ICD-10 is a New Era

By Dr. Robert (Bob) Day, Jr., Broadway Eye Center, Garland, TXdr_bob_day_web

When I started learning ICD coding, my dad, Dr. Robert Day, Sr., was President of the American Optometric Association (AOA), and they had just published the first Current Optometric Information and Terminology (COIT) book in June 1974.  It was optometry’s first attempt to participate in the new medical trend of systematically classifying diseases.  Optometry was just beginning to become more than simply prescribing a pair of glasses to help patients realize improved vision.

Learning ICD-9 versus ICD-10 is very much like comparing learning multiplication tables to learning calculus.  I can’t remember a time when I didn’t know my multiplication tables, but I remember struggling to learn calculus all too well.  I probably learned multiplication in the second or third grade. It was a straightforward process where one problem produces only one answer.  For example, 2×2 can only equal 4—easy enough, right? Then you advance to calculus (particularly differential) where one problem can produce multiple possible answers.  The learning process is far more complex, and the answers, at least initially, are far less obvious. But it can be done; you just need to spend the time to identify your best resource and to understand your goal.

Even now, I calculate simple multiplication in my head, but for calculus I need the help of technology (a calculator) to do calculus.  Likewise, ICD-9 is committed to memory, but for ICD-10, I will depend on technology in the form of my electronic health record system to handle most of the ICD-10 coding.

Speculation abounds, but it’s reasonable to assume that ICD-10 will mark the end of the paper super-bill and coding from memory. Under ICD-10, the AOA’s Express Mapping Card alone is four pages with almost 300 codes.  ICD-10 is clearly more complex, and trying to manage it without the help of technology will drastically add time and expense to your coding.

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2 Responses

  1. Unfortunately, I do not get the metaphor or analogy here.

    The fact that the author states that they committed all their ICD-9 codes to memory only indicates to me that their ICD-9 coding is very unspecific. There are well over 14 pages of ICD-9 codes related to eyecare. That expands to probably 100 in ICD-10. The problem is not ICD-10, it’s bad documentation and reporting habits developed over a period of many years–and the lack of proper coding training.

    Comparing learning ICD-10 coding guidelines to calculus makes it seem unnecessarily difficult. It’s not. Yes, most will have to spend 6-12 hours learning concepts and guidelines they never learned. It just takes desire, a little practice, and patience. And yes, we need the additional detail and information for research worldwide–to improve healthcare and prevent blindness.

    For one, over 95% of what I teach in my ICD-10 classes is already in ICD-9. There are very few new diseases out there in eyecare. Second, EHR won’t help if you don’t document specifically in the medical record or your staff does not understand medical terminology, eye anatomy or how to code a nasal/temporal pterygium, a dense cataract, or NIDDM. All of those are not in an EMR or ICD-10. EMR is a tool but proper training and communication between the coding/billers and the providers is essential to properly reporting codes.

    EMRs won’t explain how to code:
    Excludes 1 instructions
    Code first instructions
    late effects
    occurrence codes
    combination codes
    two codes when required.
    location and cause of an accident
    adverse effects of a drug properly taken
    secondary glaucoma codes
    medical necessity requirements

    and that’s just a start!

    There is so much more.

    Jeffrey Restuccio, CPC, CPC-H

  2. Bob,
    I graduated from UHCO in 1972. Your dad came to the school and all juniors and seniors attended a presentation given by your dad on CPT codes and how he was trying to implement these codes in optometry.

    I remember leaving the lecture and my classmates grumbling about this new coding system. I remember the passion your dad had for his project and was so happy when the coding came into play. I was in the Air Force at the time and used these codes on my records. I was Chief of Optometry, so my boss was an ENT doc, who had no idea what I was doing.

    Ed Makler

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