Sandy,
Like Burt, I am no expert on ICD 10; I know little about dermatology. I think it's important to discuss the general issue that you are bringing up, both as it relates to Amazing Charts and as it relates to coding and billing throughout medicine. I hope you and others are willing to discuss that here.
My opinion is that our fear of ICD 10 has been falsely raised to a fever pitch. There is an entire industry of consultants who justify their existence by telling us how to comply with the new coding system. Over the past couple of years we have read about how this is "changing medicine as we know it". We have been told that we should be taking out large loans to cover our interrupted cash flow (that's a very common recommendation, one of which of course has negative implications for us and positive ones for the banking industry). In my opinion, much of this is overblown.
When you say "I cannot comply with ICD 10" and "this would be a violation of ICD 10", I think you are responding to that drumbeat of bureaucrats and business people who want to lead us by the nose. ICD 10 is a codebook. You can't violate it. You don't have to comply with it. Yes, CMS and the insurance companies have rules, and I understand what you mean that we must follow them to get paid. They reimburse us for taking care of patients. In order to get reimbursed, we perform a service, we provide a code indicating roughly the amount of work that we did (a CPT code), and another code to indicate the diagnoses that were treated. As far as I'm concerned, what's most important is documenting important clinical information for patient care and documenting what we must to get paid. Beyond that, I will provide what CMS, insurance carriers, and statisticians demand; but only to the minimum extent required. I need to be sure that my notes document a sufficient degree of complexity and detail to document a given level of reimbursement. So if I bill a 99214, the note must reflect that. The ICD-10 codes must reflect accurately what I saw. But...and I think this is the key point... IT NEED NOT REFLECT EVERYTHING THAT WAS SEEN.
So let's look at your excellent example. First of all, you mentioned that the patient has HIV and you coded for that. You did not mention if the patient also has hypertension, diabetes, and high cholesterol. Would you feel a need to code for those diagnoses? I would argue that you need not code for any of them... including HIV, unless you feel that it will somehow document management that will allow you to be reimbursed at a higher level. Should your notes reflect that the patient is HIV positive? Of course, and I would imagine they do. That's your decision. But why do you feel the need to code for that in ICD 10? The same is true for those other medical conditions.
And how about his dermatitis of all four eye lids. Your note presumably documents the extent of his condition. In my mind, it's ridiculous that you cannot code "allergic dermatitis of eyelid" and not specify which one. But does it really mean you MUST provide an ICD 10 code for all four of them? If you pick one, for example, HO1.21, your note would be accurate, your coding would be accurate, and your reimbursement would be unchanged. (Maybe some day they will pay you "by the eyelid" but isn't that unlikely?) Do you really think that if you were audited there would be some negative consequence for failing to code for the other three eyelids? What do you think that consequence would be?
Look, I am a simple gastroenterologist. For years I would see patients with epigastric abdominal pain and I coded 789.06. I would send the bill and that was the only code. If the patient was HIV-positive with diabetes, hypertension, and a host of other problems; even gastrointestinal ones, I was not required to provide all those other codes. I was paid appropriately. I don't see why we should assume that situation has changed. Yes, some codes are more specific (with laterality, etc.) But there is no mandate to include a dozen diagnoses for each CPT code.
Please feel free to disagree and show me where I am wrong. As far as I can see, coding the way that I am suggesting would have no negative consequences for the patient, no negative consequences for clinical documentation, and really should have no negative consequences for you.
