To upgrade from the ICD-9 coding set to the ICD-10 set will cost a small practice $83,290, according to a recent report from Nachimson Advisors, a health information consulting firm.

The report defined a small practice as three physicians and two administrative assistants. For an average medium practice (10 physicians and midlevels, a coder and six administrative staff), the ICD-10 upgrade will cost $285,195. For an average large practice (100 physicians and midlevels, 10 full-time coders and 54 medical-records staff), it will cost $2.7 million, estimates Nachimson Advisors.

The Department of Health and Human Services (HHS) plans to adopt the International Classification of Diseases Tenth Revision (ICD-10) by October 2011. The ICD-10 code set will contain more than 155,000 codes vs. the 17,000 codes of the current ICD-9 set, which is expected to start running out of available codes next year.

Every physician will need training on documentation, and the cost will be up to 10 times more than the $600 per physician that HHS has assumed, says a statement from the American Academy of Professional Coders.

The implementation of the ICD-10 system in the United States will be the most significant, costly event that we will experience, says John Rumpakis, O.D., M.B.A., Clinical Coding Editor of Reviews Coding Abstract column.

While the long-term prospects may be attractive, the short-term price will be high both in real dollars spent in software and hardware upgrades, staff training and other resources, as well as intangibles such as increasing accounts receivables while claims get processed, patient and staff frustration with claim denials and rejections, and transitioning practices to the new standard, Dr. Rumpakis says.