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Guess who has newfound support for coding?

September 18, 2014
by H. Steven Moffic, MD
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Not long ago, while on vacation, I was invited to be on a panel for a radio talk show centering on coding for the upcoming 10th edition of the International Code of Diseases (ICD). At first, I tried to politely decline the offer, not only because I was on vacation, but more so because I thought I knew next to nothing about ICD.

I had always done what I could to use the American diagnostic system for psychiatry, the Diagnostic and Statistical Manual of Disorders (DSM), which published the controversial fifth version last May. I knew that by some coding magic done by people in another building my DSM diagnosis would be translated into an ICD one for reimbursement.

In recent years, as electronic medical records (EMRs) came into practice, more and more documentation came to be required to support the diagnoses. Fair enough. But that took more time when managed care was already reducing our time with patients.

So that was another factor in my reluctance to participate in the radio panel. But the host said all that shouldn't matter. He wanted me because he had read a blog I wrote on the suicide of Robin Williams and wanted to embed some mental healthcare into the program. Okay. If somehow talking about coding would help to prevent suicide and drive treatment for depression, I would try.

To my surprise, the hour-long panel presentations proved to be fascinating. The panelists were real pros at their craft. It left me feeling that there needed to be periodic on-site meetings between coders, clinicians, and administrators, as we were all part of a system that still should put the patient first.

I was also able to provide the clinician's and clinical administrator's point of view: We feel in a sort of Catch-22 situation about not having enough time for both the patient and the computer. We may do both inadequately and be criticized for that. And diagnoses, anyways, are just initial guidelines for knowing each patient in depth as an individual.

Yet, the suicide of Robin Williams did remind me of the importance of the correct diagnosis. If someone —not necessarily Robin Williams—could be misdiagnosed as having a Major Depression rather than a depressive episode as part of a Bipolar Disorder, and then consequently and inappropriately given an antidepressant, they could be made worse and more suicidal.

Nevertheless, despite my begrudging but newfound support for coding—which is necessary for reimbursement, population research, and proper diagnosis—we have a daunting task over the next year. The ICD-10 deadline was delayed a year until October 2015. At that point, we will have about 70,000 medical diagnostic codes versus about 15,000 in ICD-9. Of course, the number of psychiatric codes is much less, but still more numerous. Hopefully, the criteria for diagnoses are more relevant for the treatment of patients. If so, it will be worth it, don't you think?

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...