ICD-10: Nightmare or Non-event?

Pulling your hair out? There’s an ICD-10 code for that.

And it’s F63.3. There has been much talk about ICD-10 leading up to its implementation this past week. There have been webinars, live lectures, books, and apps dedicated to preparing us to use the thousands of new codes. I think many of us were hoping that it would again be postponed, and delayed even acknowledging its existence until mid-September.

In the last 3 days, there have been numerous humorous posts on social media-funny codes (struck by duck seems to be a favorite), curses with matching ICD-10 codes (like B85.3) have been wished upon its creators, and memes abound, including some with the Most Interesting Man in the World (He doesn't always get sucked into jet engines...).

I must say, however, that we have had a fairly uneventful transition. At least as far as generating the correct codes (hopefully) for our outpatient notes. Our EMR automatically gives us options of appropriate ICD-10 codes to replace existing ICD-9 codes. It also alerts us if there is an optional additional code we can use. For example, if we code 250.01, it pulls up E10.9 and alerts us that we can use the Z code 79.4 for long-term current use of insulin. And if we don’t like E10.9, we can search for related codes. It’s taking a little longer to finish a note than it normally would, but not by much.

So far, my biller has only submitted a few claims with the new codes. There have been no obvious issues. Whether or not claims processing will go smoothly will have to be seen.

The bigger and more tedious problem we are having now is providing new codes for old prescriptions and test requests. Any lab or radiology request we printed out previously had ICD-9 codes. Now people are calling because they need the new codes. And any prescriptions that require diagnosis codes, such as those for diabetes testing supplies, need to be resent with the appropriate codes. Since neither I nor my staff have these memorized yet, we need to look them up each time. Granted, as a specialty, there are not that many codes we need to know compared to primary care providers. I did print out the most common codes we use, but every now and then there is an outlier that we need to research more.

My staff asked me what the point was of the change. And therein lies the $100,000 question. Does it matter to Mrs. Smith’s diabetes supply company if 2 weeks ago she had 250.02 and today she has E11.65? That won’t change how many strips she needs. My biller asked if it matters if I put a code for type 1 diabetes mellitus, with mild non-proliferative retinopathy without macular edema (E10.329) or if I put E10.39 - type 1 diabetes mellitus with other diabetic ophthalmic complication. Right now, for billing purposes, probably not. Will it matter someday when they figure out how to use the data they want to gather? Maybe. 

I had been dreading ICD-10 implementation with the same anxiety I had before Y2K (Wow, was that really almost 16 years ago?). But for now, it seems that it is mostly business as usual.