Brace yourselves; ICD 10 is coming

[jedimaster91]

Here in the US, October 1 marks the beginning of the apocalypse....I mean the ICD 10 coding system. This will determine whether or not your healthcare services will be paid for by insurance and/or Medicare. And it is ludicrously specific. They tried to make up a code for everything they could think of and then a few hundred more. I'm pretty sure there are codes for alien abductions--for initial and subsequent encounters.

Needless to say, this has the medical community in a tailspin. The Way Things Have Been Done is no longer good enough. Which in some respects is true, in others it's not. I know at my place of employment we had a system wide learning module on ICD 10 over a year ago. Today it's suddenly a big deal and OMG we have to make all these changes right farking NAO! Our patient history paperwork under review to see if it's ICD 10 compatible. And apparently I've been doing it wrong this entire time. Thanks for letting me know after 5.5 years, guys.

So in order to ease the transition for everyone, here's what we need from you the patient:

--Know when your problem started. We can't use "for awhile now" and "my entire life" anymore. We need specifics. Dates. If you don't know exactly, make something up and stick with it. If you need to, bring a POA or other caregiver to help you remember details.
--If you're here for some kind of pain, be able to pinpoint where it hurts. "Chest pain" isn't enough anymore. "Substernal chest pain" or "Left side chest pain radiating to left arm" is.
--Your doctor's office is going to screw up. Be vigilant and stay on them to get everything right. Be familiar with your insurance policy. If you know something should be covered and all of a sudden it isn't, it might be a coding problem.
--For the love of all that is holy, know why you're here. I can't begin to tell you how often I've asked why such and such exam was ordered only to be met with a derp stare and "Derrr I dunno." You don't have to have gone to med school to know the answer to "Why are you here?" WTF did you go to your doctor for in the first place?
--Be prepared to answer a lot of seemingly stupid questions. If you stubbed your toe on the coffee table when you were 6, we probably need to note it.

And doctors: y'all might wanna brush up on your indications and appropriate use criteria, m'k? You wanna check a gallbladder's function, but the patient isn't experiencing any pain, nausea, vomiting, or bowel issues, it's not going to get covered and you don't get paid. No more lung scans on patients who have no chest pain, shortness of breath, or abnormal bloodwork. Your inability to give me an appropriate diagnosis and tell me why I should do a test affects my paycheck too. Exams that aren't covered and paid by insurance affect our reimbursement, which affects how much payroll we have, which affects our staffing levels and who gets to work that day.


I'm gonna need a lot of chocolate in the coming weeks.

[greek_jester]

I feel your pain, although my working world earthquake only affects people's finances rather than their health (FRS102, I am looking at you!)

My entire accounting career has been about reporting things in format A for small businesses, format B for medium sized companies, and format C (never had to use this) for large companies. Now we not only need to start reporting in the new way for accounting periods starting on or after 01.01.15, we have to go back over last year's books and format that in the same way, and the partners WOULDN'T LET US DO ANY PREP WORK THIS YEAR TO MAKE IT EASIER NEXT YEAR DESPITE KNOWING HALF THE CLIENTS WON'T SEND THE PAPERWORK BACK IN!!!

*Ahem* those of us in the trenches are somewhat stressed.

[Headset Hellion]

Do you really expect the average patient to use terms like "substernal chest pain?"

[Bright_Star]

Trying to force a person in pain to use medical terminology that they would have no knowledge of doesn't make any sense. Delaying treatment cause they didn't say it right is downright cruel. Leave the jargon & red tape to the hospital administration. Treat the patient with kindness & understanding. Don't make it harder than it has to be.

[jedimaster91]

I don't expect them to use medical terms. But I do expect them to be able to point and say it hurts here. I'll write the technical stuff on my end. I just used that as an example of how detailed my notes need to be so the more information I can get out of the patient the better.

[cindybubbles]

I think that anything that affects the two most important parts of customers would send anyone into a tailspin.

The two parts that I'm talking about? Your body and your money.

[Teysa]

I think you need more than just chocolate to deal with that mess. Copious amounts of adult beverages might be called for.

[Shyla]

Why weren't doctors asking those things already? Mine ask me when things started. They ask me to point to where the pain is. They ask if it's constant, if it's dull or stabbing. A doctor needs to know more than just stomach pain to do any treatment. I realize the new standards will take some adjusting but everyone will figure out how to handle it. I don't see doomsday.

[jedimaster91]

Why weren't doctors asking those things already?

Some were, some weren't. There's good and bad doctors just like everything else. What the issue here is under ICD 9, generalities like "Abdominal pain" could be used as a justification for many different diagnoses. For instance, it could be used as a reason to test for ulcers, IBS, gallbladder problems, pancreatitis, reflux, gastroparesis (where the stomach doesn't empty as it should and food just sits there), hernias, and probably a bunch of other stuff. All the doc had to do was scribble down "Abdominal pain" and whatever he wanted to do about it was (usually) covered by insurance/Medicare. Under ICD 10, that won't fly anymore. Insurance isn't going to approve an exam based solely on the diagnosis of "Abdominal pain" if it needs a preauth. And unless we as techs can pry out the correct information (either out of the doctor who ordered it or the patient), that patient is on the hook for an exam that costs several thousand dollars and the hospital gets no reimbursement.

