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In this publication and many others;

in private meetings and HIMSS seminars and institutes;

in business and government;

we all have discussed in detail ICD-10 and all it means. This certainly is appropriate, as implementing ICD-10 may be the most complex, convoluted, and confusing single system change any of you will ever make.

“Pre-humans,” as the anthropologists refer to Homo habilis, Homo ergaster, and others, lived in caves or trees and didn’t talk, but they did communicate. And even today—after a few million years—there still are an extraordinary number of people who talk incessantly but rarely spend any real time thinking. You know who they are.

In your business—the business of healthcare—we often see people who practice “consideration” as if it were their only role. These are the individuals who think, ponder, and analyze, but rarely analyze anything in depth. Often, these individuals are characterized by their belief that “Management by Walking Around” (MWA) is a genuine approach to the management process, which tells us only that mythology is not dead.

ICD-10—as the members of HIMSS are intimately aware—has involved an extraordinary amount of talk, much “consideration,” and almost endless analysis, and it has continued to evolve much as those pre-humans did. The result is that ICD-10 is not a fixed target, and it is unlikely it ever will be. The CM and PCS additions to the ICD-10 system put forth by the World Health Organization will continue to change—often—as CMS applies ICD-10 to both its intended purposes: tracking patient statistics and reducing the cost of healthcare (as CMS defines it, of course.) Those activities will continue far beyond October 1, 2014, so our migration to ICD-10 is merely Part One of a never-ending story.

The one “Grand Impediment” you all share is the elephant in the room we call “government.”  Most civil servants are extraordinarily analytical; it is typically their key role, and I have nothing but respect for their skills and intellect. But, too often, those individuals who write the rules tend to define the term “analysis paralysis,” as evidenced by the typical CMS Final Rule for IPPS (short-stay inpatient) published in August each year. Their bosses aggravate the problem by their tendency to make decisions only when they believe CMS and HHS will garner the greatest benefit. The traveling circus you saw with CMS before, during, and after the 5010 implementation, and continuing with ICD-10, has done nothing but make your jobs more difficult.

As health information professionals, you know the Medicaid programs often are even less rational than CMS. Sometimes it seems their prime motivation is to delay and confuse. Consider this:

  1. Have you seen ANYTHING related to ICD-10 from your Medicaid system, beyond promises and assurances they will be ready?
  2. Does anyone in your organization truly believe ICD-10 will be implemented without significant modification and improvement from CMS?
  3. And finally, are you, individually—or HIMSS, with its aggregated professionalism and expertise—confident state and federal government agencies will meet all your requirements BEFORE you need them?

Ultimately, your success in monitoring and managing ICD-10 implementation in your organization depends on “yes” responses to all three of these questions, and you cannot wait until September 2014 to raise them. Regrettably, history teaches us that public governing bodies tend not to meet our hopes, requirements, or expectations, and as health information professionals, you must raise the red flag now.  Waiting for our public servants to do their jobs is not an option.

Only when the various government entities controlling Medicare and Medicaid decide to meet their commitments and fill all the holes in the ICD-10 enterprise will we have ICD-10 as the standard of the land.

About the Author

Billy K. Richburg, M.S., FHFMA is HFMA-Certified in Accounting and Finance, Patient Accounting and Managed Care. Bill graduated from the U. of Alaska, Anchorage and earned his M.S. in Health Care Administration from Trinity University, San Antonio, TX. Over a career spanning more than 40 years, Bill has held positions including CEO, COO, CFO, and CIO in hospitals ranging from 75 beds to over 300 beds, and in home health agencies, DME stores, and a home infusion company. Bill is a Board Member of the Lone Star Chapter, HFMA, and is Director of Government Programs for the Revenue Cycle Technologies business segment of MedAssets, Inc. His office is in Plano, Texas.

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EDITOR’S NOTE: The contents of this article do not necessarily reflect the opinions of ICD10monitor.


Billy Richburg, M.S., FHFMA

Billy Richburg has had a long career in healthcare holding high positions such as the Sr. Director for FinThrive, MedAssets, and IMaCS. Billy is now enjoying the finer things in life in his sweet retirement!

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