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Should physicians use the ICD-10 delay to learn how to code?

By Jennifer Bresnick

- As the healthcare industry comes to grips with the reality of yet another ICD-10 delay, providers must turn their attention back to completing the arduous conversion process, albeit with another year of prep time.  The additional twelve months will give physicians more time to get used to clinical documentation improvements and new technologies.

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But Ron Rosenberg PA-C, MPH, President of the Practice Management Resource Group, believes physicians should also invest some serious effort in getting to know ICD-10 a little more intimately than many providers have planned.  Rosenberg spoke to EHRintelligence about how physicians should embrace a more complex role in the ICD-10 conversion if they want to see success in 2015.

What are the most pressing challenges involved in the ICD-10 conversion?

The biggest risk for the provider, of course, is not getting paid.  So the big challenge is learning the ICD-10 system, and then the second challenge is making sure your technology will accommodate the system, and that technology really falls into several categories.  The first is the tools you need to select the right code, and then the second is learning how you capture those codes into your billing system, and number three is making sure you get paid.  So to me, those are the big challenges.

How should providers address the education and workflow changes associated with ICD-10?

READ MORE: CMS to Update eCQM Value Sets for 2017 Reporting Period

From my perspective, diagnosis coding is a clinical exercise.  It’s not an administrative exercise. And my bias is that the provider should be assigning the ICD codes: ICD-9 now, and ICD-10 in the future.


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I mean, it’s a clinical decision.  Knowing what the diagnosis should be is a clinical decision.  Now, whether the physician documents the patient’s issues, and then somebody else codes the ICD-10 or the physician actually identifies the proper ICD-10 code…that may be arguable.  But ultimately, the physician is the one that has to assign a diagnosis.  And from my perspective, when you look at workflow, it just seems to be much more efficient to have the physicians either completely or partially identify the ICD-10 code.



So for instance, it may be that the physician assigns the first four digits to get in the ballpark, and then somebody else can go down to the last three digits, or the physician should assign the whole thing.  That is going to be up to the provider based on what their practice style is, but it’s really up to the physician to get it into the ballpark.

What would you say to physicians who feel like dealing directly with the code sets is outside their job description, or that they don’t have the time to do so?

What I found is once a clinician gets their hands around the structure and the taxonomy of the coding system, they say, you know, it’s not really that different than ICD-9.  Yeah, there is more specificity, and I may want my coders to be the ones to put in the laterality and the first visit, second visit.  But finding the right first four digits is really not much different.

I hate to use an old, old analogy, but when I was in PA training back in the 1970s, some of the first healthcare informatics was being done at the University of Vermont, and I trained nearby at Dartmouth.  They were developing computer algorithms for diagnoses, and they figured that would be a great way for a PA to be able to assist in the decision making.  And one of the things they found, much to the chagrin of the computer programmers, was that after about the first three tries, the algorithm became embedded in your memory.  You didn’t need the computer anymore.  So I guess that’s a long-winded way of saying that the physicians that have looked at the system and looked at the codes are finding that it’s not quite the big deal that they thought it was going be.

And when I say “learn the system,” I’m not talking about memorizing 75,000, 80,000, or 90,000 codes. I’m talking about understanding the structure and the taxonomy of it.  Many providers might decide that, given their practices setting and given the resources that they have, somebody else should do the coding.  Fine, but they shouldn’t just do it as a knee-jerk, “I don’t want to have to deal with this.”

How will specialists handle the switch?

It’s going to be a difficulty for many specialists.  Primary care physicians really have a challenge with ICD-10 because the universal codes are so huge for them.  But if you take a specialty like ophthalmology or cardiology, one of the places where they’re going to have difficulty is comorbidities.

In other words, you may have a set of 50 or 60 core ICD-10 codes for an ophthalmologist.  But when you start then adding in diabetes and cardiovascular disease and everything else that might also be affecting a patient, then that could be more problematic.  Maybe that’s something that your coder needs to look at because that could really add to the patient visit and add value to the clinical note.

What effect will the newly announced one-year delay have on ICD-10 preparation?

I don’t think it’s going make a difference.  In other words, providers would have been ready October 1, 2013.  They would have been ready October 1, 2014.  They’ll probably be ready in 2015.

From the software perspective and the payer perspective and claims adjudication perspective, I think it’s a much bigger deal.  And I’m sure a lot of them are very upset about this delay because they put all their resources into it already.  But if somehow the carriers aren’t ready, you know, it could have a disastrous disruption in cash flow.

It’s kind of like back in the day, when cameras had real film in them.  You would take pictures, and then you would wait breathlessly for the film to come back from the developer to see if you got anything, because you just didn’t know.  It’s not like a digital camera where you know instantly if you got the perfect shot the first time around.

And I think the go live date, whenever it is, is going to be the same way.  Everybody will be holding their collective breath.  The cost of any kind of fumbling on the part of the payers, or the systems companies, is really going to be placed on the shoulders on the practices. It would be wonderful if payers would do something like a dual coding system in the month of August, for example, where you could submit both sets of codes, and so everyone could test real-time.  Because the testing that’s going on hasn’t been universal. It’s still going to be a collective intake of breath.




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