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EPtalk by Dr. Jayne 6/18/15

June 18, 2015 Dr. Jayne 2 Comments


Some days I have a love/hate relationship with social media. There are simply too many things to read and not enough time in the day, especially while I’m trying to grow my consulting business and regain my sanity after years in the non-profit health system universe. It was with great dread that I read Mr. H’s comment on Twitter upping its character limit from 140 to 10,000. I have a hard time keeping up with the current twitterverse, where people are forced to parse their thoughts. I can’t imagine what things will become. I know I had to think more along the lines of Haiku than Soliloquy when posting and that was a challenge. We’ll have to see how it flows once the change becomes real.


Crushed by alligator: W58.03XA

One of my clients is arriving at the ICD-10 dance a little late. Although they thought they had been preparing, they lost some key resources and really aren’t sure where they stand. I would bet that they’re fairly representative of small-ish physician owned practices across the country. They aren’t large enough to have dedicated resources, so ICD-10 became “other duties as assigned” for members of the practice. Once those resources moved on, they were in a bind.

I have to give them full credit, though, for realizing that they have an issue and reaching out for help. My first task was to go through the former employees’ computer files (which thankfully the office kept copies of) and identify any ICD-10 preparedness work or documentation that already existed. There was actually a decent amount of material – especially vendor documentation, a couple of partially completed assessment matrixes, and a library of vendor contacts.

I reached out to their EHR vendor and found that they were already offering an ongoing series of webinars. It’s a specialty-specific EHR that I hadn’t worked with previously, so I signed up. At first, I was skeptical because the webinar started late (normally a black mark in my book). However, my opinion started to turn when I realized that they had already placed ICD-10 under the hood of the application almost a year ago. Since it’s a hosted product, the client just has to open a support ticket to get it turned on. Whenever they’re ready, the client can start with dual coding workflows.

The conversion will occur by payer, and based on an effective date of 10/1, so it doesn’t hurt anyone to go ahead and get ICD-10 going. Once the switched is flipped, providers will see an extra column in their diagnosis grid that will hold the ICD-10 codes. Additionally, when selecting an assessment, they’ll be prompted for laterality (right, left, bilateral, unspecified) on applicable diagnoses before they can make their final selections. That all looked pretty good.

I wasn’t impressed, however, by how the providers have to modify their custom lists for past medical history and assessments to associate ICD-10 codes. This provider mapping has to be done through the practice management system. Although they have embedded crosswalks to assist, it doesn’t look like the mapping process shows the native ICD-10 descriptions but rather just the ICD-9 ones. For me as a physician, it would be difficult to trust the mapping without being able to see the native description. Additionally, when walking through the provider mapping process, some diagnoses didn’t appear to have bilateral as a choice even though right, left, and unspecified were present.

They offered interactive question and answer time after the formal presentation. The attendees were pretty quiet, despite there being a number of them dialed in. It was difficult to tell whether they had no questions because they were: a) deer in the headlights; b) confident in the workflow; or c) tuned out and just attending the webinar because someone told them to. The vendor did provide a document with frequently asked questions that was pretty solid, explaining the testing processes they’ve used and their plans for handling billing should something go dramatically wrong on October 1.

I found it interesting that in the FAQ they admitted that they had to use third-party development resources to help meet the timeline. Additionally, they said that their clearinghouse is positioned to provide additional support should there be any issues with claims submission. They also explained in the document that they’ve been using SNOMED coding all along and that is the intermediary by which they are going to transition the ICD codes. The FAQ document also made it clear that they anticipate there may be some downstream issues with payers having “varying levels of preparedness for the deadline.”

Having come from the client-server, self-hosted world, I appreciated the fact that the vendor has done significant claims testing that individual customers do not have to repeat. The vendor uses a single clearinghouse, so I’m sure that made the testing a bit easier than it might have been. I feel pretty confident this client will be OK from a technology standpoint, but am planning some face-to-face provider education as well as structured practice sessions in their test environment. I’m already looking for funny scenarios to break up the monotony of training and found this one today: Z63.1: Problems in relationships with in-laws.

What’s your favorite new ICD-10 code? Email me.

Email Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. Re: Twitter change – AFAIU, the length change is only for person-to-person messaging (helping Twitter replace other “chat” apps). The tweets “for all” will remain short, and (hopefully) to the point.

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