Are ICD-10 conversion cost estimates overblown?

A new study is challenging the conventional belief that the costs of converting to the International Classification of Diseases-10^th revision (ICD-10) code set will be prohibitive for small medical practices.

The study, published in the November issue of the Journal of the American Health Information Management Association (AHIMA) puts ICD-10 conversion costs for a three-physician practice in the range of $1,960 to $5,900. That contrasts with a widely quoted study prepared for the American Medical Association (AMA)-written in 2008 and updated earlier this year-concluding that small-practice conversion costs will range from $22,500 to $105,500.

Stanley Nachimson, principal of Nachimson Advisors, LLC, and author of the AMA study, stands by his estimates, saying “I didn’t see anything in the AHIMA article that would cause me to question the costs predicted in my study.”

Read: ICD-10: Can physicians stave off or delay implementation?

The authors of the AHIMA study say their estimates are lower than those in the AMA study “as a result of readily available free and low-cost solutions offered by coding, education and software vendors.” Their findings are based on survey results, published results, and hospitals’ and physicians’ conversion experiences, they write.

In the area of ICD-10 training, they cite the availability of online documentation and coding training for three hours of clinician training at a cost of $50 to $300, and for staff from $350 to $700. They note that the ICD-10 Diagnoses Code Book can be downloaded for free or purchased from publishers for no more than $300.

In terms of upgrading software, the authors say many small practices are relying on their electronic health record (EHR) vendors, billing services, and clearinghouses to absorb the costs. “Physician office costs are not expected to change for basic software services and as a result software conversion costs are estimated to be zero for small practices,” they say. They also discount claims that small practices will have to undergo extensive end-to-end testing, because that responsibility lies with billing, EHR, and clearinghouse vendors, they say.

Nachimson notes that the AMA has long opposed ICD-10 conversion, while AHIMA has supported it. He says he “strongly disagrees” with many of the assumptions underlying the ICD-10 study. In the area of training, for example, just having printed materials is not enough. “I can give you a French dictionary, but that doesn’t make you fluent in French,” he says. “You need to learn the rules around using the words. It’s the same with having a code book. You need to learn the rules around using the codes.

“As a physician practice, you can chose to go through your ICD-10 implementation process any way you want,” he adds. “MY study measured the cost of an implementation meant to minimize the risks of moving from ICD-9 to ICD-10 and make sure physicians were prepared to use ICD-10 codes and get paid. If physicians choose not to take those steps their costs will be less, but the risks increase, I would say considerably.”