In October 2008, Nachimsons Advisors produced a landmark paper on the cost of ICD‐10 implementation for physician practices and clinical laboratories. This study estimated costs to implement ICD‐10 in six areas for three hypothetical practice sizes. The findings showed that the ICD‐10 costs ranged from an estimated $83,290 for a small practice up to $2,728,780 for a large practice. Since 2008, the regulatory environment for physicians has changed dramatically. As well, there is now have some real world experience documenting implementation costs. Based on this new information, the results of the Nachimson Advisors 2014 study demonstrate that costs to implement ICD‐10 may be much higher than what was estimated in 2008, especially for physicians who must pay for upgrades to their electronic health records (EHR) and practice management systems (PMS). The 2014 findings indicate that ICD-10 costs may run between $56,639 and $226,105 for smaller practices up to between $2,017,151 and $8,018,364 for larger practices.