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Minor results so far from major ICD-10 conversion


In the first part of our ICD-10 Diary project, physicians from various specialties and states react to the first few days of the coding transition.

Marsland, MDThomas A Marsland, MD
Orange Park, Florida

'Just Call Me Skeptical'

Sept. 22, 2015

So it looks like the final day is getting close. Several thoughts jump to my mind: "sky is falling," "wolf, wolf," and Y2K. I suspect this will be much ado about nothing. Until the last three to four weeks, we really had not been hearing or seeing much of anything other than the generic, "You must get ready." I think the fact that the implementation had been delayed so many times, many of us were immune to the message. But it is finally here. Now we are being inundated with educational promotions.

They are all over the hospitals, coming by emails, journal, and print. Our company even "mandated" a 90-minute course that was totally worthless. So I guess my question is: "Why?" What does ICD-10 really bring us? We are jumping up to 75,000 codes. Do we really need 75,000 codes. I know that this is supposed to give us more accurate data on disease so we can follow outcomes, but I’m not sure that if one has advanced widespread metastatic disease does it really matter what quadrant of the breast it started?

20 bizarre new ICD-10 codes

My fear is that the people paying the bills will use ICD-10 to find some way to restrict care and limit payments … just call me skeptical. Finally, why do "I" have to learn this? I am not a coder. Why do I have to list 50 different codes? I am not opposed to putting in the primary diagnosis, but let someone else figure out the code. Lastly, our EHR has had the crossover from ICD-9 to ICD-10, which seems rather painless. I do have worries that payers and others may not be ready, but I guess that remains to be seen.

Oct. 2, 2015

Well here we are, 48 hours into ICD-10. The sky hasn’t fallen and the Earth hasn’t opened up. So far, there has been little impact or effect on "my" day-to-day activities. I was concerned that follow up patients might not have ICD-10 codes, but magically they seem to have appeared. I was afraid "I" would have to enter them, so I questioned staff as to whether there was automatically crosswalking within the EHR or whether "someone" was doing this manually. It turns out that the nursing and lab administrators are doing this for each patient a week ahead. (Better them than me, but it is a true burden on them.)

Click here to learn about our ICD-10 diary physicians

So far, no major impact on my life directly and no snags. I am still very concerned how all this will impact our billing and collections but that will be several weeks (or months even) before we really find that out.

Next: Cram Sessions Still Available



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

Cram Sessions Still Available

Sept. 28, 2015

Our billing director's plan for the week is to revisit the most important of the 300 slides she has on ICD-10 coding with her staff. She plans to do it in a pair of four-hour sessions. It includes scenarios and exercises for the staff.

Our physicians have been using / converting to ICD-10 in our EHR for 6 months now and our pretty comfortable. Our FQHC community health center has almost 140,000 visits projected this year.

ICD-10 documentation: The key to getting paid

Our university just sent an email today to all faculty offering a PowerPoint presentation, live class, or one-on-one support on ICD-10 for those who are still anxious about the training they received earlier or for those who like to "cram" for tests.

Sept. 29 2015

Had a physician meeting today with over 50 of us, only a mention of ICD-10 and no one had concerns for Thursday (Oct. 1).

Oct. 1, 2015

I arrived at work today with an ICD-10 email from our medical director of informatics stating that we may receive alerts in our EHR in-basket regarding invalid diagnoses used for labs and imaging if an ICD-10 code isn't used and we will be prompted to change it. We also received another email from the university [University of California, Irvine] giving a schedule of question-and-answer sessions on campus and the medical center today.

Oct. 2, 2015

All is quiet here, our Informatics medical director didn't receive a single 911call yesterday from providers. Granted, we’ve been on ICD 10 for six months which has paid off. We won't submit ICD-10 claims until Oct. 7, so we'll see …

Next: A Lesson in Lice and Specificity


Brenneman, MDTerry Brenneman, MD
Raleigh, North Carolina

A Lesson in Lice and Specificity

Oct. 1, 2015

I just finished a fun 10-day vacation. Tomorrow will be my first day with ICD-10. To further add to the misery is the fact that we switched to a new EHR system on Sept. 11 that everyone is still struggling with. I am hoping all the hullabaloo over the conversion to ICD-10 will be reminiscent of what we went through with the "Y2K" scare. Remember how all the computers were going to crash on Jan. 1, 2000, because the old programs didn't account for a date after 1999? As it turned out, Jan. 1, 2000, was just another day. I hope I will be saying the same thing about ICD-10 tomorrow at this time.

