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BLOG: First reports on the transition to ICD-10
The big day came at the beginning of this month: the long-awaited and much-feared start of the mandated conversion from the beloved and revered ICD-9 to the complex and onerous ICD-10.
For those of us who were in active practice for the transition from the 1900s to 2000 and survived the dreaded Y2K virus, it was a bit of déjà vu. Some of the preparation lectures and warnings from vendors were enough to remind me of the thriller horror movies of the late 1990s that predicted the cataclysmic end of the world at the stroke of midnight on Dec. 31, 1999. That said, I was much happier to be down the road in my comfort level with my electronic health record (EHR) and wish to thank them for the work that they did behind the scenes to make the transition virtually seamless.
Even only 2 weeks into the transition, it has become automatic for me as a loyal EHR user to use ICD-10. I spoke with several of my friends who have not made the plunge into the EHR world, and even they report minimal transition problems. It seems the key for the non-EHR crowd was a few days of preparation over the summer to re-write the “super-bill” with the new codes and then a simple swap-out on Oct. 1.
Of course we have not seen the result of the payments using these new codes, so I may have a different opinion at this time next month. I am very optimistic however, that this will not be a problem. At the weekly senior management meeting of the health plan where I serve as the chief medical officer, I asked our team about the transition and received a very favorable report. Well over 97% of the providers had made the transition and were using the codes correctly for payment.
Last year, I wrote a blog that was published on April 7, 2014, titled, “Welcome relief from ICD-10.” I got a fair amount of black slaps and “atta boys” from my fellow ODs on this, but also a number of “eye rolls” from my friends at the health plan and others in the health care industry. One of my fellow health care consultants even took me aside and explained how that ICD-10 had more detail and specificity that would lead to better data on disease and ultimately better outcomes.
In retrospect, the eye rollers were correct. After that post, I got involved with the transition team and drilled down into the new system, found that it was more workable than I thought and that, for the ERH user, it would be a simple transition.
So, where do we go from here? Now that we can get more specific in our diagnosis coding and code the right eye separate from the left, as is often the case with eye disease, where else will this take us? For optometrists, it will take us deeper into the medical aspect of our care.
The correct coding of diabetes, for example, separating out type 1 from type 2 and coding for the disease being controlled vs. uncontrolled requires more questions and discussion with our patients about their systemic disease. The diagnosis list that always comes forward for each encounter in the EHR world is also part of the consolidated-clinical document architecture (C-CDA) that is created at the end of each encounter for meaningful use. The use of ICD-10 codes makes the C-CDA more meaningful and will improve collaboration of care among providers.
As I have said throughout this blog series, capturing medical eye data along with systemic medical health data points and transferring this data to other providers is key to being part of the health care team and fosters collaborative care. This, however, is not a simple one-step operation with the ability to go from isolation in our practices or in the eye care silo to full mainstream medical collaboration. This is a long-term process, all part of the health care reform agenda that will ultimately improve our nation’s health. So, in spite of the delay and all of the Y2K hype, ICD-10 is here and will be another step forward on the path to health care reform.