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ICD-10 Begins

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RichardP:
Kristen - all of us who do billing for specialists have a huge job ahead of us.  I don't think we are going to convince the physicians to figure out how to find the appropriate listing from which they can figure out which code to use.  I'm thinking a different approach is going to be used - like making the biller find the code (which will require access to the doctor's notes).

For those reading who may not understand the magnitude of what Kristen said, here are the choices for Gout.  Remember that this is one diagnosis out of maybe a number of them - for one patient, for one encounter.  Who thinks the physicians are actually going to look through all of the entries at these two links, much less the corresponding pages for other diagnosis codes.  If you click on a link, scroll down after the page loads.  This is taken from the links I provided in my first post at the top of the page.

http://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14/M10-
http://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14/M1A-

One level higher:
http://www.icd10data.com/ICD10CM/Codes/M00-M99/M05-M14

Somewhere I have the web addresses of software that can "read" the doctor's note written in the EMR and pull out key words.  Hopefully these programs will eventually be customized to read through the ICD-10 code listings - such as those for Gout - and match the keywords found in the doctor's notes with the words in the code listing.  Even if the software search can't find an exact match, presenting the doctor (or biller / coder) with a list reduced to five or so choices is better than having to go through the lists presented at the links above.  Again and again and again and again and ...

But a good half of our clients are not using EMRs and have no intention of doing so.  The have no access to the automatic ICD-09 to ICD-10 translators that the EMRs contain.  And they have no type-written notes for a software algorithm to "read" and then search through the ICD-10 lists.  How are they going to be specific with the codes in 12 months and still see patients?  There may not be time enough for them to do both.  I expect a good many doctors in this situation to join a doctors' group so they can just practice medicine and let someone else worry about the coding and billing.

gwenyth.bethan:
I'm just curious. How is the shift to ICD-10 going so far in your organization? Do you like the change?

Michele:
I can't say I like the change but I tend to not like change in general.  :)  So far we have gotten a couple rejections for non specific codes but that's all.  The next several months will be training our providers to use more specific ICD10 codes.  So far just some minor turbulence.   8)

RichardP:
I think it would be helpful if those who get non specific codes rejected would list them here over the next couple of weeks - along with the carrier that did the rejecting.

Medicare states that, for the next year, they will not reject these non specific codes if they are in the correct code family - but state that it is up to the individual commercial carriers whether to follow Medicare's lead or not.  I think it will help impress our clients of the seriousness of this change-over if we can provide "evidence" that non specific codes are being rejected.

kristin:
Richard, you said:

--- Quote ---But a good half of our clients are not using EMRs and have no intention of doing so.  The have no access to the automatic ICD-09 to ICD-10 translators that the EMRs contain.  And they have no type-written notes for a software algorithm to "read" and then search through the ICD-10 lists.  How are they going to be specific with the codes in 12 months and still see patients?  There may not be time enough for them to do both.  I expect a good many doctors in this situation to join a doctors' group so they can just practice medicine and let someone else worry about the coding and billing.

--- End quote ---

In my office, we do not use an EMR, we use Medisoft. In March of 2014, we upgraded to Version 19, which came pre-loaded with ICD-10 codes. The problem is like we discussed, that many of them are for unspecified codes. I also purchased an ICD 10 mappings book at the same time, and have spent the last year since ICD-10 was put off in 2014 slowly adding all the specified codes that I knew we would need, minus some of the bigger groups of them, like fractures. When I redid our superbills, if there was an equivalent mapping, I listed that. If there wasn't, I just listed the dx description, like gout, and left the space for the code blank, so that my doctor can write in the specifics, and I can then find the code needed in Medisoft, and select it. This system has worked great since Oct. 1. That way, I don't feel that I am "coding" so much as I am helping to "code", since I am not a certified coder. I copied pages out of my mappings book and put them in a binder for certain codes that have lots of choices, such as Gout, Ulcer, Diabetes, Fractures, etc. That way I can easily reference it, and add codes to the system as needed. I don't see the need to add every single code, if we may never use it for our specialty

I would think that most non-EMR softwares being used offer the same thing that Medisoft does, with the built-in codes to map to. And while I have heard of cases where doctors have retired or joined group practices with coders to avoid ICD-10, I think that they are really not giving it a chance. So far, it really has been very easy.

What made me really happy was checking claim status today for BCBS and Medicare, and finding out that a random selection of claims from Thursday have already been processed and paid, so I feel much better about the insurance companies being ready now too.

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