The ICD-10 switch has always been a problematic proposition with an astounding number of moving pieces that need to be upgraded, coordinated, oiled, and polished. In a large hospital or healthcare system, the onerous transition has dragged on for years, and with the most recent delay pushing the compliance date back to 2015, the industry is looking at another twelve months of very hard work.
But is the burden as great on small providers? Can solo physicians or groups of two and three providers make the necessary changes more quickly? While limited resources and a lack of technological savvy have long been cited as reasons why independent providers are falling behind the EHR adoption and ICD-10 curve, Dr. Jed Shay of the Pain Care Clinic in Rock Springs, Wyoming, believes that a small practice with a basic level of know-how can convert to ICD-10 in just a few days.
How do you think the ICD-10 delay will impact your practice?
I’ve been looking at this issue for the past year, and I believe that the impact of the ICD-10 delay is really minimal on my practice. I wish that we had gone ahead and implemented this October. It’s always better to do it sooner than later. It’s a pill that needs to be swallowed, and the longer you drag it out, the more painful it becomes. It doesn’t affect me if they implement it this October or next October. I would have been ready regardless.
Fortunately, for a small operation like mine, I have the capability of designing my templates with the appropriate ICD-9 or ICD-10 codes embedded in them and matched to my charge sheets. So when the time comes, the effect on my operation will be minimal. However, I cannot say the same thing on the side of the insurance companies. If they’re ready or not…that’s a different question.
Now for larger practices, it’s a little bit different. You’re dealing with multiple layers of operations and individuals who interact with the EHR and the practice management software. And each one of these people has their own tasks and their own rules, their own templates, and their own database that they look at and they’re trained on.
And if they don’t talk with each other, then it doesn’t matter what the doctor wrote on his notes if the biller doesn’t understand how to use ICD-10. And vice versa. If the doctor does not understand which documents support the ICD-10 codes that the biller is sending out, that’s also bound to fail.
The smaller the operation, the easier it is. It’s like a big ship. It’s very hard to turn a big ship, but a small boat you can turn on the wind. Some of the larger institutions with multiple departments and multiple physicians and different billers, they’re going to have a little bit harder time, I believe, with the ICD-10 implementation than the smaller-sized practices.
What work have you done towards the ICD-10 transition, and how difficult has it been?
I design all of my own templates, and I’ve mapped the ICD-9 codes. There are twenty to thirty different templates of different work that I do, and I’ve changed them to include the appropriate ICD-10 codes.
Of course, there will be a learning curve for me to learn what I need to document to support the mapped ICD-10 code. But I don’t expect it to take me more than a few weekends of changing my templates. And if my EHR and practice management systems are ready to have those codes in their database, which from what I’m understanding will be by October, it won’t be a very difficult transition for me, I don’t think.
Now, if you have a small practice with doctors who are not savvy designing their own templates, and they don’t understand the concept of what mapping is and how they can relate their notes to a charge sheet, then they’re going to be having a difficult time because they’re relying on someone else, their IT department, or someone from outside to do this, or their vendors to do this for them.
I don’t rely on anyone. I rely on myself. It’s my practice. I really don’t rely on my vendor to do my coding for me. I expect them to have the capabilities, but it is my duty and my job to understand how the coding works. And if the individual practitioner learns that, and understands how his EHR platform operates, then he can easily go back there and design the templates that he or she needs.
Are there any anticipated problems with the conversion?
When I go to my specialty organizations and I try to retrieve the ICD-10 codes that correspond to the appropriate ICD-9 codes, there is still lack of information out there. If October rolls around and I still cannot retrieve the appropriate ICD-10 codes, then my answer to your question would probably be different at that time. But I haven’t heard that that’s not going to be available. In fact, there are a few sites that have started putting some codes out there.
I have not seen a complete list of ICD-10 codes out there. I’m not aware of them. That’s the only area that is kind of lagging behind. But if I had my ICD-10 codes today, I could complete my ten most common templates tonight with the ICD-10 codes, and start sending out charge sheets with ICD-10 codes tomorrow. It’s not difficult. If my software gives me that opportunity and that option, and if the release the ICD-10 code, I could do it tonight.
Are the colleagues you’ve spoken to similarly sanguine about the switch?
Many of my colleagues are a little more technical. Those who have designed their own templates, they tell me the same thing: they don’t think it’s a big deal. But then I’ve got some friends who never really liked the idea of the EHR to begin with, and they are a little bit more resistant. As if meaningful use was not enough, right? And now there’s ICD-10 on top of it.
What it boils down to is that some people don’t like changes. And I think this time, the number of people who didn’t like change was more than people who did like the changes, then that’s why it was delayed. And that’s usually the government’s case. Just keep delaying stuff. It’s a pill that needs to be swallowed and we all know that. So, I’d much rather just get it over with. Source
