Wednesday, April 15, 2015

Converting from ICD-9 to ICD-10 Coding Systems Isn’t So Hard If You’re 23 , and You’re Determined To Save Your Father’s Solo Practice

Yesterday Parth Desai, a 1st year medical student at Mercer University School of Medicine in Macon, Georgia, gave me a call. He had been reading my book Innovation-Driven Health Care (Jones and Bartlett, 2007) and my blog, Medinnovation and Health Reform. He had an idea he wanted to speak to me about.

It was a blockbuster of an idea. Over the last 2 years, he and his best friend, Will Pattiz, had developed a website,, that had just gone digital. The site allowed medical practices to convert from the current ICD-9 coding system to the ICD-10 coding system, all completely free. This idea is powerful because America’s physicians have been looking forward with dread to the mandatory use of the ICD-10 system.

The new system, which will be mandated and will go into use on October 1, 2015, contains 68,000 compared to 14,000 in the ICD-9 system. To set up an ICD-10 system will take anywhere from $5,000 to $10,000 to install for a solo practice, up to $30,000 for a ten person group, and over $100,000 large hospitals. For most practices, it will require hiring a coding person, and it will slow the pace of a practice, often dramatically at first. You will have to master its complexities if you want to get paid by CMS and insurers. For many anticipating physicians, its use poses a logistical nightmare.

According to Wikipedia: "The International version of ICD-10 should not be confused with national Clinical Modifications (CM) of ICD that frequently include much more detail, and sometimes have separate sections for procedures. The US ICD-10 Clinical Modification (ICD-10-CM), for instance, has some 68,000 codes. The US also has the ICD-10 Procedure Coding System (ICD-10 PCS), a coding system that contains 76,000 codes not used by other countries."

Work on ICD-10 began in 1983 and was completed in 1992 has been modified for clinical use in other countries.

ICD-10 use in the U.S. has been delayed three times in the last seven years, the last time in because of its relationship with the Sustainable Growth Rate(SGR) fix. This delay has occurred because of the unique complicated features of U.S. health care and the objections of many special interests. Many of its features do not lend themselves to doctor and hospital ease of use.

But mandated use of the clinical U.S. version of ICD-10 is coming, on October 1 2015, CMS will mandate its use on that date, whether practices are ready or not, and whether it drives physicians or small independent practices into retirement or into the arms of larger practices or hospital employment or not.

For Parth Desai, the son of Nitrin Desai, Md, a 59 year old Internist of India descent who practices in Columbus, Georgia, , solving the ICD-10 dilemma was a challenge, a labor of love, and a means of saving the family business. His 26 year brother is also medical student, and his mother, a respiratory therapist in India, was the practice manager of her husband’s practice. His friend Will Pazzi,the grandson of a family physician in Southern California, had spent his life mastering computer programming. A fellow humanitarian and innovator, Will was spending his life creating artistic films to raise conservation and awareness for America’s National Parks through his non-profit project, "More Than Just Parks", thus Parth’s idea resonated with his very core.

Here is Parth’s story as told by him:

“My father is a physician, my brother is a physician and one day I will be a physician. Medicine is all we’ve ever known, but medicine as we know it is changing. In the past 5 years, I’ve seen my dad’s practice lose roughly 40% in reimbursements and over double in management costs due to government regulations. All the while, he is spending more time on paperwork and documentation, and less time on actual patient-care than ever before. With ICD-10 coming, there has been so much fear-mongering about projected costs for implementation and potential losses in reimbursements, that physicians are legitimately scared about what this change will do to their practice. The other ICD-10 Software vendors are taking advantage of this fear to squeeze as much money as they can from physicians like my dad. “

“Which is sad because ICD-10 by its very nature is meant to improve our healthcare system, not to burden our good doctors. But the truth I want to share with everyone is that ICD-10 should not be as difficult as they are telling us, and it certainly shouldn’t be as expensive. It should be free. I see a day in medicine when technological innovation’s are made for the betterment of our field, instead of purely for personal gain at the expense of the great physicians of our country, and that’s what ICD-10 Charts is really all about, so that maybe one day when I’m practicing alongside my father and my brother, we can look to the future of medical technology, and see it as a blessing, instead of a curse.”

The two young men. Parth Desai and Will Pattiz, were prepared for the challenge. He and Will had been coding since a young age. When Parth was 21, his mother developed carpal tunnel syndrome, and could no longer manage his father’s practice for a time. Parth stepped into the void at age 21 and served as the practice manager for 2 years. He quickly realized something had to be done, if his father’s practice and others like it were to survive and thrive. He knew the problems of the new coding system were daunting, for example, the number of codes for back pain went from 1 to 80. The problem was increased specificity. You had to search out the proper code to get paid, and that search took time, which translated into less time with the patient and less revenue.

So Parth and Will went to work and came up with a simple way to convert existing ICD-9 codes to ICD-10 codes, at the push of a button.

Doctors who want to use the system can access it for free or learn about it at They can watch a video explaining its use at : If a doctor wishes to donate $10, $20, $50, or $100 for use of the system, he or she can do so through a credit card or Paypal.


Unknown said...

"Yet the ICD-10 system has merit. It is used internationally in most Western countries." This quote is completely bogus and very deceptive.

The ICD-10-CM that the US is proposing to use starting in Oct 2015 contains about 68,000 codes.

The ICD-10 version that "most Western countries" use contains about 14,000 codes. This is more in line with the number of codes in ICD-9-CM currently being used in the US.

I wish people would stop being so deceptive when trying to make this claim.

Richard L. Reece, MD said...

Thank you, Pete for you comment, I should have indicated each country has its own clinical version of ICD-10, and the U.S. clinical version is among the most complicated because of our unique system and the difficulties of applying ICD-10 in a timely fashion in the U.S. I apologize for being "deceptive." I am not a big fan of government regulations requiring extensive data input by clinicians.