Updated on: March 17, 2016

Journey for Adoption of ICD-10 Prolonged

Original story posted on: August 27, 2012

Last Friday’s anxiously awaited announcement from the U.S. Department of Health and Human Services (HHS) establishing Oct. 1, 2014 as the compliance date for implementing ICD-10 is poised to be one of the final chapters in a controversial journey that began 22 years ago, in 1990.


Since 1975, the United States has been operating on the ninth revision of the International Classification of Diseases. Friday’s announcement essentially affirms the notion that the U.S. will be in the company of nearly 100 other countries that already have adopted the tenth revision.

But the journey is far from over, and controversy is sure to be part of it.

Lagging Behind

In last Friday’s announcement, HHS Secretary Kathleen Sebelius said the one-year delay would allow for more time for covered entities to prepare for the transition.

“(The) message should be strongly stated that physicians need to prepare for ICD-10,” Paul Weygandt, MD, vice president of physician services for J.A. Thomas & Associates, said in a written statement to ICD10monitor. “Had physicians continued to prepare for ICD-10 during the CMS decision-making process, they would have, in fact, gained substantial preparation time.”

The additional time the one-year extension provides was obviously on the mind of Rhonda Buckholtz, AAPC’s vice president of ICD-10 Training and Education program.

“This (the extension) allows for coders to have adequate time to prepare by refreshing their skills on A&P and coding,” she said. “Code set training should not occur for many coders, though, until late 2013 or early 2014 – unless they will need to utilize codes early.”

During the Limbo

Many in the healthcare industry simply expressed relief that a looming sense of uncertainty has been eliminated.

“We’re happy that being in limbo has ended, and we’re happy that the delay was not more than the proposed one year,” said Sue Bowman (MJ, RHIA, CCS, FAHIMA), senior director of coding policy and compliance for the American Health Information Management Association (AHIMA). “This will help get people back on track. I was concerned that some people would be working on other projects.”

Still, Bowman and others expressed concerns about the impact of the delay on providers.

“Unfortunately,” added Weygandt, “the vast majority (of) physicians have done nothing during the period of CMS decision-making.”

During recent months, providers of all types either continued with their ICD-10 preparation efforts or threw them into stasis. In some cases different departments under the same provider umbrella were known to have reacted differently.

With the final rule now in place, many agreed, everyone can get on the same page again.

“What happened during the moratorium is that some providers had reallocated their resources – and we’re (now) calling on everyone to get back on track,” Juliet Santos, senior director of HIMSS Business-Centered System and Medical Banking Projects, told ICD10monitor.

Moving Forward


Doing just that was a recurring concern among providers and payers, given Friday’s announcement.

“It has been a long six months of industry holding patterns, continued procrastination and financial losses since the February 2012 announcement of a potential delay in ICD-10 implementation,” said Maria Bounos, business development manager for Wolters Kluwer Law and Business. “We are happy that HHS finally came to the one year delay in (announcing the) implementation date decision of Oct. 1, 2014.  Now it is time for the industry to get back on track and work towards the new implementation date.”

"We're glad to see the rule finalized and (are) looking forward to keeping our work on track,” added Ian C. Bonnet, vice president for WellPoint. “We've invested heavily in a range of innovative efforts, including testing with our external partners such as hospitals and professional practices, to help us all get insight into the most appropriate and accurate use of these new codes – as well as the value ICD-10 can provide to all stakeholders."

Echoing that notion was Dennis Winkler, technical program director and ICD-10 program lead for Blue Cross Blue Shield of Michigan.

"With the final ruling in place that officially changes the ICD-10 implementation date to Oct. 1, 2014, BCBSM will continue its current plans and looks forward to working within the industry toward ICD-10 compliance," Winkler said.

A Rugged Journey

As mentioned, a plethora of debate, discourse and decisions led the industry to ICD-10 over the course of not years, but decades.

In 1990, the Centers for Medicare & Medicaid Services (CMS) initiated the development of ICD-10-PCS. But the lack of expandability, combined with a mere 4,000 codes, proved to be insufficient for the increasing number of new medical procedures.

The National Center for Health Statistics (NCHS) determined in 1994 that a tenth revision would be a necessary improvement to the International Classification of Diseases’ Clinical Modification. The NCHS therefore awarded a contract to the Center for Health Policy Studies (CHPS) to analyze ICD-10 for morbidity purposes.




During March of 1995, in an effort to rectify the limitations of ICD-9-PCS, CMS also granted 3M Health Information Systems a contract to generate a tenth revision of ICD-PCS. Various modalities of testing were conducted between 1996 and 1998.

Meanwhile, improvements on the clinical modification of ICD-10 continued. A technical advisory panel consisting of private and public stakeholders developed a prototype of ICD-10-CM. Because of the panel’s strong recommendation to implement the revised version of ICD-10-CM, more enhancements and reviews took place through 1996.

By December 1997, a draft of the tabular list of ICD-10-CM was made available to the public for comments, as well as a preliminary crosswalk between ICD-9-CM and ICD-10-CM. Through February 1998, a total of 1,200 comments were issued, expressing with varying opinions.

During the spring of that same year, the final version of ICD-10-PCS, training materials, and a crosswalk from ICD-9 were posted on the CMS website. ICD-10-PCS then would be updated annually on Oct. 1 to adjust to changes made.

A year later, in 1999, ICD-10 was implemented for mortality reporting. But for all other purposes, years of delay followed.

Calling for a Halt

Some say the country still isn’t ready for ICD-10.

“As healthcare providers struggle to navigate the murky waters of healthcare reform, until more meaningful changes are made to lower costs and reduce administrative costs, HHS should halt ICD-10 implementation," U.S. Sen. Tom Coburn, MD (R-Oklahoma) told ICD10monitor in a written statement following Friday’s announcement. “The adoption of the codes will, by default, force physicians to devote more time and energy toward coding, which may detract from patient care.”

It’s not a stance shared by everyone in the industry, however.

“We realize that a few are still apprehensive about the implementation process, and that is why AHIMA remains committed to assisting the healthcare community with its transition to a new code set, (which) will lead to improved patient care and reduced costs,” AHIMA CEO Lynne Thomas Gordon (MBA, RHIA, CAE, FACHE) said in another statement. “ICD-9 is an antiquated code set that no longer adequately meets the challenge of a 21st-century healthcare system.”

“The main difference between the current ICD-9 codes and the new set is there are many more codes, and they are filled with redundancies and unnecessary intricacies,” Coburn countered.

“ICD-10-CM/PCS classifications are the foundation for critical national healthcare initiatives such as meaningful use, value-based purchasing, payment reform, quality and quality reporting, and patient and population safety,” Gordon added. “ICD-10-CM/PCS will yield information that will optimize health data, allow for a more uniform health information exchange and create a move to a reimbursement system based on quality and outcomes.”

Unintended Consequences

Such debates are sure to continue during the next two years. But like it or not, it now appears certain that ICD-10 is coming.

“Hospitals and health systems must engage their medical staffs as well if the transition to ICD-10 is to be accomplished with a minimum of revenue cycle disruption,” wrote Weygandt. “Clinical documentation must provide the necessary specificity to allow appropriate coding of all diagnoses and inpatient procedures.”

“These challenges haven’t disappeared; they haven’t diminished,” Weygandt concluded. “And the delay overall has done little to facilitate preparation.”

The journey continues.


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.
Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.