You’ve just been through the nightmarish attestation process for Meaningful Use Stage I and Stage II.  Perhaps, you have even received the sought after Federal stimulus dollars.  Even worse, you’ve struggled through the transition to become a meaningful user of a certified Electronic Health Record, but you haven’t quite caught up yet.  You purchased the wrong system at first and are migrating from one system to another.  Sadly, this is an extraordinarily frequent problem.

You deserve a break.  Unfortunately, with upcoming compliance initiatives , shifting government policies, and Meaningful Use Stage III right around the corner, this can not be so. Now comes an equally daunting task, and one which puts your entire practice’s finances at even more risk than did the migration to an EHR.

As you probably have heard, you will not be paid for any medical services that are provided on or after October 1st, 2014, unless you bill for them using the ICD-10 code set.

Many of you may be under the misconception that  your coders /billers will take care of  this.  You’re  not concerned.  Well, you should be worried.   Your medical billing department, whether in your office or outsourced, will most likely be placing the actual ICD-10 codes into the billing system.  If this is an outsourced system, they probably will be able to educate themselves without too much of your assistance.  However, if your billing services are provided by employees within your office, it will be your obligation to get them trained, properly, accurately, and in a cost-efficient fashion.  Moreover, most authoritative sources, such as CMS, indicate that if you wait until 2014 to start this process, failure is imminent. In his blog,, Harvard CIO and ED Physician John Halamka wrote the following:

I’m concerned that payers, providers and government will not be ready to support the workflow changes required for successful ICD10 implementation.

Failure in this instance leads to a high probability of bankruptcy for your practice.  In an  article  titled “ICD-10 Transformation: Five Critical Risk-Mitigation Strategies,” the HIMSS organization had the following to say regarding the impending financial  impact of the new code set:

Experts from the Centers of Medicare & Medicaid Services (CMS) estimate ICD-10 will initially result in a decrease in cash flow and loss of revenue.  It is predicted that denial rates will increase by 100 percent to 200 percent post-implementation…Healthcare organizations will most likely be hindered with declining payments for up to two years after the implementation date.”

And, as far as your own education is concerned, please take note of the following:

If you are not familiar with the changes required, you are not likely to document your medical records in a fashion that will allow any billing service to accurately code your medical services.  Let’s say, for instance, a patient comes in with a sprained ankle from tripping down the  stairs at the opera.  You include this information in your progress note.  For example, a medical record which included the small detail of where the injury was sustained would have allowed for proper billing in ICD-9, using the basic CM Code Sprain of ankle: 845.00 but would likely be denied with ICD-10, where the code is Hurt at the opera: Y92253. Other examples of the level of specificity of the codes in  ICD-10 include the following:

  • Struck by Turtle: W59.29

  • Burn due water skis on fire: V9107XA

  • Stabbed while crocheting: Y93D1

Obviously, these are very extreme examples of what is to come, but  these codes illustrate quite well that ICD-10 will bring clinical documentation requirements and careful code selection to a whole new level.  While correcting for the above few omissions is very easy, you are not likely to do so, unless you understand that you need to do so.  For this reason and the implied revenue  loss, physician education in ICD-10 is so important. Nobody expects you to know the additional tens of thousands of codes.  However, you should understand the imperative nature of being well-versed in the new documentation demands, in order to minimize revenue loss.

Precyse University has been developing an incredibly robust ICD-10 online training program for a long time, and now you can gain access to the entire training program, for your nursing staff, medical billing staff, and yourself, and receive a 10% discount off of the entire order, by using coupon code SAVE10EHR, when visiting Precyse University ICD-10 Online Training Program

Eric Fishman, MD
Orthopedic Surgeon &
Founder & Managing Member, EHR Scope, LLC