Home Forums Discussions General Discussion ICD-10

Hello everyone,

Does anyone have any insight as to how Amazing Charts will be handling this?

First, we will have to find the new codes. I am aware that there is no direct conversion from ICD 9 to ICD 10, but I'm wondering whether AC will give suggestions based on current ICD 9 codes, or whether we will just be starting totally from scratch? I'm not particularly impressed by the current ability of AC to find ICD 9 codes, I hope ICD 10 will be easier.

Second, at a seminar on ICD 10, the presenter indicated that our notes must justify every detail of the diagnosis. All 7 places of it. For a new problem, or a problem being addressed specifically at that visit, I don't think this would be a major concern. But in an older patient with multiple problems, I think it will be burdensome to provide this much documentation for every problem being listed.

Over all, I'd like to remain in total denial (which is mostly what keeps me going) but I think we are going to have to address these concerns soon.

Thanks.

Gene

Just what all the payers are looking for another reason for payment denials.
This will likely be a project in the making, i.e. templates with all the required components that satisfy the top 100-250 dx's we use.

My experience with AC codes is somewhat different than yours. It may be due to using a later version (I am on 8.0.2). When you type in a diagnosis, it will give you multiple choices, some with the same ICD code based on what you type. This has already been cross-walked to ICD10, so when you flip over it will give the new codes. The incomplete codes are yellow and the complete ones green, just as before.

As to having all of your areas support your diagnosis. That is true currently. All of your information should be consistent with your current diagnosis. You can't say TM's clear and dx of otitis media. It helps to have that there was ear pain on HPI and ROS

@Koby That's the whole point - "JUSTIFIABLE" DENIAL (of claims). Who really cares about ICD10, does it help make diagnosis easier or change the course of medical care? NO! It's about making it easier to deny claims. Are the actuarials going to find a new world with ICD10, and discover new issues that didn't exist? Again NO! So why are we changing ??????????? (see first sentence of paragraph)

The question I have is how often we will be able to code "non-specific" codes.
Like, instead of trying to justify "acute suppurative otitis media of right ear with perforation of TM" -- how about just "unspecified upper respiratory infection of unspecified site"
What is the difference as far as E&M code is concerned? It's still going to be 99212 or 99213.

And what insurance company is going to look at all office records to see if we have documented everything that was coded?

I think this will lead to claims denial in outlier situations -- people who code large % 99215, or maybe some of the procedural codes.

I'm hoping to slide through this -- or I may find myself a different job.

Hi Wendell,

Yes, I have been doing this long enough I know it's probably not a good idea to diagnose a condition and put contradictory information in my note!

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.

In relation to AC's ability to find ICD-9 diagnoses, I am using AC v6.3.3. I just got 8.0.2 in a sandbox (thanks Sandeep), and you are right, much better ability to find ICD-9 diagnoses. Does this version currently allow you to search for ICD 10?

Thanks for your thoughts.

Gene

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.

With ICD-10 if we use lots of non-specific codes it will be a red flag for an audit.

Even for 99212 - 213? Where did you learn this?

The issue is the unknown. Tom hit it on the head when he said we won't know until implementation and each payor is likely to have different rules.

Again, it's an excuse to change the rules and how likely is it that they will change in our favor.

Sure, they could just apply it to 99215s but every payor will do it differently. some may want to go after 99212-3s.

Remember, they can request records without fees. That's included in most contracts. How they get the records is another matter. The cost of sending an auditor may keep them from going after "chump change" but then again.....

John, like Tom, I would be interested in seeing sources for this, but until I see something convincing, I will take this with a grain of salt.
The insurance companies and government try to keep us in line using fear of audits. There are many docs who didn't participate in MU at all because they said "the government will just use audits to take it all back". Sure, there were (and still are) audits, and they can be a pain in the neck, but the great majority of people who attested and got MU funds were not audited and few gave the money back.
This is not the place for a full discussion of ICD-10, and I am certainly not an expert, but looking at the codes, I think some of this fear is overblown.

