ICD-10 Isn’t The Monster We Fear – It’s the Data We Want
By Robert S. Gold, M.D.
Physicians are pummelled by so many outside forces that take them away from patient care that they have become afraid of “what’s happening tomorrow.” The inevitable transition to ICD-10 is one of these things. Most docs don’t know what it is, but have heard stories about the threats to income, the perception that we have to learn an entirely new language, and the idiocy of some of these new codes.
But it ain’t so.
Threats to income is “sort of” right. But let’s be sure that it’s a real threat. If a patient suffers a Colles’ fracture of the right radius and we see the patient for the first time, do we know all of these elements? Do we know it’s a Colles’ fracture? Do we know it’s the right wrist? Do we know we’re seeing the patient for the first time? Sure. It’s just that we never had to look for a code for our personal professional billing that has all of these elements in it. Now we will. So?
If the patient had an ST elevation MI involving the left anterior descending, which is where we put a stent after angioplastying it, do we know these elements? Sure! And that’s all we need to know to find the right ICD-10 code for the case.
Do we know if a patient with Type 2 diabetes has renal involvement or peripheral neuropathy or a diabetic ulcer of the right heel? We do. All we have to do is to come up with the complete information to assign codes for that diabetic patient.
A different language? The pediatric allergists wanted some more specificity for asthma to identify how frequently someone is bothered by asthma attacks. They wanted intermittent classification and mild, moderate, or severe persistent asthma. We have them. New language? Not at all. It’s what they wanted.
Heart failure is still heart failure. Viral bronchiolitis is still viral bronchiolitis – and is named if it’s caused by respiratory syncytial virus. Pneumonia is still pneumonia. Chronic kidney disease is still chronic kidney disease – and it’s still classified as stage 1 through 5, or ESRD. Nothing new at all. Identifying which lung you want to remove isn’t too scary to me – unless the resident opened the wrong chest before I walked into the room.
And, we’re NOT responsible for ICD-10 codes for the surgery we do. We have been using CPT® codes for the surgeries, and we will still use CPT® codes for the surgeries. Sure, we may be asked if we took out the whole left colon or a part of it. Or, did we take out a whole segment of the abdominal aorta or bypass the aneurysm? So long as we do our job of dictating the op report, it’s someone else’s responsibility to find the ICD-10 codes for the case.
The oddball stories we’ve all heard about a code for catching fire while waterskiing, or falling into a bucket of water and drowning, or being sucked into an engine are real – but physicians aren’t responsible for those codes, at all! These are codes for insurance companies or folks with weird ideas about what hurts people, for some data somewhere. Docs don’t have to do anything other than take a history about the patient’s injuries. We’ve done it before, we’ll do it again. If there’s a hole in the story, someone else will be responsible for filling that hole, not us.
ICD-10 is a greatly intuitive system. If we know stuff about our patient, there’s probably a code for it. Describe the patient’s symptoms or diseases as you’d talk about them with a family member or with your office manager. Identify the cause of a disease and identify the effects of that disease on other body parts. And there are codes for most of these. Not a big deal.
Dr. Gold is founder of DCBA, Inc, a consulting company in Atlanta that provides physician-to-physician education for documentation improvement programs nationwide. His programs educate Medical Staff, coding professionals and CDI specialists, resulting in long lasting results.