Drop-down menus could thwart specificity promised in ICD-10

Despite the promise of ICD-10 to improve disease surveillance--and even be a boon for national security--drop-down menus again could be a fly in the ointment, according to an article at ICD-10 Monitor.

Robert S. Gold, M.D., a cofounder and the CEO for DCBA Inc., a consulting firm that concentrates on development of Clinical Documentation Improvement (CDI) programs, notes that EHR systems tend to have drop-down menus in which the top choices end with a fifth digit of "0"--unspecified episode of care. More specific choices appear farther down the list.

He's been hearing that, in ICD-10 tests, a certain number of cases have been denied payment or seen reduced payment due to a lack of specificity--this despite ICD-10's nearly 15,000 codes, which have been the brunt of jokes. Texas Rep. Ted Poe (R) took to the House floor in a rant deploring its nine different codes reflecting injury inflicted by a turkey and three ways to be injured by a lamppost.

Yet doctors, in a rush, might choose a code higher in the list. "The practice environment and the likely found clinical scenarios should take precedence in pick lists, leaving the 'I don't know' codes to the very end," Gold says.

These lists need to be revised--and not by vendors or IT staff.

"The pick lists tailored for you by IT staff and coders are not physician-friendly," he writes, advocating that the doctors who actually use the systems need to be the ones choosing the order in which the codes appear. 

EHR templates with limited space for narrative pose a problem, as they might force physicians to leave out information necessary for the next provider or for billing, FiercePracticeManagement previously reported. To make the most of the narrative space offered by EHR systems, experts recommend that physicians prioritize documenting the parts of the story that will be relevant to the next person who may open the record.

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