11/20/2013    Bryan C. Markinson, DPM

ICD-10, a Recipe for Disaster? (Joshua Kaye, DPM)

I am the podiatry ICD-10 Champion of my hospital
network. Don't confuse the word champion to mean
any proficiency at the moment. I am just the
interface person between hospital administration
and the podiatrists and residents who must learn,
adapt, and implement the new system. They "train"
me, I train "them."

The ICD-10 system is a more exacting detailed
description, that among other things must include
severity, laterality, and, general health of the
patient. Anyone who thinks that a drop-down menu
with 35 more choices to scan though will not be
more time stealing has another thing coming. I do
believe that Dr. Kaye is correct that when we get
down to it, maybe the most common things we do
will be easy to crosswalk, but the diabetic with
no primary care physician who walks in without
pulses and frank gangrene, where you must pick the
perhaps yet undiagnosed type of atherosclerosis
they have, is another matter.

Additionally, the ICD-10 conversion on the
insurance side is completely dependent on chart
auditing, which will skyrocket as the details
required will be increasing and more apt to be
deficient. Add to that the OIG warnings on cloning
notes, and the note-bloat endemic with most EMR
systems users, I would find it miraculous that
providers who do not pay attention (most already
admit they wont be ready) will find themselves
under a mountain of denied claims, as well as
requests for notes, then money.

In my hospital, we are going live well in advance
of the implementation date to get a sense of how
it will flow, but already we have been advised
that coders will be asking us very often if we are
sure of certain things we have written in the
notes. To that end we are creating extremely
detailed templates as best as we can to address
all the key points that could be brought up by our
choice of code (and don't forget your LCD
guidelines). That these changes will cost me 5-10
visits a day on top of what EMR has already cost
me is a certainty.

Our coders in the network is somewhat of a safety
net before the claims actually go out. For those
in private practice, your office manager and coder
for the last 20 years has to get seriously trained
in this implementation, or the first level of
screening of your claims will be at the insurance
company.

Bryan C. Markinson, DPM, NY, NY,
Bryan.Markinson@mountsinai.org

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