ICD-10: More frustration than chaos for physicians

November 30, 2015

We asked the physicians in our ICD-10 Diary project about their impressions of the coding transition after two months.

Seymour, MDElizabeth Seymour, MD
Family medicine
Denton, Texas

'Change is inevitable'

The ICD-10 transition has taught me that change is inevitable. My practice must change with the times to keep up with the pace. Healthcare overall is not getting any better or more accessible. It's only costlier for all.

 

NEXT: More time needed to determine impact

 

Boland, MDMichael Boland, MD
Ophthalmologist
Baltimore, Maryland

Adaptable technology

The ICD-10 transition has taught us that U.S. health IT is now at a place where it can successfully adapt to significant changes. This should make us more confident regarding similar changes that will be needed in the future. Whether the change to ICD-10 will provide us with a meaningful benefit is another question, however, and one that will take some time to answer.

 

NEXT: Meeting challenges head on

 

Ellis Jr., MDGeorge G. Ellis, Jr., MD
Internist
Youngstown, Ohio

A team effort

ICD-10 has taught me that my practice can adapt to new changes without difficulty. We can also prepare for change without missing a beat. With a lot of hard work on everyone's part, we were able to make the conversion without a hitch.

I personally don't think that the conversion to ICD-10 will have a dramatic impact on healthcare, but will put us on equal playing field with the world as far as ICD-10 codes.

I have also learned that no matter what obstacles are thrown my way, I will work hard and focus on them to get the job done, and get the most out of the changes. 

 

NEXT: Subtraction by addition

 

Brenneman, MDTerry Brenneman, MD
Pediatrician
Raleigh, North Carolina

Another cut to a physician's time

Nov. 27, 2015

As I look back on the impact of ICD-10, it has not been as bad as feared.

At the same time it adds, I would estimate, about five to six minutes to my day. Some of that extra time comes from having to look up a code, and some from when my EHR gives me multiple choices that I have to read through and click on. Does an insurer really care if I treat a right vs. a left otitis media? The patient certainly doesn't care what I code, only that I help them get better. So why do I have to jump through an extra hoop? Five minutes doesn't sound like a lot ... until you add it up. Let's round it up to 30 minutes a week times 48 weeks for a total of 24 hours a year. Do I give up three days of vacation time to make up for it? Do I see two fewer patients per week each with a 15-minute appointment?

If I see 100 patients a week and if my overhead is 55%, then the first 55 patients I see that week go to my overhead and the last 45 pay my salary. If I see two fewer patients per week, it works out to a 4.4% pay cut for something that (from my perspective as a pediatrician) does not benefit the insurer, the patient, or me. I feel like the proverbial person "dying of a thousand cuts" between HIPAA, CLIA, EHRs, ICD-10, prior authorizations, and so on.

 

NEXT: 'Hard to justify ICD-10'

 

Miller, ODPamela J. Miller, OD
Optometrist
Highland, California

An 'overhyped' transition

Nov. 23, 2015

I am still finding that some problems have no code or that I am not able to get as specific as I need to, since I am the referring doctor requesting a consultation. If I knew the exact etiology or diagnosis on some of the medical [issues] it would help, but I am referring because I either don’t know the underlying problem or I am not able to treat it.

Nov. 24, 2015

At this point, it appears that we are getting paid for what we bill. Reimbursement is incredibly low since there are so many people now on welfare or on a plan that has the same reimbursement as welfare. It is the same for all the ODs I speak with in my area and makes staying in practice a no-win situation. The costs continue to rise and reimbursement has not changed in almost 30 years, yet licensure has increased and the equipment needed to take care of patients has expanded.

Coding is just another hassle and very time-consuming, and the patient comes out on the short end. It is hard to justify ICD-10, other than just another money-making scheme for the insurance companies and the government. Less time is being spent with the patient, let alone actually counseling or listening to the patient.

I don’t see that ICD-10 is really any improvement over ICD-9, although I do think it was overhyped; just another hassle and part of doing business. It may be time to reconsider moving over to a "no-insurance accepted" practice or at least eliminate the big name vision care companies since their reimbursement is pretty much the same as welfare and they continue to work against the profession and the best interests of the patient.

 

NEXT: Practice made perfect

 

Chandler, MD, MBAMaria Chandler, MD, MBA
Pediatrician
Long Beach, California

Valued vendor

I feel bad saying that our EHR vendor set us up well! They had us practicing six months in advance and we didn't have a glitch.

It resembled the Y2K scare that didn't pan out.

 

NEXT: An 'interesting' transition

 

Brujic, ODMile Brujic, OD
Optometrist
Bowling Green, Ohio

A tranquil transition

ICD -10 was an interesting transition. There was a Y2K sense about the whole thing. But, everyone I spoke really transitioned relatively smoothly. Overall it has been a relatively smooth transition. There was definitely some aspects that are annoying (blephariits being categorized by eyelid), but all and all, it wasn't nearly as bad as I was thinking that it was going to be.