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Good morning!

We have found that we are having two very big problems with the ICD-10 conversion.

1. As of this morning, all of the problems have been inactivated and all of our patients are showing up with no active problems. Yesterday they were all there and nicely converted to ICD-10. As you can imagine, this is a HUGE problem and will cause inaccurate reporting, monitoring and charting.

2. The code descriptions that are pulling when we try and enter them into the encounter are not the same as the standard ICD-10 descriptions. Also a huge problem. For example, Z23 for immunizations still has the specific immunization listed, but unfortunately is also wrong in most cases. Our well child visits are providing different codes for different kids and also do not include the correct descriptions. This is causing all of our chart notes to inaccurately reflect what happened during the visit.

Is anyone else running into these issues or know how to fix it? Our charting is about to come to a complete stand-still - kind of defeats the purpose of having electronic medical records. Any assistance is greatly appreciated!

Teri Shelton
Cromwell Medical Clinic

Our patient's problem lists are still there and converted to ICD-10 where there is a direct crossover code from ICD-9 and a 000 where there isn't.

As for the Z23 I see what you are talking about. I would just choose the Z23 "Other specified vaccination" until the issue is resolved. It will be Z23 for all immunizations given and not for specific immunizations any longer. Your orders or documentation in the chart will show what was given on that day and CPT code for the individual immunization administered.

I find Z00.121 and Z00.129 which have correct descriptions when you search from your main screen under billing codes but when you are in the most recent encounter it comes up with wrong description for the same codes as "Seen by pediatric neurologist" and "seen by pediatrician". Hopefully somebody as notified AC about this.

My solution would be to correct the description in the most recent encounter for now until there is a fix. It will be a bit of a pain and I am sure there are other codes it will effect but that seems like the only solution to keep things moving forward.

I don't give vaccinations, so maybe I should not be speaking out here, but I don't see what is wrong with Z23. In many situations, ICD-10 ADDS to the level of specificity, but in some cases it does not. So if you give a vaccination, and the type of vaccination is documented in your chart, then why not just bill with Z23? The code may not specify the vaccination, but it is a billable code, it should get you paid, and that is all that is needed. Or am I missing something?

I did notify AC, though the response was not the best. I was told that our search needs to be a two-step process. If I ultimately want to use code Z00.129 (Encounter for Routine Child Health Exam without abnormal findings), I must first search under code Z00.12 and click look up. From there, I still do not get the correct description for Z00.129, but instead get the seen by pediatrician description. So, from there, I need to click refine search which will THEN bring me to the Z00.129 with the description of encounter for routine child health exam. I was also advised not to use the diagnosis search in the main AC window because that search uses a different search than the one in the chart.

I have expressed my frustration with this, so I won't re-hash it here, but just wanted to share the response that I received in the event that it will help others that may be looking for the same thing. TGIF - hopefully we can all make it to the weekend!

I have noticed that the ICD 9 code 272.4 (hyperlipidemia) is not being correctly changed to ICD 10 code E78.3. The problem list remains HYPERLIPIDEMIA but the code is (000). This is a very common code in my patients, and will be a burden to fix all of these.

John,

I believe the reason you are getting 000 is because there is more than one option to choose from in ICD-10 for hyperlipidemia. That is the case on a lot of our codes we have found.

It would have been nice if AC would have sent us all a little overview of what to expect when using the ICD-10 for the first time with AC. I know it is much more exciting to find out as you go but I am one of those weird people who like to be prepared.

Jon,

In regards to the immunizations and using codes E 23, the problem is that there are multiple immunizations tied to the same code, in the Amazing Charts description of the code. Contrast this to ICD 9 when the code V04.81 was specific to influenza immunizations. If one is not careful in selecting the correct description listed under the choices for a new ICD 10 code, the wrong descriptor will be placed in the assessment, even though the code is correct. I have not experimented with this yet, but I do not think that one can modify the description, once it is under the assessment. You may want to try a selecting the Z 23 code for a test patient diagnosis, yourself, and see what I mean. As others are posting on the board, some codes have multiple different descriptions and can convey the wrong literal message in the documentation.

I don't know if you all are having problems with your services, but Quest was crashing all day yesterday with the ICD-10 codes, and sometimes they did not have the proper codes available on Care360. I think this is going to be a rough week coming up.

Y93.C9 (Activity involving computer technology), resulting in F43.0 (Acute stress reaction)

I swear if John ever leaves AC or the board, I'm gone. Hell, I should make him a global mod, just so he could wreak havoc on the board.

Never knew you were so young.

This is a compliment.

A compliment for your wit and great additions to the board.

Thanks Bert. Naw, that's not me. I don't have that much hair left.

Z23 is for all vaccinations, no level of specificity is required
they got RID OF ALL THE V6.1 and V04.81 and V03.82 etc ALL replaced by Z23
Hallelujah!
the specificity comes in when you code the vaccine given EG 90658 for flu vaccine adult 90649 for HPV egc.
this is the one place ICD10 is easier than ICD 9 so enjoy your freebie!

Lynn

ALL ICD 10 dropdowns should give us the option to code to the HIGHEST specificity. As of now, tere are a whole bunch of "unspecified" codes. I am having to use a separate database to CODE accurately.

Lynn,

The problem in selecting Z23 is not for what it represents but what ends up being entered into the assessment portion of the chart. Unless one specifically selects other vaccinations from the drop down menu, an incorrect VERBAL DESCRIPTION of the type of vaccination could be entered instead of the correct one. I would like to see influenza as a descriptor instead of selecting the code and then having to enter a description. The billers and insurance companies are going to see the CPT codes. I want clarity in my assessment so that, if OTHER PROVIDERS read my notes, they can understand what is going on, now or in the future. I was trained to document primarily to help with communicating with others in the health care field and to protect myself if I was every sued. God forbid, we now enter a code with a descriptor that is not what we intended, and we sign off on the note. I would hate to try defending that in court. I think that we are now continuing down a slippery slope.

Yes, it was a pain to give an ICD-9 Code and make sure it matched with the CPT code for that vaccine, or get denial as it 'was not indicated.' More crap that will keep Americans from becoming doctors.

That's hilarious John, love it!

I think it may be a good idea to ask all of the ICD-10 questions in one thread. I posted under Catherine Lehmann's Post at:

http://amazingcharts.com/ub/ubbthreads.php/topics/67190#Post67065

This may allow us to develop our own FAQs, and allow her to answer questions when she can. Obviously, there will be some threads that are very specific. I don't think I have ever tried anything like this. But, I don't think we have had to adjust to anythinig so confusing before. At least it is confusing for me.