Minor nuisances, but no major issues with ICD-10

November 16, 2015

Forty-five days after ICD-10 became a reality, small annoyances seem to be outweighing large payment problems, according to our latest ICD-10 Diary entries.

Drummond, MDHarry Drummond, MD
Family medicine
Simi Valley, California

Lost in translation

Nov.11, 2015

There have been a few problems with finding appropriate codes using our IMO; but our EHR ICD-10 search engine only gives limited choices. For example, a search for "DM type 2" only gives choice of "DM type with complications" or "DM type 2 without complications." You cannot get a diagnosis of "DM type2" which is all I need for my problem list.

Nov. 12, 2015

More of the same problems with ICD-10 searches. When searching for "hypertension," the IMO insists that I choose between eight descriptors beginning with "essential hypertension." All I need for my problem list and all the patient wants to read is "hypertension," but the word "hypertension" is not a choice.

Nov.13, 2015

IT informed us today that the ICD-10 descriptors in our EHR were hard coded to be in SNOMED language, which is not user friendly and hard for patients to understand. The only way we can get understandable language in our progress note assessments is to use the IMO. This is very discouraging.

 

NEXT: From discouraging to encouraging

 

Lambert, MDCarla J. Lambert, MD
Family medicine
Beltsville, Maryland

'So far, it's a win'

Nov. 13, 2016

It was a really good week with no problems at all. We might just be getting the hang of this!

One thing that is really helping me is that we integrated our EHR (Practice Fusion) with our billing company (MTBC) at the same time as the ICD-10 conversion. I was very afraid of trying anything new in conjunction with the ICD-10 switch, but I was assured the direct interface would be seamless and faster than our old method of scanning superbills for them to submit electronically. I am thrilled to say they were right and we have had no problems in getting the claims submitted and paid.

Having everything electronic is even helping me finish my notes at the time of the visit rather than putting that task off until later! So far, it's a win!

 

NEXT: What's ICD-10's advantage?

 

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

Details, details

Nov. 9, 2015

Well, here it is, the start of yet another week of fun and games. I am actually remembering some of my more commonly used ICD-10 codes, but still using my cheat sheets and my coding program (with interpretation and report features) to try and be more thorough.

I am still not sure how much I need to code on every patient – it could get out of hand very quickly.

Nov. 10, 2015

It is getting easier on the coding. I still am not sure how much coding I need to enter. It seems like a huge waste of time and energy to code every item, especially when it isn’t what the patient has come in the office for nor when the patient isn’t being followed up or referred for further care.

Nov. 11, 2015

The other doctors at my society meeting felt that ICD-10 was not a big problem and pretty much a non-issue at this point. We have a lot of issues that are far more significant, like being included in the Medicare Advantage programs, access and parity, etc.

Nov. 12, 2015

It still remains to be seen if we get paid for all of our billing. No matter how we bill, we basically are reimbursed at about 50% of our usual and customary.

Nov. 13, 2015

It has now been six weeks since ICD-10 came rushing through the door. So far, it is at least manageable, but it is difficult to see that it is any advantage to anyone. Certainly the patient doesn’t find it better, nor does the doctor, and who knows about the insurance companies, unless you count that it gives them more time and leeway to deny claims that have to be resubmitted. It still remains to be seen just how much additional issues and hassles are in store.

 

NEXT: Keeping a close eye on things

 

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

Only minor bumps in the road

Nov. 13, 2016

ICD-10 has been a smooth transition thus far!

We have not had any issues with coding, or reimbursement except for having a few denials for Protimes using a diagnosis code of pulmonary embolism. Under ICD-10, we have had multiple denials for Protimes, where they were reimbursed under ICD-9. We are working on a solution to this problem, and will know better over the next week.

We are monitoring all procedures and denials closely, to see if there is a pattern with payers for specific codes.

 

NEXT: ICD-10 isn't Y2K … I hope

 

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

'Calm before the storm'

Nov. 13, 2016

All is still quiet on this front, but I'm not convinced it isn't the calm before the storm.

I won't call it another Y2K hype that never happened until we are much farther through it, and I hope that's the case!

 

NEXT: It appears practice made perfect

 

Boland, MDMichael Boland, MD
Ophthalmologist
Baltimore, Maryland

ICD-10? OK. ICD-11? No thanks.

Nov. 13, 2015

Overall, this transition was a non-event for us. We have had no meaningful disruptions of our workflow or billing processes as a result of the change.

Based on comments from others, the keys to success were careful planning and testing of our information systems and having a vendor who did a nice job making it easy to find and specify the correct codes. None of us are using long lists posted in clinic. We just search for the condition of interest and the system helps prompt us to add the details (laterality, severity, etc.)

While this went well, I do hope we can hold off on ICD-11 for a while ;-) 

 

NEXT: 'All is back to normal'

 

Denton, MDMelanie Denton, MD
Optometrist
Charlotte, North Carolina

Much ado about nothing

Nov. 13, 2015

The ICD-10 hoopla has significantly died down at this point, and basically all is back to normal.

I still occasionally search for a code that is now worded differently, and I silently think of other ways to describe it so that it can be found, but other than that, the transition has been mostly seamless.

I remember first hearing about the transition to ICD-10 back in 2012, and at the time I was working at an office where we were all concerned about what it would be like. I remember looking at the proposed codes for glaucoma, and all of the variations that existed plus the mild/moderate/severe qualifiers. The thought of it then was a lot scarier than that it actually turned out to be. Time will tell what happens with reimbursements and the long-term monitoring of disease using the system, but truth be told at this point I think all is going fairly well. 

 

NEXT: Nothing scary on Friday the 13th

 

Brujic, ODMile Brujic, OD
Optometrist
Bowling Green, Ohio

Thousands of codes … except for the one I want

Nov. 13, 2015

Although Friday the 13th ended this week, all is still going fairly well.

The blepharitis code being broken down into upper right, lower right, upper left, and lower left is becoming pretty cumbersome! I spoke to several practitioners who are simply coding upper right and upper left if they see blepharitis on both eyes as opposed to all four lids separately. A blepharitis of all four lids code would be a welcome addition … especially for someone who treats a lot of ocular surface disease.