More codes, greater specificity and increased reporting regulations, combined with coding rules and categorization changes, are all leading to significant increases in documentation time when ICD-10 is fully implemented. It’s estimated that clinicians will experience a 15 percent increase in their documentation time and that’s a conservative number.
Many ICD-10 codes are very similar except for one or two differences, while other codes are only differentiated by which side of the body the problem affects. Searching with a GEM may turn up no results or thousands. Even practitioners who have acquired ICD-10 training and use a computer assisted search tool will face challenges when locating the exact code that’s needed.
Productivity is expected to drop by up to 10 percent due to physician queries from billers/coders. The potential for denials and the need for additional management of claims will affect revenue flows. Very real problems will arise with clinician queries using keywords. The following example outlines a potential patient complaint and the results of a keyword search.
Subjective:
Mrs. Johnson was on vacation aboard a cruise ship and was walking in the gift shop when a vase fell on her right shoulder. She has had pain in the right shoulder since then. At the time that this injury occurred, she did not consult with a healthcare provider; she thought it would just go away on its own. After a few days, the pain seemed to get worse, and she started noticing more trouble reaching up and to the side. Also, ever since the incident, she has been suffering from chronic headaches. The patient complains of severe pain across the insertion of the supraspinatus. Traditional over the counter medications do not relieve the headache or the shoulder pain. Past medical history is unremarkable. She followed up with her primary care physician, who referred her to physical therapy. Patient indicates that no diagnostic tests (i.e – X-rays, MRI) were done so far.
Objective:
The patient weighs 220 lbs. and is 5 feet 4 inches tall. Her blood pressure is 128/86, pulse rate is 72 and respiratory rate is 16. She has full strength in all muscle groups in the upper extremity with the exception of the right middle deltoids, which are 3+ and right supraspinatus, which is 2+. All deep tendon reflexes in the upper extremity are normal. Range of motion is normal in the upper extremity with the exception of right shoulder external rotation (to 25 deg), abduction (to 130 deg) and flexion (to 135 deg). All of these ranges exhibited pain at end range.
Special tests: Right shoulder (+) Neers, (+) Hawkins-Kennedy, (+) IR lag sign with pain.
Cervical range is restricted to 50% for flexion, extension and side-bend. Tenderness and hypertonicity noted at suboccipital area (right>left).
Assessment:
Exam findings are consistent with rotator cuff strain in the right shoulder. Pain, range of motion restrictions, and weakness in right shoulder, with chronic headaches.
Plan:
Physical therapy 3 times a week for 4 weeks for treatment of right shoulder pain, with range restrictions and weakness, with symptoms consistent with rotator cuff involvement. Treatment to also address chronic headaches and neck range restrictions, with therapeutic exercises, therapeutic activities, postural exercises, patient education, joint mobilizations/soft tissue mobilizations, home exercise, and modalities as indicted.
A clinician that searches for the keywords cruise ship will find 233 results in two classification sets and a further search for falling object and right shoulder pain each has 500 references in three classification sets. A more specific search for rotator cuff returns 109 results in four classifications. Results increase with a key word search for physical therapy returning more than 500 results across seven classification sets.
Searching by specific codes will display results for multiple categories ranging from nuclear medicine and obstetrics to mental health, substance abuse and poisoning. The typical practice won’t experience many of the situations described in the new ICD-10 coding, but they must still wade through a morass of potential codes to arrive at the desired data.
