ICD-10.....Ugh.

[knoxdoc]

Is anyone here an ICD-10 expert? I was looking at the ICD-10 codes and I'm confused about the "Injury codes". It used to be that an ACL tear was an ACL tear, but now acute injuries seem to be coded differently. How do we determine what is acute and what is not? If ortho sees a fresh ACL and later refers to PM&R, is our first visit considered an initial eval for the ACL or a subsequent visit? When do we switch to normal (chronic) codes?

This sucks.

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[Aether2000]

Oct 1. Many emrs have cross platform mapping so you can select from a small number of icd10 choices. I am no expert though and just resigned from a hospital that requred 6 hours training in icd10 otherwise a $750 fine and suspension

 

[emd123]

Oct 1. Many emrs have cross platform mapping so you can select from a small number of icd10 choices. I am no expert though and just resigned from a hospital that requred 6 hours training in icd10 otherwise a $750 fine and suspension

Yes, my emr and billing people just mapped all the icd 9's to the 10's so it's point and click easy (I think). We'll see Oct 1. Hopefully it won't be anarchy

 

[Tenesma]

i truly, truly, truly envy those docs who are in cash only practices --- they don't have to worry about EHRs, ICD10, billing/coding, HIPAA, Medicare penalties, etc...

 

[emd123]

i truly, truly, truly envy those docs who are in cash only practices --- they don't have to worry about EHRs, ICD10, billing/coding, HIPAA, Medicare penalties, etc...

In Pain, they're called pill mills. By yeah, I get your point. All these regulations are a major PITA.

 

[hyperalgesia]

i truly, truly, truly envy those docs who are in cash only practices --- they don't have to worry about EHRs, ICD10, billing/coding, HIPAA, Medicare penalties, etc...

It's pretty incredible how these burdens pile up. Adding to that - fixed allowable prices. I am probably one of many who dreams of going to a cash only model at some point.

 

[deleted185747]

I have been dreaming of a cash practice as well. Still trying to figure out how to do it without getting myself into trouble.

 

[NOSfan]

....a hospital that requred 6 hours training in icd10 otherwise a $750 fine and suspension

6 hours.......Ridiculous. It needs to addressed by the MEC. If your colleagues allow such, then shame on them.

 

[Tenesma]

with my current EHR it takes about 40-45 minutes to enter all of my codes/charges for billing - the hospital employed group mandates that this be done by doctors - we can't delegate for some peculiar/odd reason

with ICD10 changes and current software - it will take me about 60-80 minutes to enter all of my charges/coding per work day.... f*k that...

 

[emd123]

with my current EHR it takes about 40-45 minutes to enter all of my codes/charges for billing - the hospital employed group mandates that this be done by doctors - we can't delegate for some peculiar/odd reason

with ICD10 changes and current software - it will take me about 60-80 minutes to enter all of my charges/coding per work day.... f*k that...

Why? Can't they just map all your commonly used codes to the ICD 10 version so you can point and click? I have Anthena and that's what they allow you to do. Demand your EHR makes this easier. Fast.

 

[DOctorJay]

http://thepainsource.com/icd-10-cod...ampaign=Feed:+ThePainSource+(The+Pain+Source)

 

[NJPAIN]

My EHR wants to charge me $

 

[NJPAIN]

Sorry, wants to charge me $2500

 

[Ducttape]

the Epic build for "my" hospital is click and you're done. ICD-9 and ICD-10 codes are in there already. if i am not specific enough, a list of other codes that are complete will pop up.

 

[hyperalgesia]

If payment is declined and needs to be resubmitted in November, for a pre-October encounter, I think it has to be resubmitted in ICD-9. So ICD-9 should not fall off your EMRs in October...

 

[olafa]

My EHR wants to charge me $

might be worth it... imagine months of declined payments due to coding errors and time involved in processing by yourself and billing in your office. Those late payments reprocessed probably won't catch up for months.... meanwhile you still have rent to pay, staff to pay etc

 

[Tenesma]

1) don't you think it is amazing how many hoops we as docs have to jump through to get paid for the work that we do?

2) re: ICD10 -- cross-mapping is easy, and available for most EHRs....

