ICD-10: The Elephant in the Room
(the Patient's Room, that is !)
With ICD-10 “Go-Live” compliance
date being 12am - October 1, 2015 (36 hours 45 minutes away as this is being
written)1, we’ve been experimenting with the CMS/Medicare resources2,
and in particular their ICD-10 code lookup “tool3”. Our object in doing so was to figure out how
to quickly determine the appropriate code for any given case. Why?
While it is most likely that physicians will not be entering
their own codes on a regular basis, some will do so, either by requirement or
choice. In other cases a coder will most
often be responsible for being sure the submitted code corresponds to the
documentation. In either case, the issue
will be finding the appropriate code for the case in question. If the search for that code takes an
inordinate amount of time, care will be compromised when a physician has to
direct attention away from patients to search for an ICD-10 item. If it is a coder, the efficiency of coding operations
will be diminished, and in many cases, more coders will thus be needed. As the
cost of physicians and coders is non-zero,
such anticipated new inefficiencies can be expected to be expensive. Hence the cost of care is quite likely to be
adversely impacted. “Affordable,” you
see, exists at present in the eyes of the beholder, but not necessarily in the
eyes of the one writing the check, whether it bounces or not.
So we were trying to see how well
the CMS code-lookup tool worked, and to ascertain what insights into the mind
of ICD-10’s creators, we could obtain.
We recommend that each of you try this out. The web-link is below3, or you can
Google ICD-10 code lookup. Once there, ICD-10’s fun and complexity begin to be revealed.
Moreover, it is clear that CMS did not hire a Google-trained developer to
create its search engine. The basic
elements of good search are missing.
This one small oversight will cost millions. A good search engine needs to have certain
basic elements. For example, if you type in either cars or car in Google,
you will get a search not unlike that if you type in auto. That is, the search
engine “knows” what items are identical or nearly related. This basic component
affords compatibility with users, also known as humans, also known to be
imperfect. In medicine, no less does
such flexibility need to be present in search engines. But no!
The CMS ICD-10 search engine requires extreme specificity in
keywords. We wanted to see codes for an
aortic dissection. Entering “aortic
dissection” gets you nowhere. Entering
aorta dissection is required. Unlimited examples can be obtained if you try it
yourself.
Therefore, if you are the one who
has to put in the right ICD-10 code—good luck. But since neither luck, nor CMS
fixes, are items to be banked upon, we suggest you create a “cheat sheet” of
keywords to expedite the process. Post it, and have therein the common items
that are used in your care setting. Classic
provider diagnosis is totally inconsistent in the ICD-10 lexicon.
Examples
(try them):
1. Acute Myocardial Infarction (does not exist as an independent entity; lised in search
results are comorbidities only).
2. Myocardial infarction (returns subsets, but lord help you if you put in acute)
a. NSTEMI (works)
b. STEMI also
(works - with subsets for anatomical and arterial sites, if known)
3. Unstable angina
(works – but if you specify beyond 120.0, you are into transplantation and
bypass graft sequelae)
a. If you use the keyword angina-
ICD-10 gives you a list of 30. Have fun reading.
4. Pneumonia –
(oh boy…you get 100 to chose from)
a. If you put in community acquired pneumonia – nothing
b. Hospital acquired pneumonia - nothing
c. Better have your billing company tell
you which one to select
5. Acute Bronchitis—(works –kinda – get a list of 11, nine of which you need to specify the
organism, and the other two are organism
unspecified and neither acute nor
chronic). Having fun yet.
a. Bronchitis alone
expands the list
b. The last of these is J68.0
(Bronchitis and pneumonia due to chemicals, gases, fumes, and vapors). And if you search, then, inhalation, you get a series that begins with J69.0 (but not
J68.0). You must be having fun at this point.
6. Pharyngitis –
(sort of works –the things we see all the time, e.g. early congenital syphilitic pharyngitis come to the top of the
list….while those that are comparatively rare, like strep pharyngitis or acute
pharyngitis, unspecified are further on down).
7. As a final example (among many, many
possibilities) of what is going to be frustrating, if you put in pulmonary embolism you get a list of
six codes, none of which apply to a case of acute pulmonary embolism. If you put in pulmonary embolus, you get two codes for saddle embolus with or
without cor pulmonale. And finally if
you put in just embolism, you get a
goldmine (!), but it is longer than Tolstoy’s War and Peace. At that
point, I tried lung embolism and got “There
are no ICD-10 Codes that match.”
Oh brother, this
will be a slow process with a great deal of frustration. If readers send in
their most common, basic diagnosis list with and ICD-10 equivalent, we will try
to create a spreadsheet for common usage.
Keep in mind, too, that selected codes must correspond to the correct
code assignment (in the ICD-10 CM/PCS).
Otherwise appropriate reimbursement for any clinical entity billed to a
payor/insurance company may likely not occur.
Footnotes:
1. Countdown & Overview:
https://www.cms.gov/Medicare/Coding/ICD10/Index.html
2. Provider Resources:
https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
3. Code Lookup
XpressTechnologies practice
management, billing and Electronic Health Record are ICD-10 ready and compliant
and will provide any assistance in this major transition.
