New Medical Codes

I used the codes as an example of how government vastly complicates medical services, which results in much more costly service.  Teyates, in other threads, noted that admin costs filing for compensation from both government and insurance companies were a major cost factor,  From past audit experience at hospitals, I found this to be true, as well. 

Again, your desire to bash government as bad blinds you. The government has actually simplified admin costs by establishing standards that everyone must follow. Instead of having a different procedures and rules for every insurance company there are now one set of guidelines for all. You have no idea at all what you're talking about.

I expected Squirrelly Dawg and Crash to support government, no matter what.  Didn't expect the other lefties to be so knee jerk protective. 

 Why are you so hung up on the size of ICD-10. The size is really irrelevant. Only a very small subset of those codes will ever be used by any particular medical practioner just like the current ICD-9 codes. Does the fact the Oxford English Dictionary has over 600,000 words cause you any problems?

My comment about the standards was a general one, not necessarily specific to ICD-10. ICD-10 is just a new revision, the 10th, just like ICD-9 was the ninth. It's really not all that different to when they changed ICD-9 and added codes with 4 and five digits where before there had been only three.

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Never performed data entry on computers before, have you!  Complexity of this sort shows down completion of the forms.  Then, processing of claims. 

so lets get this straight..  a uniform system of codes.. processed by entering codes into a program.. done by the same people who do it today.. aren't smart enough to adapt a new system... which is really an upgrade, to the current system.  now, in tech terms.. windows 95 is far superior to windows 7. windows 7 contains far more code.. and will be bulky and worthless... it'll cost too much to implement and never work right. yep, rt. wingnut logic... it only exists in their minds.

dire,  your attempts a deflecting from the 'computer code' to the 'doctor's code' is hilarious. then, you try to pin it on me... at no time did i compare the two.. i simple put the statement in 'tech' terms. i even said that , in my post. you either need to take reading comprehension classes.. or just walk away from the forums... you're starting to believe your own lies.

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Comparing writing computer code with encoding data is a comparison of apples with sponges.  Computer code, once written, only requires occasional upgrades.  Encoding data is a repetitive task done over and over.  If, you don't realize that, you have no business commenting.  

logical,

I would be interested to hear what objective that ICD-10 can fulfill that could not be fulfilled with ICD-9?  The problem is the implementation of thousands of new codes, that  really have little relevance on the treatment of the patient. 

ICD-9 cannot cope with the increased need for detail in modern medical records. You must understand that the ICD codes are used by far more than just a clinician at the point of care. They serve a diverse group of people's needs.

All of the information contained in the ICD-10 CM codes is information that should be documented in the medical record anyway. Instead of writing the same information verbosely, it is all contained in the code. Once people become familiar with how the coding system works it should actually reduce the amount of documention required, i.e., there is no need to put in duplicate information. ICD-9 does not as work well for this.

This system is being ostracized by every practicing physisican I know.

Yep, same here. However, I believe that the problem is mostly just a dislike of change to something unfamiliar. A great deal will depend on the support available to a clinician and the backoffice folks. Also, the exact levels of detail that will be required by different insurance companies.  I haven't gotten a feel for that yet. I'm sure there will be some trial and error in the beginning.

 The only people who are embracing it are those who stand to make money off of its implementation (ie, billers, software writers, EMR designers).  The projected costs to implement this in individual offices has been projected to be in the thousands.

You can spend as much as you are willing to spend on this. The are innumerable folks willing to take your money, but I don't think it much of it is necessary. The software changes to provide the equivalent support to ICD-9 should be fairly minor. However, there is much more potential for improved software support in ICD-10 than were possible in ICD-9. We'll just have to wait for those to appear. I'm sure different software packages will do different things.

There is nothing that could not have been coded with ICD-9, if used correctly.

This is not true. How often do you use an "other" or "unspecified" ICD-9 code?

For simple example, how would you code a closed left ulna shaft fracture in ICD-9? The closest you can get is 813.22, but that doesn't tell you if was a left or right arm and that information is important. In ICD-10 it would be S52.202A: closed fracture of left ulna, initial encounter.

Here's a breakdown of the codes:

ICD-9

813 - fracture of radius and ulna

813.2 - fracture of radius and ulna, closed

813.22 - fracture of ulna, closed

ICD-10

S52 - fracture of forearm

S52.20 - unspecified fracture of shaft of ulna

S52.202 - unspecified fracture of shaft of left ulna

S52.202A - fracture of shaft of left ulna, initial encounter

The initial encounter (A)  is when the clinician is actively treating the fracture, a subsequent encounter (B) is when the patient is receiving routine care during healing.

What this does is give the insurance companies more ammunition to use to deny a claim. Perhaps, I am missing something so please enlighten me, but as someone who does their own coding I know how to use the current system, and the newer system looks to take more of my precious time.

Yes, it will give more insurance rejections at first, but I see absolutely no difference between this and the rejections that occurred after the 4th and 5th digit codes were added to ICD-9. Surely you remember that?

It will take more time in the beginning since you won't be able to draw on years of using ICD-9. It should be possible, however, to gain that time back plus more, by taking advantage of the things that ICD-10 will allow that ICD-9 did not. Only time will tell for sure though.

I see many  clinicians duplicate information on a patient's record. This is especially true with an EMR. It's a computer, it only needs to be documented ONCE. Duplication wastes valuable time for no gain but many don't even realize they are doing it. ICD-10 can reduce some of that duplication.

Again like you said, it has little to do with the clinical treatment of the patient, and does it really matter if the left or right arm was broken? That information is in the medical record. already. 

