Updated on: March 16, 2016

Stop the Insanity

Original story posted on: March 3, 2014

As we hurtle toward the October 1, 2014, ICD-10 implementation date, it seems more and more focus is on the outlandish, rather than the key documentation issues for physicians and coders. My grave concern is that the current “insanity” is such an unfortunate distraction at such a critical time.

In the past week alone, I have been contacted by upset physicians, listened to an informed Medicare beneficiary express concern on the related healthcare costs, heard stories of a group of professionals very publically making fun of ICD-10, and listened to some of the best coders I know angst over the embarrassment of how ICD-10 is being advertised and how negatively that reflects on their professionalism and expertise. I agree with every one of them! More frightening is why and how every one of those people, from all over the United States, heard the “bit by a turtle in a mobile home” story! It is truly a story sweeping the nation.


Why and how have we garbled the message so badly that the only news seems to be that we can soon report being bitten by a turtle, injured in a spacecraft, waterskiing on fire, or other highly unlikely events? How did the message get omitted that “there is no national requirement for mandatory ICD-10-CM external cause code reporting,” unless a state or payor mandate exists? Obviously, valuable information could be conveyed through external cause reporting, and is encouraged. However, I am confident the intent is gleaning better understanding of the normal events that provide data on high-risk populations, injury prevention, emergency services, risk management, etc. Why is there virtually zero focus on how realistic reporting of common events is valuable? How it will impact our lives in our communities? How it can improve healthcare?

The real message about ICD-10 is one of benefit to the patient and the healthcare provider. Most physicians have long known that documentation that is complete, detailed, and excellent for clinical care is also their best defense against malpractice. Accurate, complete, detailed medical record documentation is about far more than a turtle bite. It does, or should, eliminate misinterpretation by other healthcare professionals.

Given the OIG audit findings that about one in seven Medicare patients is injured or killed during their hospital visit, any and all improvements that will prevent negative events or save a patient should be the focus. Is ICD-10 one weapon in that fight to improve patient care and outcomes? Absolutely.

Most coders have long known that as documentation is excellent for clinical care it is also excellent for coding. Excellent coding is tied to appropriate reimbursement and quality data. When we take time to look at the whole picture, the pieces come together perfectly to benefit everyone: the patient, the provider, the coder, the payer, and the data analysts. So let’s focus on that. Let’s stay on topic with what we all care about most. Will I have excellent care? Will I have a good outcome if I am ill or injured? Can I prevent disease or illness? How do I pick a provider dedicated to quality? Will my bill be accurate? Will my insurance pay for my claims? Successful ICD-10 implementation plays a key role in all the things we care about most.

Unintended or with malice aforethought, these distractions divert attention, time, and resources from the critical tasks that need to be finalized, tested, and implemented in the next 214 days. Physicians need to focus on accurately and completely documenting their everyday patient encounters and care. Coders need to provide feedback on that documentation adequacy for coding. When choosing teaching scenarios, make them realistic and relevant to the physician’s practice. ICD-10 is going to happen, so those who do not take it seriously need to change their mindset right now.

I encourage every one of us involved in this admittedly gargantuan undertaking to do their part to keep the focus on the true goal, improved patient care. Take advantage of teaching moments to educate those who think ICD-10 is all about a turtle bite or skiing on fire. It’s not. This is not a competition to find the most ridiculous coding scenario possible. We have very little time left to prepare and not one second should be wasted on distractions.

Stop the insanity!

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.
Holly Louie, RN, BSN, CHBME

Holly Louie is the compliance officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho. Holly was the 2016 president of the Healthcare Business and Management Association (HBMA) and previously chaired the ICD-10 Committee. Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing, and regulatory compliance. She has previously held compliance officer positions in local and international billing companies. Holly is a member of the ICD10monitor editor board and a popular guest on Talk Ten Tuesdays.