HOWEVER - rememeber that we also see a fair amount of injury related complaints so to properly code for those you have to include
A) Laterality
B) Acuity (active, resolving, initial encounter, subsequent encounter, etc).
C) Severity

so that turns ICD 9 of knee pain to ICD 10 of left knee meniscal injury, acute, initial encounter

so crossmapping doesn't really work for that.

now you could argue that you would just use ICD 10 for knee pain unlisted/unspecified
which will work for the first year due to the grace period - but after the first year, reportedly those codes will be kicked back...

i wish i was 15 years older so i could just retire now...

 

[NJPAIN]

Or you could slam your hand in a car door and join the ranks of the disabled.

 

[emd123]

Or you could slam your hand in a car door and join the ranks of the disabled.

Please, cut off my pinkie! Please!

 

[NJPAIN]

Pinkie won't be enough unless you are in Los Angeles

 

[Ducttape]

Or you could slam your hand in a car door and join the ranks of the disabled.

Really? Cant you just say "i have back pain" and get disability???

 

[SSdoc33]

1) don't you think it is amazing how many hoops we as docs have to jump through to get paid for the work that we do?

2) re: ICD10 -- cross-mapping is easy, and available for most EHRs....

HOWEVER - rememeber that we also see a fair amount of injury related complaints so to properly code for those you have to include
A) Laterality
B) Acuity (active, resolving, initial encounter, subsequent encounter, etc).
C) Severity

so that turns ICD 9 of knee pain to ICD 10 of left knee meniscal injury, acute, initial encounter

so crossmapping doesn't really work for that.

now you could argue that you would just use ICD 10 for knee pain unlisted/unspecified
which will work for the first year due to the grace period - but after the first year, reportedly those codes will be kicked back...

i wish i was 15 years older so i could just retire now...

yes. it sucks. especially if you are a high-volume provider, like tenesma is. in previous posts, you say you see 30 patients a day, sometimes more. that is just a boatload of clicks. all day long. have to click for diagnosis, e/m code, procedure code, modifiers, and all of the meaningless use stuff.

the way i see this playing out is that you will still be able to code for "knee pain", but i dont see private carriers or medicare catching on so fast. do you think the payment will just not be reimbursed if you put in the icd-10 code for knee pain without the laterality, acuity, and severity component?? im not so sure

 

[knoxdoc]

http://thepainsource.com/icd-10-codes-for-physical-medicine-and-pain-management/?utm_source=feedburner&utm_medium=twitter&utm_campaign=Feed:+ThePainSource+(The+Pain+Source)

DocJay - Excellent listing! Did you compile that or just find it? I was comparing it to what I have and its all matching up pretty well.

 

[DOctorJay]

That's from a member of this board actually. Good guy and his website is quite helpful. I almost always go there first for coding info.

 

[Tenesma]

there are billable codes - it is just a matter of finding them - we are immune (somewhat) the first year of ICD10 phase in.
but the goal is to correlate w/ precision the visit with the documentation with the diagnostic coding
or at least that's the payers and govt goal

i think the real goal is for the govt/payers to come up with ways to slow me down so much that i don't see that many patients, and in return send in less claims, and the insurance co saves money - multiply by 800000 docs.

 

[hyperalgesia]

Our BCBS carrier is now requiring pre-auth for all MRI and CT. That means connecting to a website and filling out forms of a 3rd party (or is it 4th or 5th party?) who's sole purpose is to impede care.

 

[Tenesma]

there was successful litigation by a doc against one of those 3rd party pre=auth companies - when he charged them for his time and they refused to pay - he won, because he never signed a contract w/ that pre-auth company... would be worth checking our contracts to assess if the payers have added language stating that we will do preauths for free?

 

[yankeeh8r]

Was reading an article about ICD-10 implementation in Canada a few years back. Said that the initial hit to productivity was 50% reduction. After a year or two there were improvements, but they've never been able to get production back up to the levels it was at before ICD-10 implementation. Currently, they're running at 15-20% LESS volume/production than they did BEFORE implementing ICD-10. So yeah, totally a way to get us to see less patients.