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11/18/2013    Joshua Kaye, DPM

ICD-10, a Recipe for Disaster? (Neil H Hecht, DPM)

In reading through various articles and blogs
regarding the October 1, 2014 looming date for the
conversion to ICD-10, it is beginning to sound
like the fears during 1999 considering Y2K.
Unless I am very naïve or missing the point, the
complexity of the transition appears to be
exaggerated. There are two distinct components to
the transition. One part is the upgrading to the
new ICD-10 code number which contains two or more
digits than ICD-9. The second part is strictly a
software change, involving both the EMR and the
billing software. So let’s take a look at these
two components.

ICD-10 requires a greater level of specificity for
a diagnosis and the increase of the number of
digits of the diagnostic code will demonstrate
that specificity. So if we have a patient with an
ankle sprain, for example, ICD-10 will require
determining whether the injury occurred while
playing soccer or as a result of a car accident.
That doesn’t seem so difficult.

If the upgraded EMR, interface program and billing
software is appropriately written, if the ICD-9
code is entered, that should trigger a selection
of appropriate ICD-10 choices. Once the
appropriate ICD-10 choice has been determined, the
increased software field size should then allow
the upgraded code to be digitally transferred to
the billing software and on to the insurance
company or Medicare. Assuming that the software is
written in a user-friendly manner, we would not be
concerned with that portion of the new process.

There may be tens of thousands of new codes with
ICD-10, but realistically, as with any medical
specialty, we would likely only use a tiny
fraction of those new codes.

Using the above example of the ankle sprain, of
all the different ICD-10 codes, I don’t believe
one code will result in a greater payment than
another for the same injury. The level of patient
care will not improve or change. And if an error
in the selection of the precise ICD-10 code is
made, I don’t believe that will result in an
audit. ICD-10 was designed for the bean counters
of the medical world. Honest errors in ICD-10 code
selection will be rampant during the early stages
of the conversion.

Putting future changes of healthcare into
appropriate perspective, ICD-10 conversion will be
one of our smallest concerns.

Joshua Kaye, DPM, Los Angeles, CA,

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