Physicians Have One less Thing to Fear This Hallowe’en
Oct 20, 2014
by Dr. Jon Elion

You know, with Halloween just around the corner, physicians may find it comforting to know that ICD-10 does not need to be on our list of scary things. We’ve all heard so much about ICD-10 I think we’re getting a bit numbed to the subject and having trouble separating fact from fiction. Of course, many doctors need to be concerned about running a business (namely, their practice), and they wonder how all this will impact their bottom line. But I want to focus instead on ICD-10 as it impacts the clinical side of our profession.

Hey, docs, like it or not, we are being watched. Hospitals, HMOs, insurance companies, and other payers are profiling our clinical practice, our resource utilization and our outcomes. They are creating and using scorecards on individual physicians, not just hospitals and healthcare systems. And they’re doing all this while using a coding system that was put into place in 1979. It’s antiquated, out-of-date, and inadequate to codify modern medical practices. I like to think of it as trying to writing to write a PhD dissertation using third-grade grammar. In order to fully code what it is we do, along with all the conditions and co-morbidities of our patients, we must update our methodologies — and that means ICD-10.

I recently had to complete ICD-10 training for Cardiology in order to maintain privileges at my hospital. Now, the color slides certainly were delightful, but there was little in the training that could not have been accounted for by two simple phrases: “Due To” and “Manifested By.”  Physicians absolutely must be educated about the principles of proper and complete clinical documentation. Why is there a gap between the notes we write to communicate doc-to-doc, and those needed by the hospital to properly code and bill the encounter? And how do we close that gap? Proper training on how to write such notes will provide everything needed for helping with ICD-10 compliance.

I have one new phrase that I want to add to our list: M.E.A.T — for every condition that you mention in your clinical note, you should indicate whether that condition was M-Monitored, E-Evaluated, A-Assessed, or T-Treated. This will help in getting full and proper credit for conditions that go into risk-adjusted reimbursement models such as Medicare Advantage. There’s a very important topic we’ll need to leave for another day.

So, physicians who are vegetarians may have a little trouble swallowing the concept of M.E.A.T., but omnivores shouldn’t have any problem. Remember — payers are watching! We are being Monitored. We are being Evaluated. We are being Assessed. But the Treatment is easy. Start to use “Due to.” Start to use “Evaluated by.” Take a big bite of M.E.A.T. And get on board with ICD-10!

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