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ICD-10 Begins

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RichardP:
I asked (rhetorically):  How are they going to be specific with the codes in 12 months ... ?
Kristin responded:  ... so that my doctor can write in the specifics ...

I provided two links to the ICD-10 codes for gout above.  Pick a code at random.  Look at all the detail written there that your doctor would need to provide in his note to you before you would be able to exclude all other codes and pick the one you just picked at random.

How is the doctor going to know what that detail needs to be, and write it down, if he has no access to the information provided at those two links - either by having no access to those links, or to an ICD-10 book(s), or to the codes provided in a PM system such as Medisoft?  Or, maybe he has access to the information but no time (or inclination) to read through it to find the specifics of what he needs.

What specifics are your clients going to write for Gout?  And suppose they say "middle finger" but don't specify which hand?  What code will you choose, or will you get back to your client for clarification?.  How many codes will you need to request clarification for, and how long will it take your client to get back to you?  We have discussed here frequently the fact that any codes submitted for payment must be backed up by what is written in the chart.  So you can't arbitrarily pick which hand in the example above.  Your code will need to reflect what is in the chart.  And if no hand is specified in the chart, you can't bill for that particular procedure until one is specified.

Michele says she has already received rejections for some non specific codes.  So, to stick with the example of Gout, we are probably going to end up defaulted to a code for Gout that is specified, rather than non specific, but at the most general level possible - even if that doesn't provide all of the detail available about the Gout for that particular encounter.  But - we are still left with the question of how to best respond when we need an up/down, left/right/ back/front, specific digit, and the client has not provided that information.

I'm starting to think that the solution may be a page with several pictures of a skeleton on it, front and back, and maybe side to side - for the provider to simply circle the appropriate location for whatever code he has selected.  A picture is worth a thousand words, and all that.  That can be attached to the fee slip they forward to billing - unless the billing is forwarded electronically.  We already have separate sheets for radiology and what-not attached to the main fee slip when they come to us - so a sheet with skeletons on it would not be that much of a change.

That is where I am coming from, and at this point my thoughts are only theoretical.  But they will need to cease being theoretical in a year. 

Michele:
I should have been more specific in my post.  I guess it's not only the drs who have to learn!  We use our system for many of our providers but we also bill out of other systems as well.  We've only gotten a total of 3 rejections so far.  Two of them were from the PMS system edits, not the insurance carrier. The other was a clearinghouse rejection.  So technically we have gotten no rejections from insurance carriers yet. 

RichardP:
Thanks for that clarification Michele.

PMRNC:
My pediatric clients all went for training on documentation and ICD-10, they went different place, some online, some were at conferences, but all of them learned about diagnosing to the highest level of specificity with ICD-10, They were even given sheets and apps on their devices to help. The apps I've seen are pretty neat as they would pop up questions when a particular diagnosis was put in. I'm not a coder either, but I think if providers were on top of this and took advantage of all the educational tools they were given they will be fine with diagnosis and a lot of technology has been added to allow them to do that and remind them to document.

I'd even go as far as saying that I think those doctors won't need coders. If I had to choose between one of my clients with coding over a CPC, my money is on my client (literally. LOL)

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