My concern would be for something like C50.212, Malignant neoplasm of upper-inner quadrant of left female breast. I think it's very unlikely, when the patient is in for a recheck, that I will mention anything in the note about the breast cancer being in the upper inner quadrant of the left breast. I'm sure there are many other codes, relating to diabetes and so forth, where the degree of specificity in the code is not something that I would routinely chart at a recheck visit.
I've been trying to train myself to mention the site of lesion and side of body in the note. It doesn't take long -- just hard to remember to do it.
My understanding is that the main significant difference from ICD9 is more specific codes for location. Shouldn't be a problem for sprains, strains and cancers, etc. that have specific locations.
As far as heart failure, diabetes, COPD, anxiety, depression, fatigue, ... the things that make up most of the day, I'll be looking for the least specific codes I can get away with and still be paid.
I don't think there is any way to know this until we are really faced with implementation. No one will tell us -- and I will guess that different payors will have different policies.
