First, some history. The ICD-10 [International Classification of Diseases, v.10] is developed by the World Health Organization [and can be downloaded directly from their website at http://www.who.int/classifications/icd/en/ ]. It has nothing to do with the US government or insurance companies. It is the standard international ‘language’ of medicine and allows for standardization of medical research and epidemiology. The rest of the world has essentially already adopted ICD-10.  The first ICD was developed in the late 1800’s. From the WHO website you will find “ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994.”    “The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use.”  

It is my understanding that the USA is the last major country to adopt ICD-10, but I may be premature with that assessment. As example, the metric system is the official measurement system in the US even though no one really uses it. Individual countries modify the ICD for their particular use if desired. The ICD-10CM [CM=clinical modifications for the US] expands the international ICD-10 to over 60,000 choices.

The US government mandated the use of ICD9-CM for Medicare/Medicaid. Why not ICD10-CM?  

  • Comments (6)
  • If the ACA is upheld there will be little basis to operate a cash practice, as everyone will have insurance and that insurance will cost so much that much of what most people regard as disposeable income will be diverted to heath "insurance".  I apologize for my obvious libertarian leanings.  But all of this furthers the goals of increased governmental control over a large portion of the economy and the total voting population.  There will be little if any free market health care until we impliment a socialized health care system then offer the services not covered or restricted by the US NHS.  Please let me know if you find any sources from physicians praising this conversion.  I can only find sources showing coders apreciate the system.  I see no need to give insurance comapnies and the government any more inforation about how we treat patients than what ICD 9 achieves.  If we keep shooting for a perfect system, we will likely end up much worse off and bankrupt.

    For those of you that want more information than what podiatry publications present try getting free email updates from Moder Healthcare; Fierce Health Payer and Kevin MD.  Note these are not sources catering to conservative or libertarian leanings.  They are generally informative and present up to the minute updates on EHR, 5010 and ICD  reforms and other varying discussions.  From the world of PM News and Present Pod alone we get a bit myopic on these issues.


  • With regard to EMR, if you DON'T have one by this year, you'll lose about 5K in meaningful use benefits.  Otherwise, it would be wise to choose an EMR that already has capability for ICD-10 and, of course, 5010 transmission.  In general, I'd go with a larger company which is more likely to be around for a while.  A lot of the smaller companies may end up falling by the wayside once the big sales push relative to meaningful use is over.

  • You may be nuts to pick an EMR right now. Round two of MU will wipe a few companies off the map others will start charging rediculous rates. I would stronlgly consider Amazing charts or practice fusion. I would risk little or nothing today. I doubt we will even exist as independant offices in the next 5 years forcing you to change later anyway.

  • I'll be curious to see if ICD-10 actually goes 'online' or implements by the proposed deadline/due date, as it is still in draft phase.  Thanx, ya'all: This is an excellent and informative thread... and one(s) to be followed via all the Pod Talk Forums (ePod, Arena, PM, & PP of course) out there.

    I was just reading PM_news comment, and one fellow DPM was saying that his EMR upgrade costs had just doubled; is everyone/anyone else finding that to be true as well?  {We [my new boss, & hopefully soon-to-be senior partner] is going into EMR after ICD10 goes into effect, and we are considering the expense, up-front & over time.}

    Can anyone recommend the best -or how to go about analyzing which EMR system to get?  And which digital radiology/xray system to get into, as well?



  • Marc,

    Thanks for your links. I will review them tonight.

    I don't know much about the new codes but I understand that longer and more codes equal more time to code claim forms. HOWEVER, in our individual practice there is a definate universe of codes which we use day in and day out. I propose that once this universe of codes is learned we will come back to, or at least close to, the coding efficiency we now enjoy.

    For those who say 'I'm going cash only' I say good for you. We, as a profession, never should have left that practice model [think dentistry]. You will still need to learn the new codes because your patients with insurance will want to submit for reimbursement. And they will expect you to provide the proper coding.

    I've downloaed a copy of the new codes from the CMS site but haven't looked at them yet. Each country modifies it for their own uses so don't get it from WHO. I'm already used to the downloaded version of ICD9, which is free from CMS.

  • If you look at what happened in Canada after ICD10 implementation, we can expect many private practices of many specialties to be out of business some time after the conversion. Why? because ICD10 actually makes seeing a moderate to high volume of patients per day nearly impossible while seeing fewer patients per day may not generate enough revenue to keep your office open.

    This is an international effort pushed by the WHO for the purposes of segregating diagnoses by extent and paying less for less significant diagnoses.

    In every industrialized nations’ transition to ICD 10 there have been no crosswalk. That means there will be no way to directly convert the ICD-9 codes that you are using now, to ICD 10 codes. You will have to add in several factors into the diagnosis that will remove the ability to automate a conversion. Moreover, to substantiate these factors your documentation will be much more laborious to support these claims.

    “five percent of all ICD10 codes map directly to ICD9 codes, and only 26% of ICD9 codes map to ICD10 codes( SEE 4) Thus, from the Canadian model we can expect a permanent decrease in reimbursement and productivity ( SEE 3)

    The big difference between the US and the rest of the industrialized world is that we supposedly do not have socialized medicine and arguably better care available. So the argument that the US is “behind” in implementing this system is highly suspect. Why does the only hold out on socialized medicine want to follow the rest of the world’s lead on how to code and pay for medical services??? It is not going to help you practice better medicine, but it will severely delay your reimbursement and when it is fully implemented it will give insurance companies greater ability to deny your claim or pay you substantially less for your services.

    Pay attention as the AMA lobbies to kill or postpone ICD 10 (After supporting the legislation that demanded ICD10 implementation). Here are a few links upon googling efficiency and ICD10 to help give you a better picture of the storm headed our way.

    1. http://www.icd10watch.com/blog/after-icd-10-will-coders-ever-regain-icd-9-efficiency-levels

    2. http://www.icd10watch.com/blog/will-icd-10-spark-coder-chaos

    3. http://www.beckersasc.com/asc-coding-billing-and-collections/the-cost-of-moving-to-icd-10-20-statistics-for-physician-practices.html

    4. http://www.healthcarefinancenews.com/news/icd10-and-hipaa-5010-game-changers

    Marc Garfield, DPM, FACFAS