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Off into the wild, blue yonder ... no ... ICD-10 coding.

Physician burnout has always been the bane of medical practice (or malpractice), what with physicians burning the midnight oil and awakening for rounds at ungodly hours. Moreover, EMR, insurance reports, quality-control reviews, and prescription preauthorization requests have mightily taxed physicians and their staff. Now ICD-10 coding, replacing long-used ICD-9 coding, is jeopardizing the little sleep that physicians manage to secure each night. The ICD-10 code seeks to precisely define each disease, condition, and injury into a quantifiable form that "Big Data" will be able to analyze epidemiologically and economically. From an orthopedic standpoint, the ICD-10 code contrasts a fracture of the right and left radius, open or closed, proximal or distal, epidemiology, and whether it is healing or not healing.

The number crunchers want the code to offer as exact a diagnosis as possible, so that appropriate medical and surgical costs can be determined.

ICD-10 is looking to do away with vague diagnostic codes such as fatigue (R53.83), arthralgia (M25.50), abdominal pain (R10.9), and anxiety (F41.9). Good luck on that--I intend to irk the bean counters by utilizing these nonspecific ICD-10 codes. Of course, when abdominal pain is due to diverticulitis (K57.32) or fatigue is secondary to iron-deficiency anemia (D50.9), then I will oblige by using the more specific diagnosis. And if it's iron-deficiency anemia, I shall comply with more accurate coding, if it is due to bleeding from colon cancer (C18.9 and D50.0).

Still, the ICD-10 is replete with 100,000 codes, and it will be difficult to offer the precision that the insurance carriers and Medicare demand. Expect that by 2018 there will be quality-control letters in the mail asking for an explanation of why there are so many patients being treated for nutritional deficiency (E63.9), hypothyroidism (E03.9), adrenal deficiency/fatigue (R53.83), and obesity (E66.9).

Expect that those quality-control letters may be shuttled to the state medical board for overview and audit.

No wonder physician burnout is on the rise!

Jonathan Collin, MD

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Title Annotation:From the Publisher
Author:Collin, Jonathan
Publication:Townsend Letter
Geographic Code:1USA
Date:Dec 1, 2015
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