By: Rhonda Butler
Believe it or not, you do not need to know or care about how many ICD-10 codes there are. I know this goes against the grain. It is almost the only thing that gets said about ICD-10. Apologies in advance to all of you who already understand that the total number of codes in the system: (1) doesn’t dramatically affect your job, (2) isn’t inherently any more disruptive or costly than any other software upgrade, and (3) is mentioned by consultants and commentators because it is an easy score.
First, a question or two: Did you know how many codes there were in ICD-9 before everyone started comparing? There are roughly 17,000 ICD-9 codes. Do you know and care about each one of them? Of those 17,000, how many get coded every day by your coders?
Here are three reasons why the increased size of ICD-10 will not be an overwhelming burden on your practice.
When coding outpatient, I have found that depending on the specialist,
the same codes are used frequently. So, there is a lot of repetition. There
are many codes that are never used. I have coded for Ortho, Pulmonary,
Pediatrics, OBGYN, Oncology, Cardiology, Internal Medicine, and Primary
Care Physicians. There are common surgical procedure codes that are
used frequently as well.
Dianne
Thank you, Rhonda, for this post. I have taken the liberty to extract and rework portions of your post for an ongoing medical practice blog on iHealthBeat about same!
FYI — Here, Rhonda, is the response I received from my post to this medical practice blog on iHealthBeat!
02/02/12 – Alberto Sobrado, MD
These comments are typical of a bureaucratic mind: “Change” – not the number of codes – is the biggest provider obstacle in making an “efficient” transition to I-10″. I would invite anyone, including Mrs. (sic) Kohn to be in the shoes of a primary care doctor dealing with 15-20 patients every day plus all the burden of these issues. Do you know that now there is a great new industry trying to “catch” doctors miscoding? This is so that these companies of “professional coders” can make up to 15% of the monies recouped by insurance companies.
And, here is another!
02/02/12 – Norah Polak
I would agree with Dr. Sobrado. Ms. Kohn is demonstrating a stunning lack of knowledge for how these codes are used in reality. Her reference to now having to specify left or right eye demonstrates the absurdity of the situation. WHO CARES WHICH EYE? Will the public policy made for left eyes be different than for right eyes? Will a left eye pay more than a right eye? Ms. Kohn fails to understand the added burden on each case. The 20 patients Dr. Sobrado sees daily might have as many as 4-5 ICD codes each and this presents a tedious task and foolish errand for the physician on a daily basis as it stands now. Does she think we are all so rich that we can just hire full time coders? In my office and I suspect most offices, the physician selects the code. True, hospitals can afford full time coders, and because of DRGs they get more money for more detail. But the individual physician just pulls out his/her hair when confronted with this new level of stupidity.
Deborah, thanks for passing along the perspectives of fed up physicians. It is good to hear from them. I can’t pretend to understand in a living way what goes on in the realm of the physician practice, or to know the specific strains under which physicians struggle to do the best by their patients. I wish I could. It’s all I can do to understand my own job.
I think it must be true of every workplace that there is something fundamentally irrational and crazymaking about the way things are set up. But I maintain the modest position that of all the irritating and crazymaking things in the healthcare system, ICD-10 is not the thing you want to spend your energy fighting. The fundamental irritation at having to assign diagnosis codes will not go away, and neither will the threat of coding audits (which in the realm of physician coding is often about scrutinizing CPT codes). Physicians who are “mad as hell and not going to take it anymore” would be much better served fighting for something that would really make a difference to their sanity and their practice’s solvency. ICD-10 is not your problem. It is an easier fight than some, but I fear a victory won against ICD-10 would be a hollow one. What would you get for it? At best, the status quo, which you find intolerable.
You guys are smart, you’re doctors for heaven’s sake. If those of you who do your own coding take advantage of inexpensive apps for looking up ICD-10 codes, it will cost you next to nothing (I freely admit I have no real information about whether there will be other software costs for the small physician practice, all I have seen are the pie-in-the-sky estimates that get quoted as gospel), and after a short time you will hardly notice the difference between ICD-9 and ICD-10. I just downloaded an ICD-10 code app for the iPad, for fun. It cost me $2.99. Not five stars, but I would use it over a paper book any day, and I think it would be perfectly adequate for the physician doing his own coding. I have several ICD-10 lookup tools that I use, but one is not cheap and the others are not for sale, and all are more than you need for simply finding a code.
As to the specific comment that no one cares whether it is the left or right eye– yes, left or right eye doesn’t matter for payment or healthcare policy on the scale of a single encounter. But whether a diagnosis pertains to the left eye or the right eye will matter increasingly as payment and health policy shifts to longer episodes of care. Knowing which eye for example could tell us whether an encounter one month later is a return for treatment of the same eye or progression of the condition to the other eye. Researchers would dearly love to have this detail available now, yesterday, ten years ago. It is researchers who develop and maintain the kernal of the ICD classification. They wanted a statistical tool for conducting epidemiological and healthcare management studies. ICD is their baby. Clearly you have noticed it wasn’t designed with you in mind, but it wasn’t designed for payers either. And more importantly for physicians who code or run small practices, the actual effect that this increased detail in ICD-10 will have on the task of coding has been hugely exaggerated. It’s not a big deal.