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ICD-10: Painful To Implement, Painful To Delay
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SidS530
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SidS530,
User Rank: Apprentice
6/26/2014 | 8:16:39 PM
Re: ICD10 delay
First it is excellent that it is going to being delayed. I am a critical care physician and have used many EMR 

I have been involved when I was DOD healthcare implementing EMR and telemedicine

ICD 10 is generally a good product for its specificity and granularity. I am familar with the people who worked on SNOMED. In reality Snomed has been close to 20 years and althoug it has great specificity and exactly more in line with physicians thinking , it is cumbersome for physician to use and it is great for an healthcare dictionary for coding.

1. To make this right, this needs to be field tested by physicians in many organizations and study completed to see if it has any significant improvement in outcomes, qulaity of care,  and improves productivity and efficiency.Goal is not to make physicians a documentation puppet but to give care to patient. Looking at the ICD 10 compared to ICD 9, ICD 10 is certainly will cause more physicians to be less productive. The  reality is even with present EMR including EPIC and Cerner (has better coding database) most physicians do not use the EMR codes. Problems and diagnoses are not necessary updated. In reality most physicians free test codes. I suspect the of ICD 10 will be to free text more codes in their progress notes rather than wasting time with granularity that govt, healthcare informatics zealots, and the lobbyist who want this system. The bottom line if it impacts productivity do not expect that physicians will use this. I suspect in general that greater details may produce some more reimbursement but at the expense of multiple times to get right codes in. I suspect the reimbursements will decline for physicians overtime in spite of extensive more documentaton. 

2. We should know what percent of the codes ICD 10 documentation improves reimbursement for physicians. I

3. Although ICD 9 to ICD 10 calculators will be helpful, it still is cumbersome mainly because you are going to have detail ingreater  depth the diagnoses. You need severity, laterality, associated conditions, etc. This is onerous. 

4. Many statements are being made how it will improve quality of care, outcomes, better data, better reimbursement. I take all these statements for granted and there is not much to support these claims.

5. Like a family practic doctor said,the laterality and other specificy in coding does not make much difference for healthcare insurances for reimbursement. There are going to be exceptions but I do not see the granualrity that has needed here . 

6. ICD 10 would be ideal for one problem: Death certificates. IF Information in ICD 10 if it could be entered on death certificates will be a better tool to document events leading to a patients death and therefore a bettter comparison on outcomes on international level for various countries. 

 
Alison_Diana
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Alison_Diana,
User Rank: Author
4/4/2014 | 4:04:04 PM
Re: Convert and Train You Entire Staff in 90 Mins for $1,788 Annually (Mapping and Dual Coding) in Seconds
The complete lack of integration within EHRs is crazy. At a time when most other industries won't look at a system unless it's open and integrated, healthcare providers don't have that option for one of the biggest IT purchases they must make. 
David F. Carr
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David F. Carr,
User Rank: Author
3/31/2014 | 9:05:12 PM
ICD-10 implementation officially pushed back a year
It's official, Congress passed "doc fix" bill that includes ICD-10 delay.
David F. Carr
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David F. Carr,
User Rank: Author
3/31/2014 | 6:56:42 PM
Re: True, but....
Remember that the US edition of ICD-10 is not the same as what's used elsewhere in the world. There is a base international standard, but multiple variants and additional codes layered on top of it -- with the version specified in the U.S. probably more complex because it's being used for billing rather than just statistical tracking.

This is where my liberal friends would point out how much simpler things would be in a single payer system.
David F. Carr
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David F. Carr,
User Rank: Author
3/31/2014 | 6:53:23 PM
Re: Convert and Train You Entire Staff in 90 Mins for $1,788 Annually (Mapping and Dual Coding) in Seconds
I hear a lot of this from EHR vendors, that ICD-10 shouldn't be a problem if only everyone would convert to their wonderful product. May even be some truth in it. Just got the cook's tour of Modernizing Medicine's iPad-based touch interface for recording patient encounters, which comes in custom editions for specialties like dermatology. Easy to see how working with a 3D model of the patient makes it possible to specify the correct region of the body without looking up a code. But you have to be in one of the specialties they cover for it to be helpful.

