Ophthalmologists: Don't Put Off Learning ICD-10

Roger F. Steinert, MD


September 08, 2014

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Why Start Now?

Hello. I am Dr. Roger Steinert, Director of the Gavin Herbert Eye Institute and currently the Interim Dean of the School of Medicine at the University of California-Irvine.

The subject of this month's blog is ICD-10. Those of you who have been paying attention to this are thinking, "Why ICD-10 now? We were supposed to have that up and running by October 2014, but we have been given a 1-year reprieve, so we are looking at about 14 months before we have to deal with the challenges of that transition."

My point is that now is the ideal time for you to be seriously investigating ICD-10, learning about it yourself, and exploring how you are going to deal with this as seamlessly as possible in your practices.

For those of you who have made the transition to electronic records, you know how challenging that has been and you don't want to have this add to that burden if at all possible. In fact, this is one of the ways that electronic records, in principle, should be making the transition to the new coding system easier rather than harder. If you have an electronic system, you need to talk to your vendor and make sure that they are aggressively pursuing a method to assist you in the transition to ICD-10. It doesn't necessarily have to be a system with fully electronic billing.

Here at the University of California-Irvine, there has been some reluctance to believe that ICD-10 is going to be ready even a year from now. There are some serious challenges, and you don't want to end up with accidental repeated miscodings, reductions in reimbursement, or delays in reimbursement that could be devastating. The University is not convinced that it is going to be ready in a year; it certainly is not ready now, and it would not have been ready for October 2014, in their opinion.

On a more individual level, there are things that you could be doing slowly at the present time so that it starts to feel more comfortable and won't come as a shock. You will have systems in place so that your practice is not disrupted a year from now, which is going to come around pretty quickly.

Step One: Take a Course

So what do you do? From my experience, you have to take a course. You could take a personal course or an Internet-based course, but you need somebody to walk through this and explain it to you. I have tried to read the written explanations, and it is fairly bewildering. There are many explanations that don't sound like explanations. They sound like confusion. You need to invest the time in a course of some type, during which a good instructor walks you through this.

After that course, what do you do? I have found two things that help and they are both from the American Academy of Ophthalmology (AAO). The first is the basic manual for ICD-10 for ophthalmology. The basic concept is that you start with an alphabetical list of diagnoses. For example, you look up a diagnosis as simple as "cataract," and it will give you the approximate code area for cataract. From there you go into chapters that further define the subcategories and the subtypes of cataract, and help you be more specific. The types of cataract are different from those of ICD-9. Frankly, they do make more sense, and we just have to accept the fact that making more sense means more complexity.

The whole concept of ICD-10 is that the codes are basically six or seven characters, and most of the eye codes begin with "H," although we may delve into others that involve other body parts and other body systems. If it is a pure eye code, such as cataract or glaucoma, it will begin with "H." After that, there are typically two digits, then a decimal point and one more digit (to make five characters). The sixth digit is laterality: 1 for right eye, 2 for left eye, and 3 for both eyes. The seventh character (if there is one) will be for severity (1 through 3 for mild, moderate, and severe). Right now it feels a little foreign, but it is pretty easy to pick it up.

Step Two: Practice

To assist you in starting to feel more comfortable, the AAO has put out a workbook that provides examples. It starts with easy codes and becomes progressively more challenging. You work through the material and test yourself, allowing you to develop some confidence that you can figure out how to navigate this. There is an answer key, and when you make a mistake you will be able to see what your mistake was and how to address it.

That said, what I found deficient was that the instructions in the front of the book are way too cryptic and condensed, and all of the exceptions and deviations were nearly impossible to follow. This is why you really need to start with some kind of online instructional course.

It becomes much more complicated with diagnoses related to trauma and epidemiology. In ophthalmology, we are lucky that most of the time we are not dealing with those categories. In some fields, such as emergency medicine and orthopedics, these are much more commonly used, and those practitioners will be more challenged by ICD-10. You can feel a slight reduction in apprehension when you realize that some people are going to struggle with this a lot more than you. The horror stories that you have heard (such as the fact that the number of codes has increased by a factor of 100) primarily relate to the expansion in such areas as epidemiology and trauma. For example, a broken femur has to be coded down to a specificity level of how it was broken (eg, during a skiing accident). We will have to deal with that in a few areas, such as corneal abrasions and penetrating injuries, but it will be fairly rare.

I hope that this has been helpful to you. I urge you to start exploring ICD-10 in a methodical, measured way. Don't panic when you first try to learn about it. Just go over it a couple of times. It will become less threatening and then you can plan on how to smoothly integrate this into your practice, depending on whether you have paper or electronic billing and who your vendor is. Hopefully, long before October 2015, you will feel a lot more comfortable.

This is Dr. Roger Steinert, on behalf of Medscape. Thank you very much for listening.


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