The possibility of audits has always been there, even in ICD-9. Have you heard of anyone who had an audit for this?
As a GI, of course abdominal pain is a big deal for us. 789.00 is "unspecified" and .01-.09 denotes RLQ, epigastric, etc. We try to be specific, but sometimes we code the 789.00. I have never been asked for a more specific diagnosis, let alone something like an audit.

And guess what... the code in ICD-10 for unspecified abdominal pain is R10.9. Then there are 9 more codes for the various areas, just like in ICD-9. Are there other codes to make it LOOK difficult? Sure, but let them try to audit me because I coded for "abdominal pain" rather than "abdominal tenderness".

I am sure there will be aspects of this that will be a hassle, but I think our goal should be to make the required adjustments without living in fear or fundamentally changing the way we do business.

Bravo Jon --

Doctors have got to stand up for themselves. Our forebears did, and we owe our progeny nothing less.
Caving in under the FEAR of an audit is just so wimpy.
This is how the Administrative Class is joining the 1% -- and we are sliding into the <10%.
But only doctors can actually see the patient!
The administrators want our power, but they will have to be contented with the money, because that's all they are going to get.

I have never known anyone who was audited. I would like to hear some real-life stories, not STASI boogeymen.

Good post. My experience is the same as yours. But, has anyone ever noticed that if you look at the MULTIPLE codes they list, you would think that the U.S. was in the middle of the worst TB epidemic since Doc Holliday.

Yes, it does and in my opinion it is well-designed. When you open the coding box (e.g., View....diagnosis codes) at the top there is a radio button for ICD-9 and ICD-10. Makes it very easy to put in a diagnosis, just as always, and then compare the codes in the two systems.

Hi Jon,

This is in 8.0.2? Even prior to 8.2?

8.0.0 and up.

To my naivete, what is 8.2 for then?

It is .2 better.

If you haven't learned anything in medicine, you should have learned that you don't want to lead with a decimal. I mean what if they had given me 20 mg of Versed instead of 2 mg of Versed? Oh, yeah, I probably wouldn't have been tortured.

Thanks Jon.

Now we know why I will get to 20,000 posts by mid-July.

There are some bugs in 8.0.0 and I suppose the hope is to get rid of them by 8.2.

There will always be bugs. The key is a good list of "known bugs." What you don't want are bugs that cause a problem with function such as a crash or freeze.

Agreed. I also don't want bugs that take a process or workflow that I relied open in an earlier version and make them no longer functional in the update.

I don't think you will see bugs like that in code that has already worked well. Sometimes in changing one thing, though, a process will change slightly as I have already mentioned, e.g. changing the free-hand labs. But, I can get used to that.

My opinion, and I have many, is I don't think the beta testing is done quite right for AC, partially because of the government mandates and their being no time. But, far too often, those who beta test them, post things to the board, which should never happen, and there also does not seem to be outlines of things that need to be done. I don't beta test Backup Assist, because the beta process is so rigid, I would never get a backup done. So, my free year of updates do not happen.

Hi Bert and Jon,

I hope the definitive version of AC will have the ICD 9/ICD 10 toggle at the level of the patient encounter. I can access ICD 10 codes (as Jon suggested) by using the "view" tab.

To be useful, of course, this will have to be within the patient encounter.

Also, ideally, to be able to input the ICD 9 numeric code, to produce suggestions for ICD 10, would be very desirable as well.

Gene

Gene
that sounds like a great idea!! At least until the final switchover.

That is the money quote.

Even with Payers attempting to coerce or intimdate practices into taking government pay, ther eis a relative explosion in offerings that fall outside of their reach.

As I was told again yesterday, with new plans having a 5-10K deductible, folks are once again interested in cash payment, membership, preventative care. Those patients effectively have a catastrophic coverage, and will otherwise not afford to use it.

The clowns in the clown car will realize too late that the circus has left town without them.

In V8.0.0 you cannot do that, but I agree that it would be a useful feature. I would suggest that you send a message saying so to AC via the "Recommended improvements" tab in AC. I will do so.

Not sure if this helps. Just got it from the MMA, our medical association.

Plus, there is a job opening for Jon.

Got word back from AC that this feature will in fact be included in V8.2

Actually 0.18 to be more precise.