Home Forums ICD10 (non) specificity

Hi everyone,
I have been doing some ICD10 trials and am noticing in AC that some of the codes that I will need are not in the AC system.

For example, I am looking at Gangrene, lower extremity: I70.26_, which is classified as a 6+ code.

the only code available in AC is I70.269, which is the "unspecified extremity." I think we all know this will be a red flag (b/c unspecified), and we will likely not get paid for this. Here's the other codes:

I70.261 Atherosclerosis of native arteries of
extremities with gangrene, right leg

I70.262 Atherosclerosis of native arteries of
extremities with gangrene, left leg

I70.263 Atherosclerosis of native arteries of
extremities with gangrene, bilateral
legs

I70.268 Atherosclerosis of native arteries of
extremities with gangrene, other
extremity

I70.269 Atherosclerosis of native arteries of
extremities with gangrene,
unspecified extremity

Any thoughts? We are using 8.2.4!

Hi Dustydock:

Once you refine the initial problem, you are generally presented with a short list of "unspecified" problems. This is especially true for problems that require laterality. Once you search for the initial problem and click the "refine problem" option, click on the option next to the Google button that says "Expand Search". This will expand the search parameters for that problem to include laterality. You can then further search within that problem to narrow down the list (ei: Searching for "Left" will yield all the results with concerning the left side of the body).

I did a search and found all the codes you are referring to in V8.2.4



If you would like a walk through on ICD10 coding, I'd be more that happy set up a phone conversation with us. Just email me at mdabeck@amazingcharts.com I am also planning on covering ICD10 coding at the Amazing Academy event next month in Boston (here is the link: http://amazingcharts.com/services/ehr-training/amazing-academy-east/).

I hope this helps

thanks for getting back to me so quickly!

I entered I70.26 to search for the initial problem, but the only thing I can do from here is select I70.269..."refine problem" is greyed out, and there isn't an option to "expand search" hmmm...what am I doing wrong?

I think I should set up an appt. will do that soon!

Dusty

Feel free to send me an email and I will set up some time to walk through it with you. Its one of those things that is easier to show than it is to type.

Dusty,

The "refine selection" works for the large categories only. So in your case you should type "I70" into the search box, then hit refine selection, and then type I70.26 to see all the codes you are looking for.

In essence, you are telling the search to dig deeper into the diagnosis of "atherosclerosis" (I70) and then allowing you to drill further as needed. Not intuitive at first, and requires way to many steps.

Kindly clarify the reasoning that the newest Version 8.2.4 9 (which includes the new ICD-10 Codes) no longer permits me to create an achieve of the codes that I used most frequently (as I had previously). Now search for ICD-9 codes (such as what happens when I type in the v20.2) is extremely slow while before I had the ability to edit and label the codes in such a fashion that they could be instantaneously recalled by only typing in the edited label. Your prompt assistance would be greatly appreciated.

thanks,

Hi,
?There have been several changes to coding configured in the newer Amazing Charts versions. These changes are in response to mandates from Center Medicare Services (CMS). And are In accordance with Meaningful use.

? 2014 EHR certification criteria designates SNOMED CT for problems.
? CMS requires the use of the ICD code sets in all HIPAA transactions ( claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, coordination of benefits and premium payment).
These two code sets must be aligned and Amazing Charts does that. So although you only see the ICD description and code on the problem list it is mapped behind the scenes to a Snomed code. Unspecified codes or relabeled codes with custom descriptions may not match the intent of the actual code descriptor and may render the complex mapping ineffective and erroneous.Going forward the new ICD 10 code set will require medical professionals to be even more specific about their patient diagnoses.
Thank You

Most of what I see in a day doesn't really have a specific diagnosis:
1. "I have worms crawling out of my ears and my hair"
2. "I'm so tired." "I've been tired for 20 years"
3. Constant abdominal pain for 30 years.
4. Headaches every day for ever.
5. I feel really bad and you are the only one who understands me.
6. I can't sleep.
7. My back hurts.

What really intrigues me is how we are going to develop Quality metrics for any of this sort of thing.

Can you imagine prospective payment models for anxiety, depression, fatigue, lumbago, insomnia, headache ......

And the problem is, if you don't listen to patients, then sure enough, once in a while they will have a kidney cancer or a brain abscess or .........

It's not wonder physicians don't want to be "Primary Care Providers" any more.

Yes, but Tom, they all have a diagnosis. They wouldn't be in Past Encounters if they weren't. So, here you have a nice list in the past encounters list where it will be easy to find out how many times, he has had, "I feel really bad and you are the only one who understands me."

Oh, wait, those are a list of chief complaints. And, there isn't a Past Chief Complaints window. This has been my largest pet peeve since using AC 12 years ago.



The fever turned out to be meningitis. But, I felt that Fever should still be his diagnosis.

Yes, and the belly ache turned out to be peritonitis from a perforated colon following a screening colonoscopy about a week ago.

I pick up this patient at the local nursing home (I'm the go-to doc when the patients' own physician won't see them in the nursing home), who has been downloaded from the hospital -- last progress note 2 days from discharge, no transfer note or discharge note, completely inadequate H&P. No mention that the "perforated viscus" on admit was a surgical misadventure. Still has peritonitis, bilateral pleural effusions and a fever on admission. And no orders for colostomy care, and no pain med orders.

Medicine is getting worse with ICD-10, SNOMED, EHR and shift-working surgeons and hospitalists.

I'm hanging on by a toenail -- but I could be gone any day.

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.

Hi,
We have received other notes that I70.2 and some other codes were missing and have taken steps to get these codes /descriptions into the vocabulary. I hope you will see them soon. Thank You for your patience.