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Surgeon Roundtable: ICD-10 Code Implementation
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ORTHOPRENEUR sought comments from the Editorial Board regarding impending changes to ICD billing codes, and the delay of implementation to 2014, asking:
- Regardless of the extension, do you feel that you and your practice will be adequately prepared to implement the new ICD-10 codes?
- What steps have you taken for the new code implementation? What challenges have arisen, and how are you facing them?
- What do you expect to gain from the implementation of ICD-10 codes?
The surgeons' responses follow.
Q1: Regardless of the extension, do you feel that you and your practice will be adequately prepared to implement the new ICD-10 codes?
Jack Goldstein, M.D.: I am not sure anyone will be really ready. This will undoubtedly put a tremendous burden either directly or financially on all physicians. Essentially requiring coding to mimic an EMR is adding another cumbersome layer onto a medical system that revolves around numbers instead of people. In the current scheme, about 20% to 30% of patients do not even fit into an ICD-9 or CPT code exactly. Although ICD-10 is trying to improve this…why?? What will we gain from adding descriptive codes to diagnosis and procedure? Will it improve patient care? Undoubtedly not. I am an advocate of Validated Outcomes Measures data collection. This has nothing to do with outcome at all, and actually adds nothing to patient care.
Charley Gordon, M.D.: Yes, we’re prepared.
David Kay, M.D.: No, the documentation burden is overwhelming. It's not clear how this will improve patient care.
Q2: What steps have you taken for the new code implementation? What challenges have arisen, and how are you facing them?
Jack Goldstein, M.D.: We have switched to a “Meaningful Use” EMR that has only been more burdensome because it is very code-centric. Clearly the people who wrote this were not physicians and did not realize you could simply attach a number to everything.
Charley Gordon, M.D.: Our software company is making changes and updating all tables to accommodate ICD-10. The challenges are trying to finish the EHR implementation, because it will be vital with all the new codes.
David Kay, M.D.: Our coders are preparing and we are looking at software systems.
Q3: What do you expect to gain from the implementation of ICD-10 codes?
Jack Goldstein, M.D.: Only more work, more wasted time and less payment.
Charley Gordon, M.D.: More detailed reporting and tracking of patient diagnosis.
David Kay, M.D.: Delays in patient care and upset patients and staff.
Q4: What have we not asked you about ICD-10 code implementation, that we should have asked? Please feel free to share additional thoughts.
Jack Goldstein, M.D.: Is there any valid reason to require everyone to use it? What is to be gained and at what cost?
David Kay, M.D.: How is this data going to be used to improve outcomes?
Drs. Lee Hieb and Blair Rhode diverged from the Q&A format, offering the following replies.
Lee D. Hieb, M.D.: At least when it comes to ICD-10, the government is honest in its intentions: improved data collection. But one has to wonder, as Tamzin Rosenwasser, M.D. points out in her wonderful article, “Call a Code: This Doctor’s Heart Stopped Beating,” (AAPSonline.org): “Who cares whether it was a macaw or a parrot that bit someone?” There are over 2,500 codes for non-union of bone. ICD-9 has three. Why does it matter that a subcapital hip fracture occurred on the second floor of a dwelling or the first floor? Will my patients get better treatment with the additional codes? Need I even ask if it will improve my efficiency of care?