ICD-10 is Worthless

Man it’s been a long time since I have been here…but I have been busy fighting the good fight in other places.   The major push for the past year has come from my position as a board member for the Docs4PatientCare Foundation.  With this has come an every other Thursday chat radio hosting gig for a one hour radio show, The Doctors Lounge.  I frequently discuss health IT topics, but not always.

I have been preparing my practice for ICD=10, a disaster coming soon to a doc’s office near you.  I have one article on ICD-10 that has been published in The Heritage Foundation’s The Daily Signal, which follows.  Another more technical article is also in the pipeline which I will share here when it comes out.



As Oct. 1 approaches my inbox fills more every day with junk mail from health IT vendors offering solutions to my presumed panic.

What panic? Well, as most inside medicine know, Oct. 1, 2015, is a red-letter day that will bring the biggest single change to medical billing in the last 30 years (thanks to Congress).

Although this might not sound too scary, it will most certainly affect every American, and it has the potential to bring chaos to the health care system.

The current medical coding system, which has been in place for decades, has had successive updates built on the one before in a logical sequence. But the new coding system, named ICD-10, will be a complete break from the nine versions before it.

What’s the Big Deal?

For starters, few outside medicine understand the complex process required for doctors to get paid by insurers for their work, but those who don’t understand are nevertheless affected by the process.

To get paid, a doctor must properly log any work done, along with the reason it was done (the diagnosis), with an assigned code chosen from huge manuals containing tens of thousands of codes.

Medical coding is complex and has no room for error (I know; it’s what I do). Pick the wrong code, and a doctor will not get paid. Pick too many wrong codes over time, and a doctor might be investigated by the government. Over the years, an entire industry has sprung up dedicated solely to medical coding.

The number of codes has increased from about 15,000 to almost 70,000, and no code that appears in ICD-9 is valid in ICD-10.

Decades of coding experience will be carelessly tossed out the window, leaving many doctors to spend precious time figuring the new system out rather than actually treating their patients.

Supporters of ICD-10 (insurance companies, bureaucrats, health IT vendors, and academics) assure us doctors that it is worth the sacrifice.

They say that ICD-9 is outdated and lacks the capacity to cover the breadth of modern medicine, and it is true that almost every other country uses ICD-10, so it is time for us to “get with the program.”

How the New Coding System Was Chosen

I have been preparing my practice for ICD-10 since the congressional hearings on it last February.

After watching the farcical proceedings, it was clear to me that the “fix” was in.

The chairman of the committee professed his support of ICD-10 before the first witness uttered a single word. Those who testified were mostly a parade of IT vendors, all of whom stood to profit handsomely from ICD-10.

When I began studying the ICD-10 code structure for my specialty, otolaryngology (ear, nose, and throat, or ENT), I was shocked. ICD-10 codes are indeed increased in number from ICD-9, but there is absolutely no rhyme or reason to the expansion.

Codes for ear problems are obsessively divided into those for the left ear, right ear, or both.

For the diagnosis of dizziness due to a problem in the brain (which by definition does not involve the ears), one must still choose left ear, right ear, or both.

Although those of us in ENT medicine have yet to find any left/right differences in ear pathology, one could argue that with better data collection, maybe we’ll discover something new.

If that’s the case, then similar logic would assume that all ICD-10 codes for ENT are divided into left and right. Apparently not.

Beyond codes for ear diagnoses, almost nothing is coded by side.

For the rest of the article, click here

About the author

Dr. Michael Koriwchak

Dr. Michael Koriwchak

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery.
After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations.
Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia.
With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

1 Comment

  • Amazing that the rest of the industrialized world already has figured out how to adopt ICD10 but docs in Texas think it is too hard. Yes It enables reporting of laterality (right vs. left designations), reflecting the importance of which side of the body or limb (e.g., left arm, left kidney, left eye) is the subject of the evaluation. I would hate to have you do surgery on the wrong ear of one of my patients

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