How much will ICD-10 implementation really cost?

By Carl Natale
10:48 AM

I just read an interesting item out of the HFMA conference in Las Vegas this week. A couple panelists shared their ICD-10 implementation costs.

The North Shore Long Island Jewish Health System, New York, a 14-hospital system, expects to pay about $50 million for IT, training and other upgrades.

Sutter Health, California, a 24 hospital system, estimates it will cost more than $100 million. That includes $60 for IT and $25 million for a computer assisted coding (CAC) program.

Does that mean only about $15 million for training? I'm hearing that training is going to be a much bigger part of the budget. And training includes more than sending medical coders to ICD-10 boot camp.

Nonetheless, a commenter who identifies himself as "Steve S." points out this classification confusion:

"It doesn't seem reasonable to allocate any of the costs for CAC to 'ICD-10' as that CAC functionality is not dictated by ICD-10 but rather an investment that will pay off regardless of ICD-10 or not. Also, how much of the $60 million in "technology upgrades" is really dictated by ICD-10? Or is it just a good time to upgrade out of date technology?

"It's sorta like me going for an oil change and telling my wife it's gonna cost $3000 because I wanna get some cool new wheels for the truck."

To stick with Steve's analogy, I think it's like telling the wife we need to pay about $30,000 for a new pickup truck because we need it to bring home the new couch she wants.

You get the picture. I'm not sure the people at Sutter Health do though.

One last thing. Any guesses as to who is "Steve S."?

Speaking of insightful comments

This week I expressed some confusion when I read that Kaiser Permanente CEO George Halvorson was at the same HFMA conference and expressed frustration with ICD-10 coding. But "sjsteindel" explained it in the comments:

"It is easy to understand why KP does not like ICD-10. All their internal systems use their internal version of SNOMED and it maps to ICD-9-CM. All the great work they do is based on the internal SNOMED codes and the increased clinical precision of ICD-10-CM offers them nothing, except a lot of work in doing new maps for payment."

So for Kaiser, ICD-10 doesn't do them any good because they're already working with a high level of specificity.

And "sjsteindel" had this take on ICD-11:

"I really don't see why ICD-11 is rearing an ugly head at this time, out side of introducing a stall. Anyone interested should sign up and look at the present Alpha code. It is essentially just ICD-10, not 10-CM, with some expanded explanatory text. There are no links to SNOMED nor does it appear to be anyplace to put them. Also, look at the WHO site regarding ICD-11. All mention of SNOMED was dropped. Hence, we have no real idea what 11 will be or when. Also, it appears the WHO is working on just the mortality side of 11, which is their domain and interest, and not the morbidity side which is purpose of 10-CM. Hence, at this time, ICD-11 when if appears may not work as a replacement for 9-CM."

A "stall?" You mean someone might argue for ICD-11 instead of ICD-10 as a tactic to delay implementation? Can't imagine it.

 Tweet of the Week

"Did you know ICD-10-CM requires highly detailed documentation. Build an action plan for your practice:  #ICD10" (@AmerMedicalAssn)

That link will take you to an  opportunity to buy a $160 book on ICD-10-CM. And there are more books you can buy from the AMA on the subject. I guess vigorous opposition doesn't mean they can't make money off of ICD-10 implementation. (Thank you @ShimCode for pointing that out.)

4 Lessons Learned from HIPAA 5010 That’ll Benefit Your ICD-10 Project

Sunday is the first day that the Centers for Medicare and Medicaid Services will start enforcing  HIPAA 5010 compliance. Remember that was supposed to be enforced six months ago. Sisko explains how four aspects of the messy transition portend complications for ICD-10 implementation. (ICD-10 Impact to Health Care Payers & Providers)

ICD-10 Training: Staff will need to translate edits

Expect the HIPAA 5010 reimbursement delays to be a predictor of what's going to happen after the ICD-10 compliance deadline. (ICD10 Watch)

ICD-10 codes already change how we die

A roundup of studies that use ICD-10 mortality codes to drive public policy. (ICD10 Watch)

Petition To Use The ICD and not The DSM.

When ICD-10 implementation finally drives Halvorson crazy (his prediction), his therapist may assign an ICD-10 code to his condition. That's because the The National Alliance of Professional Psychology Providers (NAPPP) has launched a petition for psychologists to endorse using ICD-10-CM for Diagnosis of Mental Disorders (DSM). They want to be able to collaborate with the physical side of medicine better. (NAPPP)

Five steps to avoid ICD-10 stress

Ken Bradley has five strategies to help make the ICD-10 transition a bit easier:

  1. Examine existing documentation and coding.
  2. Understand the unique scope of a practice’s ICD-10 efforts.
  3. Get a sense of coding staff’s attitudes toward ICD-10.
  4. Understand vendor partners’ plans.
  5. Garner buy-in from the entire practice.

(Health Management Technology)


Carl Natale blogs regularly at

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