We are a commune of inquiring, skeptical, politically centrist, capitalist, anglophile, traditionalist New England Yankee humans, humanoids, and animals with many interests beyond and above politics. Each of us has had a high-school education (or GED), but all had ADD so didn't pay attention very well, especially the dogs. Each one of us does "try my best to be just like I am," and none of us enjoys working for others, including for Maggie, from whom we receive neither a nickel nor a dime. Freedom from nags, cranks, government, do-gooders, control-freaks and idiots is all that we ask for.
OK class, take out a pen and piece of paper, I am going to tell you a bit about ICD 10.
First, don't be alarmed by the prophets of doom who say you docs will be required to use this carefully crafted taxonomy in order for the insurers to refuse to compensate you for your services. This is true. I had dinner with an oncologist friend who is in bankruptcy because even though his patient's insurance company gave prior approval for a $100,000 course of chemotherapy they maintained that did not obligate them to actually pay for the cost. He already had, and on multiple occasions.
Back to ICD 10. This document will allow you to kick back and have some laughs about the conditions you likely will not be called upon to treat. The Monty Python crew had a field day constructing this and they've arranged for the ICD 10 office to be right next door to the Department of Silly Walks. Viz:
V9733XA: Sucked into a jet engine, initial encounter V9733XD: Sucked into jet engine subsequent encounter (Should this person be allowed on runways?) V9733XS: Sucked into jet engine, sequelae ( this is for the litigators)
But, don't overlook, Index to External Causes of Injury Accident E919.1 Bore, earth drilling or mining
Land or seabed E919.7 Bulldozer E909.9 Cataclysmic: Earth surface movement or eruption
So, be grateful if you only have to deal with intangibles and won't get blood on your shoes.
I'll be back soon to discuss Scott Stossel's heroic battle with anxiety and transgressive therapists.
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If Obamacare Doesn't Kill Small Medical Practices, Bureaucratic ICD-10 Coding Requirements Might
How much input have M.D.s given- or permitted to give- to the design of these systems? Very little, I suspect.
It is my understanding that that when a company wants to design a "smart system" to aid professionals in a given job, it has been found that it is better to train the job professionalsl in IT than to have IT professionals learn the job. The professionals already working the job will know better than the IT professional the ins and outs of the knowledge base of that given job.
I strongly suspect that these coding requirements were designed from A to Z by a bunch of legislative aides or attorneys with little input from M.D.s or other medical professionals. To the extent that IT people were involved in how the coding requirements showed up on the computer screen, I doubt that M.D.s were given much opportunity to give feedback.
At the least, M.D.s should have been permitted ample testing of the electronic medical records systems before it was dumped on the marketplace. I doubt even that much was done.
Most physicians see the same things on a regular basis. Specialists have an even smaller list of diagnoses.
Most EMRs will let the physician search the ICD9 or ICD10 database using keywords, like retinopathy and then create a list of favourites, so that the next encounter is a single click.
The advantage (assuming that the assignment of the code to the patient is not too time consuming), is that an analysis of their total patient population is trivial. A list of all diabetic patients, their medications and next appointment? No problem.
These kinds of searches would be impossible with a paper based system.
A good EMR will get out of the way of the physician but still be able to capture the important information they need to be better doctors.