I sat poised at my keyboard on October 1st 2015, waiting to write up all the stories about difficulties in making the transition to ICD-10. I put out email blasts asking healthcare professionals to send me their stories. I scoured the internet looking for experiences from others. But, as you may have guessed, I came up empty-handed. Despite the doomsday predictions, the conversion to ICD-10 turned out to be much like Y2K, when we all woke up January 1st 2000 to find that our utilities still worked, the news media was still broadcasting, and we kept receiving our various bills on time (darn it!).
So much for my great hopes of having some juicy material to feed some blog entries.
So, ICD-10 is all set, right?
Wait just a minute! I have started thinking about the great proliferation of electronic medical records which continues across the country, if not across the globe. In both inpatient and outpatient settings, it is common to ask the physician to select ICD codes for a problem list, for an outpatient encounter, and for inpatient admissions. The user interfaces are designed to be “user friendly” and get to a code as fast as possible. There generally is no error-checking, validity-checking, or prompting, just a fast, slick way for the physician to select one or more codes and to tie one or more to the encounter.
How much training have physicians had in medical coding? Generally none. Sure, they have been trained in using the above-mentioned screens to enter to codes, but not coding principles. Of course, I would maintain that they should not be required to have such training, as they have trained professionals to do just that. But how much scrutiny do their selected codes get? How much do coders review the physician-entered codes, or do they just use what the physicians provided? And most importantly, what metrics are being put in place to evaluate “mismatches” –; to give the physician a report card on the codes that they selected versus those that were actually used by the coder(s). And, when there is a mismatch, what is being done to feed that back so that the problem lists (for example) are being updated?
This remains a vast uncharted territory in the world of Health Information Management, and something that I hope will start to be addressed in 2016.
Now that ICD-10 is “all set” 😉
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