February 23, 2012

“Keep on course” with ICD-10, Advises CMS Director


Don’t wait for the Centers for Medicare & Medicaid Services (CMS) to make its decision about the implementation date for ICD-10, advises David Sayen, a CMS regulatory director.  “Even if I-10 is delayed, keep on course,” he said, and make sure things are functioning properly. That’s the advice Sayen offers to providers and payers during this time of uncertainty.


Juliet Santos, senior director at HIMSS, delivered Sayen’s comments during today’s HIMSS Week podcast, produced by ICD10monitor. Santos, one of the five panelists reporting live from the 2012 Annual HIMSS Conference and Exhibit in Las Vegas, said that Sayen also commented on whether the agency would issue a proposed rule and gather public comments—a long process of several months—or simply decide independently about the date. He replied that the agency doesn’t know yet what it will do and that staff are still gathering data on the impact of an I-10 delay.

On the topic of what impact an implementation delay would have on the 5010 implementation, Bonnie Cassidy, vice president of health information management at QuadraMed, indicated that those at HIMSS, including the American Health Information Management Association (AHIMA), will continue to stay the course on both. Although AHIMA hasn’t yet performed an impact analysis related to the delay, she notes that CMS is evaluating the 5010 and I-10 delay as well as meaningful use and other initiatives.

Speaking of meaningful use, Pam Arlotto, president, Maestro Strategies, commented on CMS’s release of the Stage 2 meaningful use proposed rule. She believes that the data and detail from I-10 will affect the meaningful use requirements.

“We believe there’s a synergy between meaningful use and ICD-10. We can’t do one without the other. In Stage 2, CMS will push organizations to go closer to I-10. If implementation is delayed, data will be missing,” said Arlotto.

Arlotto also believes that the data being gathered with initiatives such as I-10 will help the industry “prepare for the quality avalanche as we move to value-based reimbursement and accountable care in the future.”

When speaking of the future of healthcare, John Pitsikoulis, strategic advisory service client executive, CTG, quoted former New York Yankees catcher and manager Yogi Berra: “It’s hard to make predictions, especially about the future.”

Even though the future of ICD-10 implementation date is uncertain, Pitsikoulis agrees with other panelists that most providers and payers plan to move forward.  As he says, “There’s more fear than relief about the possibility of losing momentum, senior leadership support, and loss of resources” than anything else.

There also are questions about the “collateral impact” of a delay. Pitsikoulis asks, “How will even a year delay impact other reforms? How can we maintain and sustain parallel issues?”

Payers also would like to see the momentum to continue, Ross Lippincott, vice president, UnitedHealth Group says. However, if CMS does decide upon a delayed implementation, he sees it as “an opportunity to increase quality and readiness across the board, especially with payer-provider collaboration,” and provides the following example.

One large provider has partnered with a major payer to simultaneously submit claims with I-10 and I-9 codes in order to ascertain the impact the transition will have on their business relationship. In addition to getting insight into revenue impacts, they’re also gathering the unanticipated side effect of increasing the quality of the I-9 codes assigned as they assign the more detailed I-10 codes.

Takeaways for Tomorrow

HIMSS attendees are sending a clear message to each other and the industry in general:

  • Provide input to CMS about the need to keep the current implementation date and the impacts that a delay would have. Although there is no formal way to submit these comments, Santos suggests sending your data to your professional association or public policy group. You also may send your data to HIMSS, which is collecting information this week, per CMS’s request. To do so, email , and be sure to include your facility’s name and contact information.
  • Continue to move forward, especially with clinical documentation improvement, physician education, and technology needs.
  • Recognize that the biggest challenge will be addressing the concerns of senior executives, who have to address many simultaneous strategic initiatives with a set amount of resources.
Read 7 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 RACMonitor.com and ICD10Monitor.com; 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.