The emergency room doc I spoke with is worried about having to use multiple EHRs at different hospitals he contracts with. On October 1, doctors are going to be using all sorts of EHRs at different levels of capability related to ease of use and ICD-10. They're not all going to flock to your product or any other. Whenever this transition happens, it's going to bring pain and disruption -- the question is whether the time has come to get it over with.
LSPEECE
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LSPEECE,
User Rank: Apprentice
3/31/2014 | 6:52:26 PM
True, but....
Good points on both sides. As a facility medical coder, we have no idea what the small physician offices have to go through to make ends meet. I see your pain. On the other hand, why did the rest of the civilized world move to ICD10 in the 1990's? They somehow managed to make the transition well enough and Australia, for one, is in the 8th edition of ICD10 now. The US refuses to bite the bullet in all things fiscal and do what needs to be done and utilize all the modern technology we have available to us in the 21th century. I think that reimbursement would increase with the detail available in the new codes. I like the compromise the family doctor suggested a few posts ago and letting the large facilities move to ICD10 in 2014 and postponing it for the small offices to 2015.
sburgernutr
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sburgernutr,
User Rank: Apprentice
3/31/2014 | 5:15:24 PM
Re: ICD10 delay
cdavant3, I am a board member on a professional association for about 100 SOLO practitioners.  I just sat down myself and went through the ICD-9 and the ICD-10 codes for conversions.  For our profession the new codes are spectacular and very straightforward.  The old ICD-9 codes really are inadequate and give the insurance companies more leeway to deny our claims.  I for one regret the delay.  I found one of those coding websites that only cost about $50 a month.  It wasn't that hard to work with. I created superbills and a coding book for all our members.  It was not rocket science.
sburgernutr
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sburgernutr,
User Rank: Apprentice
3/31/2014 | 5:09:50 PM
Re: What's in it for Me?
Lewis, as a solo practitioner in a small field that is not well recognized by insurance companies I actually find the ICD-10s to make sense for my profession.  They diagnoses are clear cut, unlike the ICD-9s which require all sorts of extra digits that make no sense whatsoever.  I can't tell you how many practitioners in my profession have rejections thanks to the need to add the "fifth digit" codes for the ICD-9s. 
rjohnston2268
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rjohnston2268,
User Rank: Apprentice
3/31/2014 | 4:56:20 PM
Convert and Train You Entire Staff in 90 Mins for $1,788 Annually (Mapping and Dual Coding) in Seconds
The numbers being thrown around by, "The American Medical Association predicting this will be extremely costly for physicians, is false!!!!!  "The AMA estimates the cost of switching to ICD-10 at as much as $8 million for a large physician practice and more than $225,000 for a smaller one".  This is also grossly inflated.

 

What if I told you we have a solution that is cloud based and can covert the ICD-9 code to ICD-10 code in less than 2 seconds as well intelligently build your common codes automatically, in real-time with in a few seconds.  And your staff can be trained with in 90 mins at a cost of $1,788 per provider annually or $149.00 per month.  I demoed this to 3 well known health systems in Northeast, Ohio and the first comment I received was when can I get it and how much. 

 

The government and the Big 5 Consulting firms are trying to scare all of these small practices and the large health systems in to thinking it will cost millions.  That is a completely false.  It will cost a small community health system in Ohio with 127 doctors in the network roughly $227,076.00 Annually ($1,788.00 avg., per provider), for all 127 practices.  These are estimates, but based on what we where going to quote a small health system this is pretty accurate.   I challenge anyone on this. 

Contact me at:  rjohnston@strongbasehc.com 

 

Key Features Of our Solution: 

•       Explore ICD-10 Chapters 

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•       One click access from GEMs to ICD-10 code details 

•       Forward and backward GEMs with 2 clicks 

•       Auto complete Index search 

•       One click navigation from Index to Table 

•       Search directly in ICD-10 Table 

•       One click navigation to Exclude codes 

•       Color-coding based on CMS guidelines. 

Key Benefits Of our Solution: 

•       Convert your existing ICD-9 cheat sheets to ICD-10 SmartSheet in seconds. 

•       Utilize GEMs to create Personalized Crosswalks with just a few clicks. 

•       Dual Coding 

•       Review relevant notes and guidelines at time of selecting the code. 

•       Color-coding to ensure selection of only valid codes 
anon2858894915
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anon2858894915,
User Rank: Apprentice
3/31/2014 | 4:22:54 PM
Re: What's in it for Me?
Doctors have a hard enough time following the rules of I-9; yeah so I 1-10 will be a nightmare.

 
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