Author Archives: Rhonda Butler

ICD-10: No news is good news

It seems that wishes are not just for fairy tales, they can come true after all. So far, it looks like the wish for an uneventful ICD-10 transition is a reality. Even the month-end report from CMS was fabulously dull.

The bottom line is, coding issues are historically a tiny percentage of the total claim denials, and that is just as true for ICD-10 as for ICD-9. Historically, total claim denials run around 10% of total, and of those, 2% are due to incomplete or invalid information of any kind, including things like provider ID. Both the 10% and the 2% statistic remained stable across the transition to ICD-10. Continue reading

ICD-10: Keep up the calm

Keep calm and carry on…that was the title of the first thing I ever wrote, in early 2010, about the hype surrounding ICD-10. Less than six months after the CMS final rule for implementation of ICD-10 on October 1, 2013, the engines of hysteria were already churning out alarmist rhetoric.

In a moment of nostalgia, I went looking for that article. Here are a couple of examples of ICD-10 sound bites that were popular in 2010, and my reaction to them. Continue reading

ICD-10-PCS: Let it evolve

Ten years ago I had the chance to make my job portable and work from home, so I moved to a small town called Florence that I “discovered” on the Oregon coast—a perfect jewel set down between forest and river and ocean.

It soon became apparent that my definition of “perfect jewel” had strings attached. I loved Florence as it was when I moved there, and I didn’t want it to change. The changes that occurred after I arrived—the new blocky condos right by the riverbank, the new housing developments chewing up more of the forest, the old fish market replaced by a cheap chain restaurant—were all changes for the worse, I thought. How dare they mess up my town! Florence was supposed to stay the way it looked in the snapshots in my head. Continue reading

ICD-10: Design for change

In Neil Stephenson’s latest novel Seveneves, one of the main characters says, “politics” is a word nerds use when they feel impatient about the human realities of an organization. When I read that sentence, I got a shock of recognition—yes! That is me, exactly! (I didn’t even mind the nerd part, because some nerds are pretty cool. Steve Jobs. Ruth Bader Ginsburg. Dr. Who).

Over the past dozen years, I could have developed some patience with the human realities of getting organizations to prepare for ICD-10. But no, the closer the implementation date gets, the more impatient I become. Continue reading

ICD-10-PCS: Making It Real

A system for classifying knowledge is a framework for organizing information. It is usually a vastly simplified model of some aspect of reality as we understand it, like the periodic table, is a simple model for representing our understanding of chemistry. In that sense, ICD-10-PCS is one among several systems that attempt to construct a systematic way of describing the things done to the human body that we collectively call “procedures.”

When I remind coders who are grappling with some aspect of ICD-10-PCS, that PCS is a model of reality and not reality itself, it gets a wry laugh and a sort of “no kidding it’s not reality” look. Continue reading

ICD-10 Cheat Sheet, Part 2: DIY for Physicians

This blog assumes you have read part 1, so if you haven’t, see you back here in a few minutes. Part 2 is for those of you in specialties where the number of codes has gone up significantly—orthopedists, OB/GYN docs and oncologists—it takes a bit more work to build a cheat sheet of reasonable size. I called it an “interesting challenge” in Part 1 of this blog, but it’s doable.

After accessing the Tabular.pdf (see instructions in part 1), I would recommend you first take half an hour and do an eyeball review of your specialty’s home base chapter without copying or pasting any codes (you might have to review sections of multiple chapters if your specialty doesn’t have a single home base). This will help you see what you are up against, and help you apply the two principles I introduce below. Continue reading

ICD-10 Cheat Sheet: DIY for Physicians

Did you end up here because you haven’t done squat about ICD-10, and you googled “ICD-10 cheat sheet?” Fantastic. Come on in, there’s plenty of room. I could get all high and mighty about cheat sheets, but by temperament I am practically allergic to telling people what to do. So, if you want to stick with the cheat sheet for coding in ICD-10, I will not try to talk you out of it. Continue reading

ICD-10: After the Thaw

If you have the slightest inclination to freak out about ICD-10 because change makes you nervous, please ignore this blog.

Okay, now for the rest of you: the code sets have been frozen for more years than is good for them, and once we get to “thaw” the code sets, they need to be updated. How can that be, you say? ICD-10-CM/PCS is brand spanking new. No, not exactly—not new, unused. New and unused are not the same thing. Putting meat in the freezer does not make it fresh—it lets you put off cooking it for a while. Continue reading

ICD-10: One Small Step for Health Care—Politics Can Take a Hike

If no further weird politics intervene, we will be able to use ICD-10 codes for real, finally, beginning October 1, 2015.

This experience has been emotionally draining for everyone. For years now we have worked in good faith toward what should have been a modest, straightforward and totally un-newsworthy goal—upgrading an old transaction infrastructure. Imagine this headline: “Old Wiring in the Basement Replaced.” That’s about how exciting ICD-10 implementation should have been. Continue reading

The GEMs are ICD-10 Training Wheels

It’s our 500th blog post! Our first blogs focused on ICD-10, so it’s fitting that today’s post is written by ICD-10 blogger Rhonda Butler. Read Rhonda’s very first blog post here.

The GEMs are nothing more than ICD-10 training wheels. You can use them to get the hang of ICD-10, but then you should just use ICD-10 directly—stop leaning on the extra wheels and just ride the bike.

Remember that first moment? Pedaling faster to get off the training wheels is intolerably scary for about two seconds, and then suddenly it’s like flying and you don’t even remember being afraid. As an industry we have had the training wheels on long enough. We should be weaning ourselves from the GEMs. Continue reading