Good Grief! ICD-10-CM Is My New Adventure

Accepting the upcoming code set has been an emotional experience for this seasoned diagnosis coder.

By Brenda Edwards, CPC, CPMA, CPC-I, CEMC
I’ve been assigning ICD-9-CM codes for quite some time … okay, a really long time—over 25 years. I’m quite comfortable with the codes. In fact, I’m better at using the tabular index than the alphabetic index (I’m proud of that achievement!). I have been an approved instructor for the Professional Medical Coding Curriculum (PMCC) for 10 years and I have taught many people how to use ICD-9-CM. I even entertain my son and husband by reading license plates and telling them the diagnosis code description. My favorite license plate is on my friend’s car, 311 AWD (depression, all wheel drive).

New Code Set Inflicts Grieving Process

As ICD-10-CM started to become a reality, however, I went through the stages of grief.
Stage 1: Denial
“This can’t be happening, not to me. There is no way I have to learn a new code set.”
Stage 2: Anger
“Why me? It’s not fair! I already have to do so much to get the claim paid.”
Stage 3: Bargaining
“Let me retire before it gets here. Please delay this, so it won’t happen before I retire and I can ignore it.”
Stage 4: Depression
“Why bother, I’ll never learn this stuff? This is too overwhelming. How do they expect us to learn all of this?”
Stage 5: Acceptance
“I can’t fight it. I must prepare for it. I may need to take it a little at a time, but I can do this.”
I’m sure you have had similar thoughts. To ease your pain and suffering, you may find it helpful to hear about ICD-10’s impact on me. Perhaps my breakthrough can help you overcome your own grief.

Denial and Anger

I remember my first introduction to ICD-10-CM a few years back. I had my first draft copy and began paging through the book. When I tried to look up my first code, which was in the musculoskeletal system, I shut the book, got up, and told my friend, “There is no way I’m doing this.” These were the first stages of denial and anger.


I didn’t touch “the book” for quite some time, about a couple of years. Like many, I thought the implementation would be bumped back like the Health Insurance Portability and Accountability Act (HIPAA) and the Red Flags Rule. That was my bargaining stage.
Then, the Centers for Medicare & Medicaid Services (CMS) clearly informed us that “the compliance dates are firm and not subject to change.”


I finally decided to go back to “the book.” What I mean by this is that I gave it a half-hearted attempt. This was my depression stage. I tried to find shortcuts to learn this massive book. (Now, don’t laugh at me because you would never look for shortcuts!) What I found instead is that if I use the resources available at World Health Organization (WHO), CMS, AAPC, the American Medical Association (AMA), and other reputable sources, I can use this code set with great accuracy.


My acceptance has made the transformation to ICD-10-CM manageable. How do you eat an elephant? One bite at a time. The same is true with learning the code set. It is possible, just as it was possible to learn ICD-9-CM. Use one of those quiet Friday evenings to read the ICD-10-CM Official Guidelines for Coding and Reporting. Once you’ve read them, read them again and again. Then read and highlight key points for quick reference. Look up the most common diagnosis codes you currently use in the alphabetic index, and then look for the code in the tabular index to see what additional specificity is required.
I may not be able to play a good game of “license plate coding” for awhile, but I am looking forward to a new adventure. I know I’ll be able to solve the mysteries that lie ahead with greater detail than ever before!

Brenda Edwards, CPC, CPMA, CPC-I, CEMC, serves on the AAPCCA board of directors and is coding and compliance specialist at Kansas Medical Mutual Insurance Company. After starting at an entry level position nearly 25 years ago, she progressed through chart auditing, compliance education, ICD-9-CM and CPT® coding, accounts receivable, billing and insurance, coding education, and medical records. Brenda has spoken to coding chapters throughout Kansas and presented at AAPC regional conferences in Springfield, Massachusetts, Kansas City and Des Moines, Iowa. She is co-founder and past-president of the Northeast Kansas local chapter.

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