Regulatory Developments

Industry Prepares for ICD-10 Changeover — Again

The WC industry is not required to convert to ICD-10 codes, but so much of the health care industry and payer community is impacted that comp must be prepared to follow suit.
By: | August 10, 2015

Oct. 1 is the scheduled implementation date for the latest version of the International Classification of Diseases codes. While the workers’ comp industry is not a covered entity under the Health Insurance Portability and Accountability Act and therefore not required to convert from ICD-9 to ICD-10 codes, many practitioners have heeded the advice of experts and have begun preparing.


But questions abound about the transition, and physicians have criticized the costs involved. The American Medical Association continues to raise concerns about the impending transition from ICD-9 to ICD-10 codes.

When the latest compliance date of October 2015 was announced, AMA responded: “While the AMA appreciates that physicians have additional time to comply with ICD-10, we continue to have fundamental concerns about ICD-10 and its implementation, which will not be resolved by the extra time,” said AMA president-elect Steven J. Stack.

“The AMA has long considered ICD-10 to be a massive unfunded mandate that comes at a time when physicians are trying to meet several other federal technology requirements and risk penalties if they fail to do so.”

Payers and others are also questioning the impact on the system once the conversion takes effect.

“ICD-10 [codes] are very detailed. There is one for someone who jumps off water skis after they caught on fire! Who would ever need that code?” — Phil LeFevre, director of business development, Work Loss Data Institute

However, several experts say that while there will be some costs and training involved, things are not as dire as many think.

“The truth is, organizations don’t have to be that scared,” said Phil LeFevre, director of business development for the Work Loss Data Institute, which publishes the Official Disability Guidelines. “I’m the first one to tell you the ICD-10 codes are more detailed than needed. There are 65,000 codes vs. 15,000 [in ICD-9]. Much of the detail is unnecessary from a disability duration and medical management standpoint.”

ICD Background

ICD has been revised for all entities covered by HIPAA. The 10th revision of the diagnostic and procedure coding system was endorsed by the World Health Organization in 1990 to replace the decades old ICD-9 codes.

The codes are used to study health conditions and will also serve as the foundation for documenting diagnoses and associated services provided by health care settings in the U.S.

In October, medical providers will be required to make the conversion to ICD-10 codes despite concerns of the American Medical Association. In one report, the association estimated the cost for small provider practices to convert would be between $56,639 and $226,105 because of the costs of software and training.


Opponents have successfully delayed implementation of ICD-10 a number of times in the last decade. But workers’ comp stakeholders are fairly confident this year’s planned conversion will occur.

“My crystal ball says there will be continued attempts to delay, but the closer we get, the less successful they will be,” said Jennifer Wolf Horejsh, executive director of the International Association of Industrial Accident Boards and Commissions. “The sense I get is that there is a lot of active preparation [among workers’ comp stakeholders]; so people are really cognizant that it is coming up and making sure they can manage that transition as smoothly as possible.”

The Transition

The multitude of delays in implementing the ICD-10 codes has provided organizations with more time to get ready for the conversion. However, many expect snags.

Ohio, which has a monopolistic workers’ comp system, is requiring providers involved in the workers’ comp system to switch to ICD-10. The effort has been ongoing since last year.

“It will definitely slow down the process of bills being submitted and getting paid,” said Noel C. Shepard, an attorney with Frost Brown Todd LLC in Ohio. “Self-insurers are exempt, but realistically, third-party administrators will probably switch eventually. They will probably all switch over. It will delay the billing process, but not of actual allowances.”

TPA Sedgwick, in fact, recently announced it was finalizing changes to its systems “to ensure our readiness for the conversion.” The company is also providing training to its clients on the proper use of the ICD-10 codes with the ODG.

The Work Loss Data Institute began preparing its clients for the conversion about 10 years ago, according to LeFevre. “ICD-10 [codes] are very detailed,” he said. “There is one for someone who jumps off water skis after they caught on fire! Who would ever need that code?”

Since 2011, the ODG have been set up to allow users to toggle between ICD-9 and ICD-10 to understand what is needed.

“For example, [one of the ICD-10 codes] is a lumbar sprain. There are a bunch of codes below that one that are valid, but they don’t change the disability duration or medical management scenario,” LeFevre said. “What we’ve tried to do is highlight in bold the level of detail they need to focus on.”

All of ODG’s tools are set up to be run in both ICD-9 and ICD-10. CPT codes can also be searched through both.

“It’s a lot, especially for the provider, to get the billing right, for claims and medical staff in workers’ comp,” LeFevre said. “We try to accommodate [users] so no matter what you get from your physician, you can find it — either way.”


“I think there is a broad awareness of ICD-10, and people recognize that, yes, even though workers’ comp is exempt from HIPAA so they are exempt, so much of the health care industry and payer community is so impacted by ICD-10 that it certainly impacts workers’ comp, even if indirectly,” Wolf Horejsh said. “I know our state members have the infrastructure that is tied to national health care standards. So things even like fee schedules will be impacted.”


For workers’ comp practitioners, the best advice is to become comfortable with the new codes. The Work Loss Data Institute is providing online training for its clients.

“It doesn’t have to be as daunting as it sounds,” LeFevre said. “You don’t have to unload 65,000 codes on the adjuster. Just go back to the lumbar sprain. There are 15 codes and only one that [relates to] return to work.”

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Matrix: Presented by Liberty Mutual Insurance

10 Disruptive Trends That Are Impacting The Insurance Industry

As we move into a new decade, several risk trends are starting to emerge that could potentially disrupt the insurance industry.
By: | February 3, 2020

The R&I Editorial Team can be reached at [email protected]