ICD-10 from the Solo Physician's Perspective

By: Georgia Newman, MD

ICD-10 has arrived, but we don't yet know the extent of its impact or exactly how prepared we are for this new reality.

Do the insurance forms have enough room for the multiple digits and letters some codes require? Are we going to have to change each diagnosis in each and every patient's problem list manually? Are there programs like workers' compensation, which are not planning to switch? Do we have time on the fly after a visit to put in the new codes and switch the old codes before moving to the next patient, or will we become hopelessly behind, adding additional time to each visit? Are the payers prepared and will they pay us promptly, or are we in for delays like the sequestration snafus of the past? Will the payers pay at all, or come to a crashing halt?

I realize some physicians, usually employed, have someone else to code for them and figure it out. Those physicians simply have to add a lot of extra words to each visit: "initial or subsequent," "right or left," "complicated or not," etc., etc., and the poor sot in the coding department will have to struggle. Unfortunately, in solo practice, there is no "coding department."

The level of underlying angst has been slowly rising since June, complicated by the announcement that my office manager/biller would be moving to another state. She has now moved, but will bill through my cloud-based EHR from Georgia. In a sense, the chaos currently happening is like a nuclear strike in outer space: soundless and distant.

In the days prior to Oct. 1, my level of general anxiety and fear escalated and I was forced into action. I spent most of three weekends, laboriously looking up codes on an online site. I created lists of common codes and totally reworked my lab and X-ray order forms. I found an online program -ICD10charts.com - which is the brainchild of a medical family and purports to be able to magically transform all of the codes in your EHR to ICD-10. Or will it crash the entire program irretrievably? So far, I am afraid to install it.

To add to the misery, even the code books are a mess. One can purchase an ICD-10 2015 book, useful at great expense, for three months, or/and purchase an ICD-10 2016 book, which could have codes not yet approved if used in 2015. Of course, I could be hit by a bus tomorrow and all this worry would have been in vain.