The ICD-10 CM codes document the patient's diagnosis. Usually that is for a third party, i.e.. another clinician, an insurance company, researcher, employer, etc. It can however, be the original clinician who is merely revisiting the record. ICD-10 allows a more precise recording of that information in a single place, in a standardized way, that anyone reading the record will be able to understand without trying to decipher how a particular clinician documented.

It does matter whether it is right or left. You document it already, but not in a form that is easily transmissible. With ICD-10 that documentation is part of the code instead of separate. Just don't document it twice.

These codes are primarily used for billing and statistics.  Why go thru the extra work of having to code these right and left, superior and inferior designations, when this is already documented in the medical record? And if you look at the case you cited, the designations are still unspecified, it just adds more codes and separates out the ulna and radius (unspecified)  Insurance companies should not care if it was the left or right ulna breakage? Insurance should pay the same for the fracture.  As far as statistics, again this is semantics, and is complicating an already frustrating job.

Insurance companies whole business model is based on statistics. They like them just a bit. More codes provides more detail. More detail and more structure. The new codes are much more amenable to automatic processing than the old ones. More automation means less labor, higher consistency, and less cost.

I do remember the pain with the five digit codes.  I remember some companies holding on to reimbursements for months, and going thru several denials, all because the billing software at the pass thru office was dropping the fifth digit.  This charade starts in October, but we are signed up to be first in the billing with ICD-10, so I can report back in August and September to tell you what to expect.  I know last time we went several months with reimbursements being held until software changes took place and this was in regards to a single digit.

Such a problem is not caused by the codes, that was merely incompetence on the part of your clearinghouse/billing service. The same will be true in this case.

The ICD-10 codes do not go live until 1 Oct. They cannot be used for claims/billing except in for testing purposes until that time.

I am not a big fan of coding material so that some statisitician can collect data.  Reimbursements have been cut enough in the past few years and to be honest it looks more and more like the logical thing to do is to become a cash only business and forget the CPT / ICD shenanigans, but I don't really have that option. I know several who say the same thing and can afford to do this. Like most jobs, the paperwork is the worst part.

Yes, cash only would greatly simplify many things, but unfortunately that would most likely also include the number of patients seen. CPT codes are a complete crock. A cash cow for the AMA. They are mandated by the Gov, but you can't even see what they are unless you pay the AMA.

The EMR system you talk about is another huge cost for most offices.  We have it, and I use it, but know many who don't like it and find it to be too expensive. 

Like you, however, I think change is just not welcome, and after a while it will be accepted, but right now for us it is a nightmare waiting to reveal itself.

One thing about EMR's that is too often ignored: If you decide to change EMRs, how do you get your medical records out of the existing one, and into the new one? If you can't, or the process is too expensive then you're locked in. There are precious little standards in this area. Being locked into a software vendor is bad for the customer, especially their wallet. It is great for the vendor, however.

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Learn the difference in writing code to produce a program and using a program to produce reports.  The latter requires data entry (ICD refers to the data as code).  Requiring overly complicated reporting that will provide a database of little use will run up admin costs. 

logical, I surely hope the new system is not as cumbersome as reported.  Especially since ICD-11 is reported to go live in 2015....haha.  Here is pretty good summation of the feelings held by most practiioners, and the reason their fears should be eliminated.

I'm not worried about ICD-11 at all. If it was less than ten years away, I'd fall over in shock. Things just don't change that rapidly in medicine in the US in my experience.

Funny that you mention the ulna break, since according to this paper there are over 1800 codes alone for this fracture, though very few of them would be used.  Perhaps that is  part of the frustration.  WHy the need for so many codes, when a fraction would work.

Interesting read if you have time.  It is written by a physician advocate for ICD-10.

http://www.himss.org/files/HIM...rwardNichols4-12.pdf

Many thanks for the article. I had not seen it before and found it very well done. It makes many of the same points that I have made. Don't worry about the number of codes, it really doesn't matter how many there are. It only matters how many you actually need to use. That number will be higher than ICD-9, but probably not a huge amount.

Also, kudos to you for actually looking into ICD-10 and trying to get some handle on it in advance.

Give it up guys. Dire knows everything about any topic. He knows more than those who do it every day. 

I have just begun to think of him as a grumpy old knowitall man. We all know someone like that, right? We just smile and nod and allow them to live in their delusions of grandeur. Once they are that self deluded and ancient, there is no reasoning with them anyway. 

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When, unable to argue a point, the desperate will attack the person.

I'll quote Robert Heinlein

"A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.' "

Unlike Kafka's story, I'm not a bug.

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bahahahahahhaha!!! heinlein was a socialist and later a democrat... that's funny, i don't care who you are! bahahahahaha!

 An argument that the insurance companies require the ICD codes is not valid.  The requirement is from government.

You have ZERO credibility on this subject. Zilch. Nada. Your only purpose is a political one. It is not helpful to those who have to implement and use something you so obviously know nothing about.

libertarians are quick to claim people for their 'founders'.. even after they express their dislike of the party and the ideas.. and i need to do more research.. gotcha. rt. wingnut politics.. they even claim to make it up as they go.

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Logical,

I've read nothing of value from your posts, except that the more complicated system will be useful to the insurance companies -- doubtful.  Whereas, the only person actually in the medical profession posting is adamantly against it -- for the same reasons as I am. 

Its stated my posts are political.  However, I did not bring up party politics in this, only a bureaucracy that invents stifling rules.  Teyates has no choice but to learn the new system as it will be required for all payments after October.