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ICD-10: The Elephant in the Room

With ICD-10 “Go-Live” compliance date being 12am - October 1, 2015 (36 hours 45 minutes away as this is being written)1, we’ve been experimenting with the CMS/Medicare resources2, and in particular their ICD-10 code lookup “tool3”. Our object in doing so was to figure out how to quickly determine the appropriate code for any given case. Why?

While it is most likely that physicians will not be entering their own codes on a regular basis, some will do so, either by requirement or choice. In other cases a coder will most often be responsible for being sure the submitted code corresponds to the documentation. In either case, the issue will be finding the appropriate code for the case in question. If the search for that code takes an inordinate amount of time, care will be compromised when a physician has to direct attention away from patients to search for an ICD-10 item. If it is a coder, the efficiency of coding operations will be diminished, and in many cases, more coders will thus be needed. As the cost of physicians and coders is non-zero, such anticipated new inefficiencies can be expected to be expensive. Hence the cost of care is quite likely to be adversely impacted. “Affordable,” you see, exists at present in the eyes of the beholder, but not necessarily in the eyes of the one writing the check, whether it bounces or not.

So we were trying to see how well the CMS code-lookup tool worked, and to ascertain what insights into the mind of ICD-10’s creators, we could obtain. We recommend that each of you try this out. The web-link is below3, or you can Google ICD-10 code lookup. Once there, ICD-10’s fun and complexity begin to be revealed. Moreover, it is clear that CMS did not hire a Google-trained developer to create its search engine. The basic elements of good search are missing. This one small oversight will cost millions. A good search engine needs to have certain basic elements. For example, if you type in either cars or car in Google, you will get a search not unlike that if you type in auto. That is, the search engine “knows” what items are identical or nearly related. This basic component affords compatibility with users, also known as humans, also known to be imperfect. In medicine, no less does such flexibility need to be present in search engines. But no! The CMS ICD-10 search engine requires extreme specificity in keywords. We wanted to see codes for an aortic dissection. Entering “aortic dissection” gets you nowhere. Entering aorta dissection is required. Unlimited examples can be obtained if you try it yourself.

Therefore, if you are the one who has to put in the right ICD-10 code—good luck. But since neither luck, nor CMS fixes, are items to be banked upon, we suggest you create a “cheat sheet” of keywords to expedite the process. Post it, and have therein the common items that are used in your care setting. Classic provider diagnosis is totally inconsistent in the ICD-10 lexicon.

Examples (try them):

  1. Acute Myocardial Infarction (does not exist as an independent entity; lised in search results are comorbidities only).

  2. Myocardial infarction (returns subsets, but lord help you if you put in acute)

  3. NSTEMI (works)

  4. STEMI also (works - with subsets for anatomical and arterial sites, if known)

  5. Unstable angina (works – but if you specify beyond 120.0, you are into transplantation and bypass graft sequelae)

  6. If you use the keyword angina- ICD-10 gives you a list of 30. Have fun reading.

  7. Pneumonia – (oh boy…you get 100 to chose from)

  8. If you put in community acquired pneumonia – nothing

  9. Hospital acquired pneumonia - nothing

  10. Better have your billing company tell you which one to select

  11. Acute Bronchitis—(works –kinda – get a list of 11, nine of which you need to specify the organism, and the other two are organism unspecified and neither acute nor chronic). Having fun yet.

  12. Bronchitis alone expands the list

  13. The last of these is J68.0 (Bronchitis and pneumonia due to chemicals, gases, fumes, and vapors). And if you search, then, inhalation, you get a series that begins with J69.0 (but not J68.0). You must be having fun at this point.

  14. Pharyngitis – (sort of works –the things we see all the time, e.g. early congenital syphilitic pharyngitis come to the top of the list….while those that are comparatively rare, like strep pharyngitis or acute pharyngitis, unspecified are further on down).

  15. As a final example (among many, many possibilities) of what is going to be frustrating, if you put in pulmonary embolism you get a list of six codes, none of which apply to a case of acute pulmonary embolism. If you put in pulmonary embolus, you get two codes for saddle embolus with or without cor pulmonale. And finally if you put in just embolism, you get a goldmine (!), but it is longer than Tolstoy’s War and Peace. At that point, I tried lung embolism and got “There are no ICD-10 Codes that match.”

Oh brother, this will be a slow process with a great deal of frustration. If readers send in their most common, basic diagnosis list with and ICD-10 equivalent, we will try to create a spreadsheet for common usage. Keep in mind, too, that selected codes must correspond to the correct code assignment (in the ICD-10 CM/PCS). Otherwise appropriate reimbursement for any clinical entity billed to a payor/insurance company may likely not occur.


1. Countdown & Overview:

2. Provider Resources:

3. Code Lookup

XpressTechnologies practice management, billing and Electronic Health Record are ICD-10 ready and compliant and will provide any assistance in this major transition.

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