March 10, 2014

ICD-10: Today is the Day!

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Halfway through my morning drive to the office, it slowly dawns on me: this is the day! Wednesday, Oct. 1, 2014. Today it starts. ICD-10 is here! I wonder what I will find when I get to the office.

Will everyone be in an uproar? Reflecting on my preparation, I realize I could have done better. I breezed through that webinar, and it seemed pretty easy. I already do a pretty good job of documenting. Fortunately, I am not an orthopedist, so I think the change for me will be pretty minimal. That time I spent looking at the new EHR interface did not leave me with any great concerns. Okay, admittedly, I just went through one encounter, but it seemed to work just fine. That one prescription caused a little trouble, but the trainer told me the EHR people were working on it, so it should be fixed by today.

I wonder again how things are going. Images of frustrated staff huddled together, gnashing teeth and wringing their hands, cross my mind, so I am relieved when I arrive to see that it seems to be business as usual. I am going to find my office manager right away and seek a little reassurance.

“Good morning, Cathy. Looks calm around here. No problems with this ICD-10 thing?”

She looks up from her computer monitor. “No, so far so good,” she says. “We pre-printed all the superbills for today’s clinic last night, so we are ready for everyone. Check-in seems to be running smoothly so far. Don’t forget, you won’t have the preprinted diagnosis codes on the superbill anymore. For your labs, you will need to look up the codes in the manual. I have some common code cheat sheets on the way, but frankly, I didn’t get around to ordering those until last week, so we will have to ‘wing it’ and use the code books for a while.” Sounding calm and reassuring, she added, “Come and get me if you encounter any problems.”

“Will do” I reply, and head off to my nurse’s station. Christy, my nurse, is intently studying her monitor and seems oblivious to my presence. “Good morning, Christy,” I say. “Is there a problem?”

“Oh,” she says, not looking up, “ordering this is giving me trouble. I thought the EHR was going to convert the ICD-9 codes to ICD-10 codes, but the problem list in the patient’s chart has codes that contain an asterisk. Is that the same as an ‘x’ place holder?”

“Hmmm. I don’t know,” I respond. “Better check the code book to be sure.”

“I will, but Melissa from station B just came to borrow it,” she says. “One of their nurses was using theirs and she had a code she needed to look up.”

“Well,” I respond, “I wouldn’t worry about it now; just wait until you get the book back.”

“Well, what do I tell the patient?” she says, sounding a little perturbed. “The lab won’t draw her blood without a valid diagnosis code.”

“Oh…” I respond, now understanding her predicament. “Tell the patient it may take a few minutes and let Cathy know about the issue.” Problem solved. “I’m going to get started with my first patient. Are they ready?”

“Yes,” she sighs. “It’s Mrs. Johnson in room two.”

Mrs. Johnson, I recall, is the new patient I saw last week. She has hypertension and her lab showed that she has a significant cholesterol problem. She is here today to complete her evaluation and we will need to start cholesterol medication. Grabbing my stethoscope, I enter room two.

At the end of the encounter, I enter the new diagnosis of primary hypercholesterolemia, and everything goes smoothly. I also note with reassurance that in the problem list, her old ICD-9 diagnosis of benign hypertension, 401.1, has been replaced with the new ICD-10 code of I9. “Hmmm,” I think to myself, “this is working as it should.” A couple of clicks later and I am prescribing her simvastatin, but I almost instantly recall that this is not the best choice for her, given that her hypertension is being treated with amlodipine. As expected, the “wait” icon comes onto my screen. In a second I will see the drug interaction warning about simvastatin and amlodipine, and I will have to change my selection. But a second passes…then 10 seconds. After an awkward minute or two of silence, I make my apologies to the patient.

“I’m having a little trouble with the computer now, Mrs. Johnson. We’ll call that prescription in for you later today.” She seems understanding, so I usher her down the hall to the checkout window. I am looking at my tablet PC and the wait icon is still spinning. Then, as I watch, it stops. It doesn’t go away, it just stops. A more few clicks just confirm my fears that the computer has locked up.

I pop into Cathy’s office, and it is a bit crowded now. She and two ladies from the back office are peering at her desktop monitor. “I think I have a problem,” I announce. “I tried to send a prescription and the computer locked up.”

Cathy does not look up. With tension in her voice, she says, “the whole system is down.”

“What?” I am incredulous. “I crashed the whole system with a prescription?”

“I don’t know if it was that,” Cathy responds, “but I do know that when Lois downloaded an electronic remit file and tried to post it, everything came to a screeching halt. I am on hold with our EHR vendor now, and I am sending Betty to try to get through to our claims gateway representative.” She looks and sounds worried. I make my exit unnoticed, and I see that throughout the clinic there seems to be more activity than usual, and there is a palpable feeling of concern in the air.

Seeking some respite, I head across the hall to check in on my buddy, Dr. Frank Goodman, the orthopedist. Suddenly, I am aware of a faint buzzing noise. Ignoring the sound, I open the back door to Frank’s clinic and see a cluster of frustrated staff huddled together, gnashing their teeth and wringing their hands. Now the buzzing sound is really annoying. It gets louder and louder until I can’t ignore it anymore.

I wake up. My heart is racing, and there are a few beads of sweat on my forehead. I reach for the alarm clock and shut off that infernal buzzer. Groggily, I search my memory for today’s date. Thank goodness! It is nowhere near October. I have months to get ready! Hooray! That was a close one.

As I get ready for work, I have a fresh understanding of the ICD-10 transition. I need to take this seriously. We had all better do some intense training. We need to be asking our vendors a lot of questions. We need to be testing everything we can before October. Hopefully, my little dream will help us avoid a big nightmare!

About the Author

Stephen C. Spain, MD, CPC, is a family physician with more than 30 years of patient care experience. He currently serves as Physician Advisor to Career Step and, as such, informs their ICD-10 provider documentation education and presents the introduction to the Career Step online overview module, ICD-10: Understanding its Purpose and Value. In 1998, Dr. Spain founded Doc-U-Chart, a consulting firm that helps medical professionals improve their understanding and application of documentation and coding principles.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Dr. Stephen Spain, MD, CPC

Stephen C. Spain, MD, CPC, is a family physician with more than 30 years of patient care experience.  He currently serves as Physician Advisor to Career Step and, as such, informs their ICD-10 provider documentation education and presents the introduction to the Career Step online overview module, ICD-10: Understanding its Purpose and Value.  In 1998, Dr. Spain founded Doc-U-Chart, a consulting firm that helps medical professionals improve their understanding and application of documentation and coding principles.