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Workflow slowdown accompanying ICD-10 transition


Nearly three weeks into the ICD-10 coding system and little issues are starting to mount for the physicians in our ICD-10 Diary project.

Marsland, MDThomas A Marsland, MD
Orange Park, Florida

'A Couple of Small Issues'

Oct. 15, 2015

We are well into the third week of ICD-10.

We are still hanging in there, with no major disruptions.

Well, there are a couple of small issues.

First, we had a note from our state oncology society that one of our practices in Florida recognized the updated carrier local coverage determination (LCD) had not included a new ICD-10 code that previously had coverage under the old ICD-9 code. This was for Gemzar. We are investigating, but no response to date.

Also, we have received our first request from an outside lab/imaging group asking for the ICD-10 code which apparently had not been automatically updated. (They want us to do it I guess.) We queried the billing office about any payment issues. Apparently, there are none to date, but it is still pretty early in the game.


NEXT: Doomsday delayed


Ernie Bowling, OD

Bowling, OD
Gadsden, Alabama

Slow and Steady (Part I)

Oct. 15, 2015

I avoided the "ICD-10 doomsday" by taking last week off.

There's an old saying that if your practice is slow, take some time off and it'll pick back up. That was certainly true in my case. The practice was extremely busy, which isn't necessarily unusual, but the patient flow was tremendously slow as we tried to become familiar with these new codes. Most of the codes we use are fairly repetitive: the vision codes, cataract codes, cornea, and conjunctiva codes. Yet we still have to take just a second to look these codes up, and after a while that slows the flow down.

Then you get a case complicated case like a diabetic retinopathy patient with macular edema, neovascularization elsewhere, and now you've really got to dive into the weeds; likewise in cases with ocular complications of a systemic disease. Still, although it slowed us somewhat, we made it through the week without any loss in production.

Now we must wait to see if our coding is correct and if we get paid!


NEXT: Complex codes


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

Slow and Steady (Part II)

Oct. 15, 2015

We've had no major issues with ICD-10 to date.

There hasn't been pushback on claims yet or getting paid for claims without difficulty so far. No major denials or rejected claims either.

The biggest problem is coding accurately for ICD-10 as detailing initial visit, subsequent, or sequela.

For instance, coronary artery disease (CAD) has approximately 36 ICD-10 codes under the diagnosis. This impairs the ability to see more patients throughout the day, as it is time consuming to search for the correct code. As you see below it is quite confusing sorting through the list.

Ankle sprain has 44 different codes under the diagnosis; this slows down the process dramatically of getting through a note and finishing them in a timely fashion.


NEXT: Business backup


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

Not All on the Same Page

Oct. 16, 2015

We are still here and have not evaporated … but the business office still having issues in posting charges.

I guess all parties involved should have multiple oversight committees.  We can wait until productivity reports are published …


NEXT: 'An extreme hassle'


Seymour, MDElizabeth Seymour, MD
Family physician
Denton, Texas

Building Bureaucracy

Oct. 16, 2015

I haven't noticed any major changes on payments … yet.

There is more time allotted daily to add more extensive and detailed coding.  The laboratory side has been an extreme hassle with billing and ensuring the use of acceptable codes.  Many companies are requesting new forms and documentations to be signed with the new codes. 


NEXT: Several questions persist


Miller, ODPamela J. Miller, OD
Highland, California

Payer Skepticism

Oct. 12, 2015

It has now been almost two weeks since ICD-10 began. We still have some appeals using ICD-9, which is a bit of a pain; particularly the going back and forth.

Most of the coding in our office is for refractive services, so it isn’t catastrophic so far. I had to double check a couple of some basic optometric definitions I haven’t used since school, like irregular astigmatism, but it isn’t a big deal. My coding system helps a lot, but I am still finding some things that don’t seem to have a code. Obviously, I need to rethink some diagnoses or do more research.

Oct. 13, 2015

No real issues cropped up today. We are still working on the correct coding for medical issues, which are definitely not very clear cut. For example, take a patient who suffered a stroke, with resulting vision problems. Frankly, it is difficult to ascertain which type of infarction the patient sustained, as the breakdown exceeded the information I actually had, so it resulted in a best-guess situation.

Oct. 15, 2015

I'm still not really certain on the coding. How much should I code out and then if the patient is a presbyope, do I code just presbyopia or should I include astigmat or myopia, etc.?

I'm not certain if I should include the medical aspect, when I am not billing for medical. It seems like overkill and frankly the insurance companies are not paying for this service-so I am spending more time and energy for even less money. Furthermore, the insurance companies (especially the big one that uses initials) is reimbursing less and less while competing directly against the private practitioner.

Oct. 16, 2015

Good news: The week is ended and I am pretty much remembering to code all patients. I have my staff double checking to be sure that I don’t forget to code.

It will be interesting to see the reimbursement. At this point, I don’t have much good or positive to say about the government or the insurance companies.


NEXT: Keeping calm in charm city


Boland, MDMichael Boland, MD
Baltimore, Maryland

It's Quiet … Too Quiet

Oct. 16, 2015

I am pleased to report that there is nothing new to report.  We are continuing to encounter minor issues related to the mapping of diagnoses to codes in our EHR, and between allowed codes and procedures, nothing major has happened to impact our clinical practice since ICD-10 went live on Oct. 1.

Hopefully this is not the calm before the storm ...


NEXT: Becoming code conversant


Denton, MDMelanie Denton, MD
Charlotte, North Carolina

Getting the Hang of This

Oct. 16, 2015

As the days have gone by, I have had the opportunity to continue to use unique codes and become further acquainted with the nuances of ICD-10.

For instance, this week I searched for and found the code for ocular hypertension; one that I had not needed to use up until that point. I do not recall an ICD-9 code specific to ocular hypertension without also specifying glaucoma suspect. In addition, I continued the credentialing process for my new practice, and did not encounter any differences from the process when ICD-9 was the classification system.

Not much to report this week.

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