Why Do People Find ICD-10 So Amusing?

In case you missed the news, ICD-10 has been delayed a year. It’s likely that we’ll be taking a break from talking about ICD-10 for the next 6-10 months. However, before we put ICD-10 on the shelf, you might want to read two opposing arguments for and against ICD-10: The Forgotten Argument For ICD-10 and Why ICD-10? Plus, below is a guest blog post by Heidi Kollmorgen, Founder of HD Medical Solutions, putting some perspective on where we’re at with coding. She has some good insights I hadn’t heard before. I’ll probably wrap up this series on ICD-10 with a look at what organizations should do now that ICD-10’s been delayed.
Heidi Kollmorgen
Many people who don’t understand the value of ICD-10 go straight to the “humorous codes” as a reason to justify delaying its implementation or even not adopting it at all. Does anyone realize those codes only make up 67 of the 1583 pages of the 2014 Draft Set?

Those seemingly “useless” codes are stated in the ICD-10 Chapter 21 Guidelines as having “no national requirement for mandatory ICD-10-CM external cause code reporting”. External Causes of Morbidity codes “are intended to provide data for injury research and evaluation of injury prevention strategies” only.

The *real* ICD-10 codes are more specific and allow greater accuracy for clinical data purposes. Many would agree that patient safety and effective and timely patient-centered care are the goal of most healthcare providers. Clinical data gathered and analyzed is what allows this to be achieved and ICD-10 codes are critical for more accurate analysis (1).

ICD-9 was adopted and went “live” in 1979 – how many advances has medicine made since that time? The ICD-9 code set does not allow doctors to accurately identify how they are treating patients any longer, nor does it allow accurate reporting of the services they provide to their patients. In 2003 the NCVHS recommended the adoption of ICD-10 and fourteen years later providers still claim they haven’t had time to prepare (2).

Doctors and other healthcare professionals who choose to take advantage of the daily barrage of free ICD-10 training and education from CMS and countless other sources for themselves and their staff will not go out of business. Providers who recognize that hiring an educated and/or certified medical biller/coder is an investment with huge ROI potential.

Those individuals have the training and ability to prevent and decrease denials and rejected claims from the onset when the claims are initially prepared. They also understand the intricacies of carrier guidelines so providers who hire them will never go out of business or suffer from decreased cash flow, rather their reimbursement would improve and they would also be compliant.

The days of hiring your neighbors daughter or friend because they need a job, or because they like working with numbers are over. It shouldn’t be impossible to understand how saving money in overhead and payroll only costs you infinitely more in lost reimbursement. Is the irony lost in correlating the profession of Health Information Management to Nursing? In the history of medicine it was only in the last one hundred or so years that licensing of nurses went into law. http://www.nursingworld.org/history Would any doctor today work with an unlicensed or inexperienced person who claimed to be a nurse? Would any hospital or facility hire someone who applied for a nursing position only because they liked working with people? That’s basically how the profession of nursing began.

In regards to the opinion held by many how ICD-10 codes are outlandish I would agree in some cases. I have a wicked sense of humor and because I know the codes I could create funnier cartoons than any you have come across. The difference is that coders understand how that argument holds no merit and only proves how providers don’t even understand ICD-9-CM. Unfortunately, most are probably using it incorrectly as well and it may be one of the causes of low reimbursement.

Just in case you see a patient today who is a water skier and has an accident while jumping from a burning ship use ICD-9-CM E8304. Have a patient who was knocked down by an animal-drawn vehicle while riding a bike? There’s a code for that too – ICD-9-CM E827.

The good news is how the Guidelines for ICD-9-CM patient encounters are similar to ICD-10-CM for these types of codes. If you don’t typically use them now you won’t when ICD-10 goes into effect either. Providers who document what they did, why they did it and what they plan to do do about it will have no problem switching to ICD-10. Aren’t we lucky nothing has changed about that?

Heidi Kollmorgen is the founder of HD Medical Solutions which offers practice management services for solo and multi-physician groups. She holds AHIMA certifications and is dedicated to optimizing reimbursement by following compliant measures. She can be found at http://hdmedicalcoding.com/ or follow her on Twitter @HDMed4u.