Oct. 2, 2015

Just finished my first day with ICD-10. It turned out to be a breeze, for the most part. My EHR came up with a code after typing in a diagnosis. Will this code be specific enough for the payers? I will get to find out in a few weeks. I did open a line of credit for $150,000 for our three-provider practice anticipating a lot of rejections.

Oct. 3, 2015

Ah, the joy of pediatrics and getting the opportunity to work on a Saturday. I did use an ICD-9-to-ICD-10 crosswalk computer app that I found on Google to look for the correct code for head lice (our weekend hours are supposed to be for emergencies and acute illnesses only, but pediatricians learn very early that what we consider an emergency is very different from what parents consider an emergency. In most parents' minds, head lice constitute at least an emergency call if not an office visit).

3 medical billing strategies to counter ICD-10

I put in the specific ICD-9 code for pedicullosis capitis. The code from the crosswalk turned out to be a non-specific code for any pediculosis; head, body, pubic. With a little more searching, I did find the more specific code for head lice. I worry that maybe I needed to search yet further for the needless details that ICD-10 seems to want sometimes. Will "they" want to know how long this has been going on, where it was acquired, etc.? I didn't have the time to dig further and unless I could interview one of the lice I'm not sure l would be able to come up with the answer anyway.  

Next: Sometimes, You Have to Just Laugh


Siegel, MD, MSDaniel Mark Siegel MD, MSDermatologistBrooklyn, New York

Sometimes, You Have to Just Laugh

Oct. 2, 2015

I am still at the AMA's RVS Update Committee, where payment sausages are made, to paraphrase Otto von Bismarck. We've been hearing many ICD-10 tales ranging from extreme annoyance to "It's not so bad; just a nuisance." Most are resigned that it is here to stay.

My office (my partners at least) are not having any problems yet. I am like a fly on the wall as I am at various conferences and not back in the private office until the Oct. 12, so am living vicariously through my partners. My email continues to be filled with ICD-10 headlines of one sort or another that have gotten monotonous. The emails with cartoons are more entertaining. So I end this first week of the new era of ICD-10 suggesting you kick back and relax and enjoy a brew. Just watch out for low flying planes. I’d hate for you to be a V9733XD.

Next: Day One Drama



Rafieetary, ODMohammad Rafieetary, OD, FAAO
Germantown, Tennessee

Day One Drama

Oct. 1, 2015

Since the full conversion to our electronic health record (EHR) system over three years ago, our clinic has been gearing up for the inevitable changes that finally happened (I guess). As of approximately six months ago, we had been consolidating the ICD-9 and ICD-10 codes for each individual patient contact so that on the final go we were better prepared for the changes. In my particular setting, my clinical assistant and scribe is extremely valuable in assisting me with posting the proper codes. Our clinical administration and business office has been on top of the changes at all times. Nevertheless, there have been bumps on the road.

ICD-10 training: Coding for diabetes

In the long-term, it may be more efficient, but for now finding the correct "combination" fitting codes to describe complicated cases is the biggest challenge. An example is ICD-9 code 250.50 (diabetes with ophthalmic manifestations, type II or unspecified type, not states as uncontrolled) or 361.01(recent retinal detachment, partial, with single defect) are now having several options to choose from.

Today, I saw 48 patients and after each encounter painstakingly selected the proper new code(s) and posted the charges. My assistant informed me at the end of the day that none of our charges went through. I am not sure any other profession working a 10-hour shift isn't expecting to not get paid for their work! My business office is hard at work trying to figure it out.

Oct. 2, 2015

I was told our billing/coding side was not in sync with the clinical side (clinical side was sending ICD-10; billing side still looks for ICD-9). The problem is being fixed. I'm also unable to process PQRS, because it is still linked to ICD-9.

