Dr. Kent W. Gabriel guest column: Impact of ICD-10 on physcians practives

ICD-10 Code replaced ICD-9 on Oct. 1 after two extensions from 2013 and 2014.

AMA President Steven J. Stack stated, “While the AMA appreciates that physicians have additional time to comply with ICD-10, we continue to have fundamental concerns about ICD-10 and its implementation, which will not be resolved by the extra time. The AMA has long considered ICD-10 to be a massive unfunded mandate that comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so.”

CMS plans to conduct acknowledgement testing (tests only whether the claim makes it to Medicare’s front door) in March and June of 2015. (National testing 89 percent of claims accepted, normal Medicare claims accepted is 95-98 percent).

End to end testing by Medicare, which tests the claims from submission through to the receipt of remittance advice, is planned for April and July 2015.


The differences between ICD-9 and ICD-10 are significant. These codes are used in documenting diagnosis. Currently, ICD-9 codes are 3-5 digits in length and number 14,000 diagnoses.

ICD-10-CM codes are 3-7 characters in length and total 68,000 (allowing for right and left, some 140,000).

Moving to ICD-10 is expected to impact all physicians. Due to the increased number of characters per code and increased code specificity, this transition will require significant planning, training, software system upgrades/replacements, as well as other investments.

ICD9 is over 30 years old and has become “outdated”.

ICD-10 can include much greater detail, is more flexible for expansions to include new technologies and diagnoses.

Much of the new system is based on a World Health Organization code set in use in many countries with government single-payer systems which pay to support this more complex coding system.

The American version developed by the Centers for Disease Control and Prevention, and CMS, is considerably more “fine-grained.”

The WHO, for instance, didn’t see the need for 72 codes about injuries tied to birds. American Doctors will be able to code for patients who have run afoul of a duck, a macaw, parrot, goose, turkey or chicken and can select from 9 codes for each animal. There are 312 animal codes in all, compared to 9 in the international version. There are separate codes for “Bitten by a turtle” and “Struck by a turtle.”

Code V91.07XA: “Burn due to water-skis on fire.”

Code W22.02XA: “Walked into lamppost, initial encounter.”

Code W22.02XD: “Walked into lamppost, subsequent encounters.”

Codes for injuries in: opera houses, art galleries, squash courts, and 9 locations in and around a mobile home.

The ICD-9 code for suturing an artery will become 195 codes in ICD-10.

A single code for a mal-united fracture will now be 2,595 different codes.

The Specialties of Orthopedics, Cardiology, etc., will be especially impacted.

One CMS official compares ICD-10 to a phone book. “All the numbers are in there,” she says. “Are you going to call all of the numbers? No. But the numbers you need are in there.”


There is currently no grace period for ICD-10 introduction, as of Oct. 1 all claims must be submitted in this format.

The Wall Street Journal predicts large cash flow interruptions to medical practices.

Estimates range from 25 percent or more reduction in “billables” for several months to a year.

Recommendations are for physicians to establish a line of credit for up to one year of collections.

The WSJ estimates that 25 percent of small practices may not survive the transition to ICD-10.

Dr. Kent Gabriel is an orthopedic surgeon and is affiliated with Carson Tahoe Regional Healthcare and Sierra Surgical Hospital.


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