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  • Thank you Dr. Webster, for your comments and asking for my thoughts on the cost, confusion and cash issues in response to http://www.emrandehr.com/2014/03/24/why-icd-10/.
    As far as cost and cash, I would be interested in how the estimates are being calculated for a typical practice regardless of its size. In my opinion, the amounts were grossly inflated by using all numbers at the highest end possible. The AMA offered a recent study http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=e38cf47a-fc5f-473b-9234-c9e714c1c8f0&plckPostId=Blog%3ae38cf47a-fc5f-473b-9234-c9e714c1c8f0Post%3a69395571-cc32-4518-9c4f-09031dc2a367&plckScript=blogScript&plckElementId=blogDest#.UzyTlqLRXAk which explains their findings and also provides a graph showing estimated costs. If you look at it like I did however, implementing ICD-10 in 2008 might have saved a large practice over $5 million dollars.
    Most software vendors offer upgrades as part of the contracted support agreement while others offer upgrades “ala-carte” giving the provider the choice to upgrade or not. The same type of agreement is often signed with vendors who process claims. The cost will depend on the contract the doctor negotiated and agreed to initially.
    I’ve worked with a number of providers over the years and the ones who have chosen to pay for support and upgrades would have no additional costs for software compatibility. On the other hand, the providers who choose not to upgrade may be facing more issues and higher costs – but only because they didn’t follow recommended upgrades throughout their relationship with the software vendor.
    In my experience, many of the smaller practices don’t even pay for minimal support after the initial implementation. The typical reason I receive is how it’s “cheaper” to just pay when you need something done rather than every month. For those practices, the cost depends on how long they have been using their system without anything happening. If it’s been years, it may not even be possible and so I would agree, those practices might incur detrimental costs for software integration. However, I don’t believe it’s fair to blame that on ICD-10, that’s just a disaster waiting to happen all the way around.
    For the practices who don’t use computers, the cost for an ICD-10-CM book ranges, but you can find one here http://www.amazon.com/gp/product/1622540670/ref=as_li_ss_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=1622540670&linkCode=as2&tag=crashutah-20 for around $70 plus shipping and handling.
    As I stated in my post, numerous resources are available for providers and staff which offer free training, practice, explanation and guidance online. Although, without a computer, here again I would agree costs might be considerably higher and this is where consultants and hiring additional temporary staff might really put a practice over the edge.
    It may also be taken by some to be cynical on my part, but I find it interesting how so many opposed to ICD-10 go into great detail to explain the negative impact of ICD-10 with a simple insert at the end offering free resources as well as the recommendation to continue preparing. I tend to twist things around but to me it seems like the reverse of what Phillip Morris does with tobacco products, meaning advertise and market what you really want with a warning included.
    In regards to confusion, I have great faith in the brilliant doctors the U.S. healthcare system allows us to have access too – whether we are insured or not. I also have complete and utter faith they are able to overcome the initial discomfort of ICD-10 because so many already know and are required to provide specificity when they document for their admitted patients in the hospital setting. It will take time and effort and it might be hard in the beginning, but not any harder than the patients who they tell time and time again to exercise and lose weight so they will be healthier. In both situations, everyone knows what the right choices are and yet it’s easier to just do what you’ve always done. Once you get started though, and really start to realize the benefits, most typically embrace it and finally understand it was the right thing to do all along.

  • Has anybody actually done an analysis of what it will take to get the information ICD-10 requires? Who is asking/how are we getting:
    — Patients will not call up and say “I’d like to schedule a sequelae visit with Dr. Smith.” And if they did, would we take their word for it? They might be wrong — it might be the left ear, not the right, so it’s an initial visit.

    Do you think the provider is going to remember? Nope.
    Is reception going to need to let the MA know? Should they really be doing that?
    Will it fall to nursing staff/MA to look it up?

    What about other historical conditions? Coding for that will require constant chart research.

    With EMRs, we eliminated transcription and filing personnel. Are we adding back a “Chart Researcher?”

  • Sue Ann, in a hospital setting, the “Chart Researcher” is known in the industry as a “Coder” and yes, that is exactly what they do now and always have. Hospital billing and professional fee billing are completely different.

    Do you think a patient who had a heart attack calls to schedule a visit to the E.R. before they arrive unconscious suffering from another AMI? Of course not, the E.R. doctor documents what he did, why and what the plan is (Discharge or admission). When the patient is discharged, the entire chart goes to the coders (or chart researchers if you prefer) and they review the entire record to determine all the codes which ultimately make up the MS-DRG which is submitted for payment. Private docs bill by individual line item – again, completely different.

    I’m guessing you work in a doctor’s office and you should not be starting the medical record for the visit when the patient schedules an appointment. That record should begin when the patient arrives and begins receiving care. Whether it’s a new visit, left/right ear etc. doesn’t matter at time of scheduling – the doctor is already required to include all of those details in his record. Schedule for whatever the patient says he/she is coming in for – that doesn’t change at all.

    If you aren’t using a certified EMR, yes, you will need a “chart researcher” to assign proper codes based on the accurate documentation your doctor writes. If you are using a certified EMR, their are tools included for the doctor to choose his code based on what he included in the note.

  • We all know how funny SOME of the ICD 10 codes are. But 9 just doesn’t cut it. As an example (near and dear to me), 283.0 refers to autoimmune hemoltyic anemia. The problem is that there are a few main variations, and many lesser known ones, each having a varying number (overlapping between variations) treatments and expenses. Some treatments that make sense for one are useless in others. If you can’t be specific enough then insurers including CMS may well reject appropriate treatments. Plus, it makes doing research much harder.

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