Next: Technology Easing the Transition


Denton, MDMelanie Denton, MD
Charlotte, North Carolina

Technology Easing the Transition

Sept. 28, 2015

Nothing major to report today. In terms of preparation for the transition, I have participated in a few webinars and read the American Optometric Association documents provided by my state association. A couple of days ago, my EHR provider, Revolution, start providing an ICD conversion tool. It works really well, and is simple to choose the appropriate code. The only difference from ICD-9 is that I’m choosing laterality and the codes are longer. 

Sept. 29, 2015

Asked my boss today what she thought about the transition in terms of billing/submitting claims and getting paid. She doesn’t foresee an issue. So we’re just converting codes for now!

Sept. 30, 2015

I coded my first cataract today and converted it to ICD-10. My ICD-9 code was for cortical cataract, and when it converted it changed to an "infantile/juvenile" cortical cataract! I made sure to search for another code and was able to find the more appropriate age-related code. This was the first time that my ICD-9 code didn’t immediately convert to an ICD-10 code that made sense and I had to take a few extra seconds to find the appropriate code. 

Oct. 1, 2015

Today is the day! So the only thing different today is that now our EHR isn’t giving the option of ICD-9 codes. When I start to code, it’s automatically giving me the ICD-10 database. Luckily, with Revolution it has always been easy to find codes as long as you know the partial description. Today when searching for allergic conjunctivitis it came up immediately but I did have to sort through "allergic dermatitis, bilateral, allergic dermatitis right eye, left eye, etc." The ICD-10 lists are longer, but it really hasn’t been a big deal so far; just a few extra seconds maybe, if that, to code. 

Oct. 2, 2015

More of the same from yesterday. I actually think some of the ICD -10 codes are more appropriate/more descriptive than the ICD- 9 codes were. I like that the code itself specifies which eye, I think it will be quicker to scan prior diagnoses and know exactly which eye(s) were affected rather than combing through notes. 

Next: 'So Far, So Good'


Miller, ODPamela J. Miller, OD
Highland, California

'So Far, So Good'

Sept. 28, 2015

Only three more days before this massive billing and coding changeover takes effect. I have double checked my billing and coding system and gone over the program with my staff. I feel that we are not fully prepared but I, as the doctor in a solo practice, will be doing my best.

I met with a group of physicians who were joking about ICD-10, but then they have a large staff that only does the billing and coding. They have no clue what it is like to be in a private practice with just one doctor and my staff who do everything from pre-testing, to making appointments, ordering, dispensing, etc.

Sept. 30, 2015

Tomorrow is the big day. We haven’t scheduled any patients today so that I can be certain that my system is working properly and the ICD-10 codes are uploaded into the computer. I gave a last minute pep talk to my staff (and myself). We will move forward and hopefully make no or at least very few errors. 

I am counting on my staff to act as my back up and double check my codes. This isn’t the first time we have had to face big changes and I am sure it won’t be the last. Maybe I am getting too old for these issues and hassles. Okay, just a passing thought. Forging ahead – tomorrow is a new day! OK Helen Reddy, "I am Woman – Hear me Roar!"

Slow and steady and don’t forget to keep a sense of humor – I think we will need it in the weeks to come!

Oct. 1, 2015

Today is the big day – we have scheduled light. We have a third monitor/computer in my exam room: one for my acuity; one for billing, coding, and reports; and one to handle my fundus photos, fundus autofluorescence, email, and fundus documentation. Good grief, this is just ridiculous.

We are as prepared as we can be until I see where we need to modify or change our procedure. We just updated our exam sheet to include an area for the ICD-10 codes to help my staff as well as me. I think once we get the hang of it, things will work out better. I am pretty much eliminating anything that says "unspecified" eye, as it seems extraneous.

My staff is trying to determine the basic codes for the outside prescriptions we are filling. Already unable to find the code for accommodative insufficiency, but they are doing well on the rest. At least it is a good sign that we are all moving forward.

Oct. 2, 2015

OK, we are one day out and so far, so good. Nothing has crashed and my staff and I seem to be coordinating our outcomes. It will be a bit bumpy for a while and the real test will come when we either get paid or our claims are rejected. Hopefully, it will all be smooth without any major glitches. It will be at least a month in order to see if we continue getting paid. Otherwise, we will need to reassess immediately.

We are keeping our fingers crossed and trying to make sure that we code correctly for every patient. Coordinating the computers are a bit of a hassle, but doable. If only all of the outside hassles were going as well!

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