"When we go live with ICD-10," Leigh Williams said, "there are no experienced users."

And that is exactly why William's colleague, John Showalter, MD, is predicting a blackout period of approximately 90 days. "I know for a fact that the CIO or someone is going to ask me how ICD-10 is on about October 7 and I won't know," Showalter said here at HIMSS14. "The first 90 days, I know my physicians are going to do this, they'll ask me how they're doing and I won't be able to tell them."

Showalter is the CMIO at the University of Mississippi Medical Center and Williams, the school's director of revenue cycle management, described that blackout period as one marred by "confusion and lack of data," dual coding to finish ICD-9 work, and scrambling to gauge "which fire is blazing hottest," and "which is most important."

Any comfort in the reality that Showalter's predicted blackout period will not last too long into 2015 -- and will give way to stages of stabilization, between three and nine months after the compliance deadline then optimization during month 9-12 -- might be doused by the presaging that life will get even more complicated in October 2015, a year after initial compliance.

"We don't think CMS is really going to come together to really use (ICD-10) with payers until Oct. 2015," Showalter added. "That's when it sets in. When CMS knows how to use this and the payers know how to use this, it's going to get much, much harder."

As in case mixes, DRGs, revenue cycle issues, internal metrics, reports that have to change, trending that has to change and ICD-9 essentially being a big wastebasket for historic data.

"We're entering an era where big changes like this are going to be happening rapidly," Williams added. "There are going to be changes for years to come."

Those being the same manner of changes and updates to the code set that CMS published with ICD-9, which Williams expects will necessitate taking ICD-10 certification for the rest of her life or until ICD-10, whichever happens to come first.

"Beyond Oct 2015, expect some changes," Williams said. "We're going to need to make the new norm continue forever."