Appreciating the Layers

ICD-10 changeover represents a multi-level issue for practice owners

What makes the ICD-10 changeover so challenging?

“You just have to know your onions,” said Carmen, waving a wooden spoon.

Ben snatched a mushroom from a prep bowl. It was always fun to visit his wife’s pizzeria, even when he was worrying about his chiropractic practice. “I don’t usually envy you,” he said, “but just for the moment I wish onions were all I had to worry about.”

“See,” Carmen continued, spreading onions over the sauce and cheese on a pizza with a practiced hand, “not everyone likes onions sliced and on the pizza, but everyone wants them in the sauce, where they don’t even notice them. Tomatoes, cheese, sausage — that’s the stuff people think is key to a pizza, but the onions are really essential. Without onions carefully chosen, chopped, and simmered in the sauce, you won’t have the flavor.”

“Down-home philosophy based on pizza,” Ben laughed. “Just what I need today.”

“I know this whole changeover in the insurance reporting is bothering you a lot.”

“True. Payments from insurance companies are a very large part of the profit at the clinic. If I don’t make the changeover correctly, I could lose out in a very big way.”

“So the codes are like onions,” said Carmen. “It’s not something everybody knows about and notices, but it’s very important. When someone says you know your onions, it means you’re really knowledgeable and experienced, not just on the surface.”

“I’m not sure they’re really talking about pizza.”

“Come with me on this,” Carmen laughed, pushing the pizza into the big oven. “The codes are changing, and you would like that to be a small thing, something your office staff can take care of, but it’s really important, the way onions are important. Just because your clients don’t notice it doesn’t mean it’s a small thing. It’s worth an investment of time and money if that’s what it takes.”

“I think it will take time and money,” Ben admitted. “The ICD-9 set has 14,567 codes, while new ICD-10 has 69,832 codes.”

Carmen turned away from her workstation to stare at her husband. “Did you make those numbers up?”

“No,” said Ben, “I have them stored right here on my phone.” He showed her the note. “I’m not sure why I’m saving these numbers, but I guess they seem to explain the reason this is such a big deal. It’s not just about changing a few numbers. Things for which we’ve been using just one code will now need to be divided up into a lot of different codes depending on lots of new criteria, including which side of the body is involved and how the patient got the injury — there’s a special code for turtle bites, and I am not making that up.”

Carmen cupped Ben’s face with her hands, leaving his cheeks dusted with flour. “You’re a great chiropractor and you can do this. I’m just saying, accept that it’s a big deal. It’s complicated, it’s urgent, and it requires an investment.”

She suddenly sniffed the air, whirled, and pulled the pizza out of the oven.

“See,” Ben said, “you caught that just at the right moment — because you know your onions when it comes to pizza.”

He hoped his knowledge of chiropractic would be enough to bring his practice through the reporting changes successfully. Sometimes it seemed as though the business side of the practice was overwhelming.