April 11, 2015

ICD-10: Better and Newer Codes, Finally

By Robert S. Gold, MD

There are plenty of outside forces that take physicians away from patient care. But are there so many that physicians have become afraid of letting “what’s happening tomorrow” beat them? 

The inevitable move to ICD-10 is one of these things. Most physicians don’t know what it is but have heard tons of stories about threats to income, the perception that we have to learn an entirely new language, and the perceived idiocy of some of these new codes. Yet this isn’t the case. Well, not entirely, anyway.

Threats to income are a legitimate fear. 

But let’s be sure that it’s a real threat. If a patient suffers a Torus fracture of the right radius and we see the patient for the first time, do we know all of these elements? Do we know it’s a Torus fracture? Do we know it’s the right wrist? Do we know we’re seeing the patient for the first time? Sure. It‘s just that we never had to look for a code for our personal professional billing that has all of these elements in it. Now we will. So?

If the patient came in from a nursing home with a stage 3 pressure ulcer of the left buttock, do we know these elements? Sure! And that’s all we need to know to find the right ICD-10 code for the case.

All of this is intuitive to physicians, but we’re not used to looking for this degree of specificity – and dropdown menus don’t help.

There are, indeed, some holes in the current version of ICD-10-CM, and I have been communicating with the cooperating parties for the past five years to see if they might be corrected. A couple of them did manage to come to the forefront and are on the way to being corrected. 

Hypertensive emergency and hypertensive urgency were once listed under malignant or accelerated hypertension, but not in the way that physicians refer to the condition. The newer verbiage is more intuitive to physicians, and we will probably have I16 codes to cover malignant hypertension with organ failure (known as hypertensive emergency) and malignant hypertension without organ failure (known as hypertensive urgency). 

What is recommended is to code any stable background hypertension that the patient has or to designate those cases that might be caused by endocrine disorders or renal artery stenosis or eclampsia. 

What is not yet suggested is to code also the organ failure that leads to the conclusion that it is indeed hypertensive emergency. And doctors should not misuse the terms, as they misused malignant hypertension in ICD-9.

The operations for congenital heart disease have been discussed and are under consideration regarding how to handle them. There may well have to be a 32nd primary procedure code or a new body part identified for primitive organs that never made it to the adult counterpart.

Be on the lookout for other new code discussions. Physicians have been begging for them, and maybe with ICD-10 we’ll be able to get them.

Sue Bowman with the American Health Information Management Association (AHIMA) and Nelly Leon Chisen with the American Hospital Association (AHA) have been massively helpful in getting the new system as up-to-date as it can be, for which I am most thankful.

About the Author

Robert S. Gold, MD, is a nationally known physician, responsible for having championed clinical documentation with a peer-to-peer educational approach in hospital organizations. Dr. Gold is a cofounder and the CEO for DCBA, Inc., a consulting firm that concentrates on development of Clinical Documentation Improvement (CDI) programs that aid in proper data streams, proper communication within the medical records and proper reimbursement.

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