The biggest part for me at a hospital are the changes to inpatient coding. We're not supposed to "rule out" anything. Yet every time I get orders for lung scans, the indication is "Rule out PE (pulmonary embolism)." In order to make my coding comrades not hate me and the patient not hate me anymore than they already do, I get to play twenty questions. Are you having trouble breathing? No. Chest pain or tightness? No. Any lung diseases like asthma or COPD? No. Any abnormal bloodwork (like elevated D-dimer, a clotting indicator)? Not according to the chart; they haven't even run it yet. Any swelling in your arms or legs? No. Recent surgery? No. History of clots where they shouldn't be (stroke, MI, DVT)? No. Recent cough? No. Abnormal heart rhythm like A-fib? No. That, my friends, is a scan we're not going to be reimbursed for because I don't have a single appropriate diagnosis to justify it. And yet, I still have to do it because the doctor is going to tell me to do it anyway, regardless of anything I have to say because they don't have to explain themselves to me, the lowly tech. Believe me, I've called enough times to know better by now. It was akin to a kid getting burned on the stove: you learn real quick not to do that again. And my playing twenty questions delays getting the actual test done and read. Which on the off chance they do actually have a PE, could kill them.

Those who actually work as medical coders aren't going to be having much fun either. ICD 9 had around 13,000 billing codes. As medical science is constantly improving, evolving, and changing, there obviously need to be updates from time to time. ICD 10 has around 68,000 codes. For now. And there's no clear "translation" between the two; ICD 10 codes are not around the same numbers as the ICD 9 codes. A single ICD 9 code can "translate" to one ICD 10 code, several ICD 10 codes, or no ICD 10 codes.
Here is a brief overview of more of the differences. I think it's not too jargony.

So TL;DR, this is a huge change that affects the entire healthcare industry. Hospitals, pharmacies, coders, insurance companies, private doctor's offices, clinics, employees, and patients. And at least where I am, hasn't been prepared for very well. Maybe other places have had more and better training. I sure hope so. Yes, we will get through it; we have no choice. But the transition is sure to be rough for awhile. It's kinda like all of retail changing to a brand new, standardized POS register system that was nothing like what you were using before. Workflow slows because it's new and unfamiliar. Stuff gets rung up incorrectly. Looking up odd merchandise is time consuming and frustrating because all the numbers are different. Oh, and all this starts next week and we've given you little to no training on it. And do you work in a specialty area that no one understands unless they actually work in that specialty (like I do)? Boy are you in for a world of hurt. And no, you don't get extra help to deal with the angry hordes. Have fun.

Now replace peoples' daily caffeine fix and groceries with their lives, health, and well-being (along with very expensive consequences if it's not done correctly), and maybe you can get an idea of what healthcare workers are in for over the next little while.

[wolfie]

That, my friends, is a scan we're not going to be reimbursed for because I don't have a single appropriate diagnosis to justify it. And yet, I still have to do it because the doctor is going to tell me to do it anyway, regardless of anything I have to say because they don't have to explain themselves to me, the lowly tech.

The way I see it, the doctors (who see themselves as a couple notches above God on the pecking order) are ordering scans without providing a valid (to the insurer/Medicare) reason for doing so, and if you question the orders you catch hell (even though such a scan won't be reimbursed, so the hospital will have to "eat" the cost). Any way of indicating in your paperwork that a particular scan falls into this category? I'm sure the "bean counters" will NOT be happy with doctors who do this, and these doctors are likely to lose admitting privileges if they keep costing the hospital money rather than bringing it in.

[jedimaster91]

Not sure yet. I've asked what I'm supposed to do in that situation and no one can give me a clear answer. For now I suppose I'll be writing "do per Dr Whatever" but that might not be enough. No way to tell yet. Heck, we probably won't know what will go through and what won't for a couple months when the denials start coming in. Which will of course be our fault.

[LesserSouthernFroglet]

In Australia we've been using ICD10 for nearly 20 years now. We're up to version 8.

I remember the changeover, with which I was only peripherally involved. It was ugly. And we still have legacy systems using ICD9.

Much sympathy, alcohol, and chocolate to you.

With the PE exclusions, can you legitimately document them as 'suspected PE'? Considering the docs are specifically asking you to check for them?

(I'm not a coder, nor do I play one on television. But I do use these codes in analyses, and was a nurse in a past life.)

[jedimaster91]

I think they want to know why a PE is suspected. Which is perfectly reasonable, IMO. But if the doc can't tell me why they suspect a PE (other than "gut feeling" or "cuz I said so how dare you question me"), it won't get paid for.

[malmalthekiller]

I work in the billing department of a large kidney care provider. Everyone has been worried about this for months, but we still seem unprepared. I heard my manager giving the electronic claims team an ill-informed pep talk about tomorrow. It should be interesting.

[jedimaster91]

To add to the fun, starting tomorrow the Busy Cardiologist Office is house. Which means anyone who comes in with chest pain gets seen by them unless the pt already sees a different cardiologist. You even hint at chest pain--whether it might actually be heart related or garden variety bronchitis--they'll probably order a stress test. This is going to be fun.