAA Transaction Rule, you see: How we comply is up to us and is infinitely variable. There is no “best way” to implement ICD-10. But the final solution is specified, mandated, forced, compelled, coerced: pick your verb. It must look the same everywhere.

And that’s okay, because if it didn’t, it wouldn’t be a “standard,” and it would have no value. A primary purpose of ICD-10 is to allow comparison, statistical analysis, trending and other data manipulation – and if it doesn’t look the same everywhere, those goals are meaningless.

So, smile, hold your head up high, pursue your solution to the problem even though you must tolerate those other people in your organization who think they have a better idea, and take some comfort in knowing that several hundred thousand other people are doing exactly the same thing – but you’ll all end up in the same place. After all, anything less is failure.

About the Author

Billy K. Richburg, MS, FHFMA, is HFMA-certified in accounting and finance, patient accounting and managed care. Bill graduated from the University of Alaska in Anchorage and earned his MS in healthcare administration from Trinity University in San Antonio, Texas. During a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO, in hospitals ranging from 75 beds to more than 300 beds, and in home health agencies, DME stores and a home infusion company. Bill is a board member of the Lone Star Chapter of the 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

Read 76 times Updated on September 23, 2013
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.