ICD-10 reaction from my favorite busy physician

Finally -- a final final rule from CMS declaring that we will switch to ICD-10 after all, on Oct. 1, 2014. Good for them, good for us. In this age where democratic dialogue has become a contact sport, it seems miraculous when anything at all like progress actually occurs.

At the time the announcement was made, I was as far as you can get from Beltway politics, hiking to one of the minor peaks that form the rim of Crater Lake, in Oregon. For the first time in five years, I actually left it all behind -- no cell phone, no email alerts, just putting one foot in front of the other and breathing, stopping to take in the amazing views in every direction. How fantastic is it that I chose that week to be off the grid.

In July, I spent a weekend in a similar place, stopping in at a family reunion in Mt. Shasta, Calif. The whole mob of us were trailing along the McCloud River to a grandkid-friendly waterfall. I ended up walking for a while with my nephew, Josh, a doctor in private practice and a first-rate human being. He runs his ophthalmology practice from a smallish town in the inland West, just him and his office support team. He is only a few years out from his residency and doing well enough that he could discontinue the periodic visits to satellite towns if he wished, but he can’t bring himself to do it. He fears his glaucoma patients would not get the care they need.

As we walked and talked, the subject of ICD-10 came up. Josh is one of those people who has actually looked up some ICD-10 codes -- an empiricist, after my own heart. His reaction? Not a big deal. My EHR vendor will take care of it, he said. He expressed mild surprise at the profusion of detail in the glaucoma codes. He said that since he often doesn’t know the precise mechanism or type of glaucoma for a while, he can’t be that specific. But when I reminded him that there is always an unspecified choice in ICD-10, and that he can use that unspecified glaucoma code for as long as he needs to, that was the end of it.

This conversation about ICD-10 struck me. Josh is supposedly one of the doctors who will be hardest hit by ICD-10. Where was the panic, the outrage? There was not one word from him about ICD-10 being the last straw that would break his practice. When we talked about finances, it was about the costs of his EHR system and his diagnostic equipment.

Now, I am the last person to say something glib like, “If Josh can do it, you can do it.” Everyone’s situation is different, and your struggle to be the physician you want to be is unique. However, I will continue to make only this one modest claim: ICD-10 is not such a big deal. It is a classification upgrade with significant improvements over its predecessor. Its effect on individual physicians in private practice is not by itself a major disruption. It is a change, yes, but it need not be a crippling change. Whatever low-tech or high-tech method you use now to get ICD-9 diagnosis codes assigned to a patient encounter, the same method will work for ICD-10. If you are in the process of switching to an EHR, the fact that the system will switch to ICD-10 codes in a couple of years will be a comparatively minor part of the transition.

You owe it to yourself to be like Josh in this way: Take 30 minutes to find out for yourself what ICD-10 is like for the codes that form the 80/20 majority of your practice. You can get the ICD-10-CM PDF off the CMS website at http://www.cdc.gov/nchs/icd/icd10cm.htm.

Click the link that says ICD-10-CM PDF format, and download the .zip file that says Full PDF in the file name. Open the one that says Tabular. There are links in there that allow you to click to the chapter and sections that interest you.

Next time, for Josh and his colleagues, we’ll look at the detail available in ICD-10 for coding glaucoma, cataracts and who knows what else.

Rhonda Butler is a senior clinical research analyst with 3M Health Information Systems. She is responsible for the development and maintenance of the ICD-10 Procedure Coding System since 2003 under contract to CMS, and for the development and maintenance of the ICD-10 General Equivalence Mappings (GEMs) and Reimbursement Mappings under contract to CMS and the CDC.  She leads the 3M test project to convert the MS-DRGs to ICD-10 for CMS, and is on the team to convert 3M APR-DRGs to ICD-10. Rhonda also writes for the 3M Health Information Systems blog.


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