ICD-10 : For What Purpose?

OPlogo_jmSomebody had to say it, and leave it to our outspoken colleague, Dr. Art Epstein, to note in his editorial this week what a bureaucratic nightmare the ICD-10 is going to be.  Here’s what Art has to say:

“ICD-10 is a little more than a month away. I hope the powers that be will forgive me, but I can’t muster any excitement about it. To the contrary, I am dreading it. Dreading ICD-10, not just for me, but for you and for our patients. Now, don’t paint me a “techno anarchist conspiracy theorist contrarian-geek.” I do get it. I understand greater specificity and more detail can facilitate inter-professional interaction and has the power to improve care. However, I am enough of a realist to understand that won’t happen.

I made the mistake of actually looking at ICD-10. In some areas, it seems to have been based upon reasonable clinical input and reflects current medical thinking; in other areas it seems outdated by at least a decade. Dry eye, for example, is a disaster area. Whoever drafted that section appears to have been locked in a room without access to the Internet nor seen a patient since the Mets last won the World Series.

I know ICD-10 will find its greatest use, at least at first, for rejecting insurance claims and making charting painful. It’s not as if our love affair with EHR hasn’t been rocky enough already, this will add yet another layer of meaningless and unnecessary complexity. It will force us to turn our backs to our patients even more, typing away, praying for drop-down lists that actually list helpful things. Sadly, it will waste the precious moments of patient face time that once defined quality healthcare. In its place, meaningful use—yet another bureaucratic cluster—will steal more time, add more meaningless complexity, fuel greater doctor/patient distrust and, in the end, accomplish little to help anyone.

As doctors we are bound by the tenet of first, do no harm. What a shame that the bureaucrats and administrators, the insurance companies and the other middlemen who have managed to wedge their way in between the doctor and their patient aren’t bound by the same principle. ICD-10. My diagnosis? More pain.”


9 thoughts on “ICD-10 : For What Purpose?

  1. I took it upon myself to computerize office records in the 1970s. My oldest son’s computer teacher helped write a program for the Optometric office. The program was done on an Apple II computer and included filling out insurance forms. We traveled the country lecturing about it. Optometrists were not interested, with some exceptions. Now we are still playing catch-up with the 21st century world and still ‘demanding’ a seat at the table. Wake up Optometry.

  2. “Surely this is one of those “inevitabilities”. But one has to wonder whether this iteration of ICD is one that is really necessary. What was wrong with ICD-9?” That’s the same response I got 40 years ago to computerizing and Optometric practice. The thing that is wrong with ICD-9 is that it doesn’t keep up with the latest scientific advances and the changes in the delivery of health care. Allopathic medicine says, ‘If it ain’t broke, don’t fix it.’ We are not allopathic physicians. I don’t want to be one. I have always advocated practicing at the point of advancement in Optometric care. Lead, don’t follow.

  3. I’d like to agree with you, but I’m inclined to agree more with Dr. Epstein that ICD-10 has many elements that don’t seem to fit with the latest science. He cited Dry Eye as a topical example. I can tell you from what I’ve seen with BV-related issues, ICD-10 obfuscates more than it illuminates. It really does happens sometimes that new iterations are offered as “improved”, but are not. At some point, leadership might involve challenging bureaucratic busy-work rather than accepting it as an improvement. Isn’t it ironic, Michael? So-called evidence-based medicine is wielded as a sword for slashing reimbursement. Yet the same reimbursement system offers no scientific evidence that ICD-10 is an advancement over ICD-9.

  4. I like to face the patient and do the best I can then fill out the ICD -10 later. This is contrary to my PCP who has eyes on the computer and rarely looks at me, but she does read the blood work report. My solution you may not like, but I take the ICD-9 codes placed on the left side and the ICD-10 codes on the right side (paper) (I like paper)…then I find the ICD-9 description and run my finger over to the right side to further specify. Other than E (endocrine, nutritional and metabolic diseases), and D (neoplasms) we are going to use mostly H eye codes.
    Example: 373.12 Hordeolum Internal…Meibominitis on the left side of the page goes to the right side of the page and on that side I pick H00.021 H00.22 HOO.024 H00.25. Never use unspecified for an insurance claim. That gives me only four choices.
    Many ICD-9 codes have only one ICD-10 code anyway. 367.31 ICD-9 goes to H52.31 ICD-10. (Anismetropia)
    Sorry, as stated, I use paper and send the super bill to my expert biller and she gets my office lots of claims and no rejects.
    For this she charges $2.50 per claim and even thought I pay her over one thousand per month I do not have to worry about someone calling me for a chart and the computers are down.
    I know I am old school and the kids coming out of Optometry School love the ICD-10 system, but I refract better.
    For Len: Saw today an 8 year old boy who had a right exotropia; surgery at U of M and now his right eye turns 40 degrees in.
    The surgeon told his Mom, the surgery did not work so maybe see an Optometrist and just get glasses. Well, pushing plus with 30 prism diopters out and nasal occlusion might work, but no guarantee after the mess they created. And you are too far for the patient to travel. Best, August

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