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ICD-10 proving to be benefit and burden to physicians


From 'a waste of time and energy' to 'piece of cake,' physician experiences vary in our latest set of ICD-10 Diary project entries.

Spear, OD, MBA, FAAO and Gilbert-Spear, OD, MPHCarl Spear, OD, MBA, FAAO, and
Katie Gilbert-Spear, OD, MPH
Pensacola, Florida

Some Tech Troubles

Oct. 22, 2015

We are still having a few software issues that interfere with ICD-10 code transmission and did another patch to resolve some issues. We patched Officemate [our practice management system] to fix issues or glitches that interfere with filing claims or transmitting.

Examwriter [our EHR] will, on occasion, populate diagnostic codes that do not make sense as well.

Claims are now trickling in for October from all payers; our first Medicare payments were received this week.

All 12 of our doctors seem to have a good grasp on the coding. We are deleting the nonspecific codes from the dataset so that we have to select specific codes. We continue to add new codes as they come in-most are systemic codes needed to relate to ocular abnormalities

The one thing in our software is that there is a left and right diagnosis code and we still have to use modifiers for left and right which is somewhat confusing. Everyone needs to understand that one is a procedure code and one is a diagnosis code.

Insurance companies seem willing to help with the transition to ICD-10 and even though they say there are delays, we have been getting some payments. It seems like the processing is a bit slower, but other than that they are processing now regularly.


NEXT: Late-night claims review



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

Diagnoses Dilemma

Oct. 23, 2015

No new issues to report with ICD-10. We are submitting all claims with ICD-10 and being paid on all claims. The only problem is choosing the correct diagnosis from the long lists.

I go through claims every evening, making sure there have been no rejections.


NEXT: Avoiding reimbursement remorse



Miller, ODPamela J. Miller, OD
Highland, California

'An Incredible Waste of Time and Energy'

Oct. 19, 2015

Starting another week, but not noticing much change in the office. My time is taken up a bit more and I end up with my back or side to the patient while I look up the correct codes, so I have to apologize and let patient know why I am at the computer more than previously.

Oct. 20, 2015

Most of the patients in our area are on welfare now-a huge changeover from about two years ago before the Affordable Care Act was implemented. So reimbursements are much lower and the no-show rate is higher. I am doing more Interpretation and reports now, which also requires additional coding, but darned little in the way of reimbursement. In our area, most patients are covered through a medical group and must be referred to their primary care physician for any medical issue, who then refers to the ophthalmologist. I am using minimal coding; there is little reason to code everything at this point, just because a patient has other issues. Basically, we are seeing patients for a complete vision examination and nothing more.

Oct. 21, 2015

So far, we haven’t seen any reimbursement or denials under ICD-10. I am expecting that will start probably around Nov. 1. Hopefully, we won’t be seeing any rejections. The next step will of course be a pay-for-results type of exam.

Oct. 23, 2015

We better start getting reimbursements pretty soon. Unfortunately, the bills continue to come in, but the reimbursements under ICD-10 haven’t started yet, so it can be a concern. My staff is continuing to do their best and we are definitely doing the coding at time of service. It is a bit of a hassle since the reports also have to be done pretty much at the same time, rather than waiting until the end of the work day or even later in the week.

This is truly an incredible waste of time and energy. Thank heavens, our practice is pretty much limited to the eyes-I can’t imagine being an ER physician, oncologist, etc.


NEXT: Speaking of oncologists …



Marsland, MDThomas A Marsland, MD
Orange Park, Florida

'Bring on ICD-11'

Oct. 23, 2015

I survived another week; still treading water and no major snafus.

Well, there are a couple of things. ICD-10 did come up at our carrier advisory committee meeting last weekend.  The carrier felt that things were going smoothly for the most part, but did comment on paying attention to EOBs and if they did miss anything in the crossover to be sure and let them know. And to appeal a denied claim, there would be no "fixes" automatically.

Another observation that probably is unique to our EHR is that it is still easier to find the code under the old ICD -9 listing and then hit the crossover button, rather than try and find the ICD-10 primarily in the listing of codes.  I talked to the billing people again and so far no problems.

Piece of cake. Bring on ICD-11.


NEXT: Still learning



Siegel, MD, MSDaniel Mark Siegel MD, MS
Brooklyn, New York

The View from Abroad at ICD-10

Oct. 19, 2015

I'm back in the office after a meeting in London of the International League of Dermatological Societies. My non-U.S. colleagues are amazed that anyone can use ICD-10 for payment purposes. They would all find it disruptive of their practices. They look forward to ICD-11 in 2018 as being better and dynamic, and are proud that one of our own, Manchester, England, dermatologist Robert Chalmers, spent a year at the World Health Organization getting that on track.

For the curious, here's a look at for the project and the beta. Of course, it may be 20 years before we use it. Go figure.

Oct. 20, 2015

Back at the VA and no emails from compliance, so it looks like the system is working. I'm still waiting to see the "gang of two" who will teach the whole place to use ICD-10 correctly.

Oct. 21 & Oct. 22, 2015

I received the minutes from our local society meeting and it looks like one of the insurers we have to work with, GHI, is failing to cover L70 diagnoses (for acne) and ICD-10 codes for xerosis (L85.3), and some eczemas. I wonder: Is it a tech glitch, intent to delay payment, or error in the doctor's office? To be announced. All in all, there is less angst than expected. We have a year to go before they start looking at etiology coding for many diseases.

Oct. 23, 2015

I'm still trying to memorize the new codes which still feel "foreign" after a lifetime of ICD-9. I'll learn … I hope.


NEXT: So far, so good



Boland, MDMichael Boland, MD
Baltimore, Maryland

No News is Good News

Oct. 23, 2015

On the one hand, I wish I had something exciting to report.

On the other, I continue to be glad that ICD-10 has been a non-event for us so far. There is still no evidence of major issues with coding diagnoses or with transmitting claims.


NEXT: 'Piece of cake'



Joseph E. Scherger, MD, MPH
Family medicine
La Quinta, California

Thanks, IT Department

Oct. 23, 2015

Our transition was almost completely painless due to a robust IT team able to imbed crosswalking ICD-9 codes to ICD-10 in the EHR. They also rebuilt the needed diagnosis favorite lists. It was a piece of cake. 


NEXT: Cheat sheet to the rescue



Brujic, ODMile Brujic, OD
Bowling Green, Ohio

Curtailing the Codes

Oct. 23, 2015

Everything is continuing to go pretty smoothly. I find myself using my cheat sheet more than I would have expected. Although the EHR does convert from ICD-9 to ICD-10, I find that with the number of choices presented at times, it’s easier to look at our cheat sheet.

We will see how things are going as we start (or don’t start) receiving payment for services performed using ICD-10.


NEXT: Prepare, prepare, prepare



Rafieetary, OD, FAAOMohammad Rafieetary, OD, FAAO
Germantown, Tennessee

We're Doing Our Part

Oct. 23, 2015

As with anything else in life, the ease of transition is in preparation.

In our office, we always stayed at task whether it was the Physician Quality Reporting System, conversion to an EHR, meaningful use, and now ICD-10. We did our job and kept our side of the bargain.

We have now submitted claims too. So now we have to wait to see if or when the payments are coming back and if all parties were ready for it.


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