Saturday, October 3, 2015

ICD 10

This week, I have been in ICD 10 hell.

I understand needing a new coding system to address new diseases or whatever. (Actually, I don't entirely understand.)  But so far, it's been a big pain in the butt.

One problem that I see right off is that it seems to expect us to have much greater knowledge than we actually have. If a person had a stroke, you have to know the exact reason why they had the stroke. Ditto with any other medical condition. Because medical knowledge is apparently perfect.  

Also, the diagnoses are ridiculously long.  Take E08.329, which is:

"Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema"

It took reading that three times just to absorb what it actually meant, much less figure out if it applies to my patient. It seems like the goal of this coding system is to make our heads hurt.  If that's the case, it has succeeded big-time.


  1. I agree. It's awful. And I'm doing with it solely from a cardiology standpoint.

  2. Please be sure to take whatever time is necessary to verify the patient does not have macular edema before using this code. Note sarcasm.

  3. Say what you will about Epic, but on this one it is stepping forward: Epic's diagnosis entry has a "selector" which allows you to pick a diagnosis quickly and (as much as possible) accurately. For the one you gave, you would put diabetes, then with complication, select retinopathy as the complication, and specify the macular edema. It takes about as long to pick the diagnosis as it did to read your example, honestly. The problem comes in when it won't let you put "unknown" for something you genuinely don't know (for example, if you didn't know if the patient had a complication from the diabetes or not; it doesn't give you "complication status unknown".)

    Dr. Fizzy, are you on EMR, or do you still use paper charts?

  4. Glad Epic is working, because Eclinical just sucks. Aieee!

  5. It suuuucks from an ED perspective because it is so very, very focused on final diagnoses. No, ICD10, I cannot identify the organism causing the pneumonia, because the cultures were sent in 2 hours ago and won't result for 2 days. No ICD10, I don't know whether the stroke is due to carotid occlusion, because the advanced tests that will determine this won't happen until tomorrow. If I have the answers to the questions asked, it means people are being boarded in the ED way to damn long.
    Also, seriously, why do I have to clarify whether the assault by a bee was intentional or not? Am I supposed to interview the damn bee? I deeply resent that I had to spend around 4 hours of my free time doing computer training so that things are simpler for the people we pay money to code the charts.
    Although, as noted above, Epic really does their best to make finding the common diagnosis you want amid the thousands of extraneous ones less onerous.