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Issue #5 - November 10, 2010
AAPC ICD-10 Newsletter


Featured Article
In the News
Coding Snapshot
I-10 Tips
ICD-10 Resource
Upcoming Events


AAPC and Ingenix have partnered to bring you the most up-to-date and essential news and information about the transition to ICD-10. If you would prefer not to receive these monthly updates, you can change your email preferences in your account.


Making the ICD-10 Transition Manageable

There are two things that immediately come to mind when talking about ICD-10 implementation. First is the thinking that 2013 is still a long time away, so many practices put it on the back burner to deal with it later. Second is the realization that it is going to take a tremendous amount of time and effort, which is another reason practices put off the preparation for ICD-10.

ICD-10 cost is controllable if you take a strategic approach. First look at your vendor contracts. Do you have anything written in the language that states government mandates are covered? If so, the cost of implementation may have just gone down for you. If not, consult early with your vendors to see what updates are needed and any costs associated with them. Also be sure to check to see if you have enough capacity to handle running dual systems during the transition. By working with vendors early you can strategically budget for upcoming costs.

Next to hardware/IT costs the next biggest expense will be education. Each staff member will require some level of ICD-10 training to perform their job functions. If you take the training in steps, you will experience a higher level of understanding as well as a reduced loss of productivity. Start now to examine your documentation to see how it will affect your transition to the higher level of specificity found in ICD-10-CM. Work with clinicians on documentation and show them the differences so that they can alter documentation to meet the needs for the future. This also helps them to become more familiar with the changes and more easily learn the code set when the timing is right.

Keep in mind that it is too early to learn the code set in detail now. There were thousands of changes between 2009 and 2010 and we anticipate many more for 2011. Waiting for a stable learning environment enables you to learn the system just once and allows you to hone in on final guidelines once they become set in stone. It is suggested that you do not learn the entire code set until late 2012 or early 2013. It is much more effective for you to start on implementation efforts today and set the stage early for the overall impact of ICD-10 on your practice.


America's Health Insurance Plans (AHIP) posted an article titled "ICD-10 Spurs Overdue Healthcare Technology Change." The article includes a number of technology issues that will be compounded with the implementation of ICD-10, especially if payors are not ready. The article also includes a number of long-term benefits that are included with implementing new technologies. Here are highlights from the article:

  • ICD-10 will touch every aspect of a payor's business, including IT systems, claims processing, workflows, staff training, customer service, physician contracting and reimbursement, and more.
  • Payors must decide whether to remediate their outdated legacy systems to handle ICD-10 coding or replace their systems entirely with next-generation technology that can handle not only ICD-10 codes, but fundamental business changes that are transforming the healthcare industry.
  • Organizations that adopt a core technology platform that's flexible, agile and easily configurable will not only transition smoothly to ICD-10, they will also enjoy a distinct competitive advantage.
  • In the U.S. healthcare industry, merely "keeping up" won't cut it. Constant change and evolution are here to stay, as evidenced by dynamic plan designs and a growing commitment to make positive, quantifiable improvements in the health and well being of Americans.

To view the full article go to AHIP's website.


NAME: Oakes, Kristine DATE: 6/01/09

Surgeon: Christopher Walls, D.O.

Preoperative Diagnosis: breast mass

Postoperative Diagnosis: breast mass

Procedure: Excisional biopsy of left breast mass

Procedure: The patient was identified as Kristine Oakes and taken to the operating room. She was placed in the supine position on the operating table. Once adequate sedation was given, the breast was prepped and draped in the standard surgical fashion.

Using a #15 blade, a lateral circum-areolar incision was made. A superficial flap was created over the mass. The mass was elevated using a Babcock and using electrocautery and using sharp dissection, the mass was removed from the surrounding tissues. This mass did extend down to the pectoralis fascia.

Once the specimen was removed, silk suture was cut short at the superior pole and a silk suture was cut long at the lateral pole. The specimen was sent to pathology. Hemostasis was achieved using electrocautery. The wound was irrigated with warm sterile water. The subcutaneous tissues were reapproximated using 3-0 Vicryl suture and the skin was reapproximated using 4-0 Monocryl suture and covered with Dermabond. A fluff and sterile dressing were then placed over the incision site. By the end of the procedure, sponge, needle, and instrument counts were correct. The patient was then transferred to the recovery room in stable condition.

Pathology Report: The specimen is identified as a left breast mass. It consists of a fragment of breast tissue with attached surgical sutures.

Diagnosis: Invasive ductular carcinoma of breast, completely excised.

ICD-9-CM Codes: 174.9
ICD-10-CM Answers: C50.412

Rationale: Neoplasm; breast; female; upper outer quadrant left breast. It is important to note that location is very specific in ICD-10-CM with laterality also an issue, good documentation for specificity is required for proper code assignment. At this time there are 19 location choices for a neoplasm of the female breast making documentation very important.


We will be sharing a number of steps to help any practice successfully implement ICD-10-CM. They are also found in your ICD-10 Benchmark Tracker on AAPC's website.

Step #5: Budget Development
Create a budget for implementation and reassess the budget at least every six months. Include all costs associated with ICD-10-CM implementation, such as staff training (including overtime and temporary help), software and hardware costs, workflow process changes, and testing. When reviewing the software and hardware costs, keep in mind software licenses and upgrade fees. Keep in constant communication with your vendors so that you can plan your budget accordingly.


AAPC has offered a reference sheet to compare the ICD-9 and ICD-10 code sets.  Click for a free PDF.

Upcoming Events

Upcoming ICD-10 Boot Camps
2011 ICD-10 Boot Camp Schedule Now Available

The schedule for the 2011 ICD-10 implementation training boot camps has been announced: See the full list.

The AAPC/Ingenix ICD-10 Newsletter is offered as a benefit to AAPC and Ingenix customers and we hope you find the information useful. If you'd rather not receive future ICD-10 Newsletters, please log in to our account and change your email preferences.

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CPT® codes Copyright 2009 American Medical Association. All Rights Reserved. CPT® is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.