Electronic Health Records

Policy & Regulation News

Many Physicians Reporting a Downside to ICD-10 Transition

By Kyle Murphy, PhD

- A vast majority of physicians report that the ICD-10 transition is having a tangible effect on patient care, according to the social media network for doctors SERMO.

Impact of ICD-10 use on physician productivity

Out of 200 members surveyed, 86 percent indicated ICD-10 having an impact on patient care with the responding report no effect whatsoever.

Individual physician responses highlight the most immediate impact coming in the form of time spent adapting to how the ICD-10 code set works. On the whole, the prevailing criticism of ICD-10 compliance to date from a physician's perspectiv is a decline in productivity and physicians are worried that added time spent conforming to the new code set will impact patient engagement and the number of patient visits.

One pediatrician decried the ICD-10 transition's effect on time spent engaging with a patient during a relatively simple encounter:

I recently saw a young man as a follow up from a car accident. Under the old ICD 9 I would type motor vehicle, and get the choices, passenger and driver. With the ICD 10, I typed motor vehicle, the first 20 choices were 3 wheeled vehicles and all different descriptions. I took a couple of minutes to find the right code. All the time taken from the patient. [A] real waste and no improvement in quality of care.

Another physician, a family medicine practitioner, determined the impact of the ICD-10 use to have added an additional hour to his time in the emergency room:

Right now it’s about an extra 60-80 minutes per 12 hour ER shift. Each diagnosis that used to be in the chart from past encounters can't be 'checked off', it has to be re-translated to ICD-10 by the person making the first post 10/1 encounter, which for the next few months will oftentimes be the ER physician. 2-3 sets of multiply nested boxes to filter through per patient, 15-30 times a shift…

The impact of the ICD-10 transition is likewise reported to have affected how many patients another physician has been able to see:

ICD-10 is one more impediment to good medicine for the patient. It wastes too much time, decreasing the number of patients I can see a day. I am now having to schedule some return visits farther out than is ideal as a result. Waiting time for new patient appointments is longer.

The most glaring of negative ICD-10 transition experiences comes a primary care provider who provided this rather lengthy breakdown of events:

It has added boatloads of time.

1. We are not able to do referrals because the online referral system will not accept ICD10 codes (for our biggest payer).

2. Wait times to get thru to insurance company now is hours (3 hours is not unusual)

3. The personnel at the insurance companies do not know how to answer any ICD10 related questions: the answer is, submit and we will see.

4. We were locked off the sites of several of our payers because they were updating

5. Our local Medicare carrier closed for the last week because of technical difficulties

6. And now the wait game to see if we will be paid

7. And when all that is ironed out, I expect the 3rd parties and government to reduce our reimbursements using ICD10 and citing quality measures (which they will set to maximize their own profits).

8. I used to enter my own charges. I quit on October 1st and now my biller is doing it. I used to bill every day.....we are now 3 days behind.

9. It takes a gazillion of hours to fill out the lab requisition forms looking up new and useless codes.

and on and on and on...

and no one is listening...

More to come as ICD-10 enters its second full week in use.

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