n Socioeconomics & Politics | Coding Q & A
R. Dale Blasier, MD
Co-Chair, NASS Coding Committee
Arkansas Children's Hospital
Little Rock, AR
ICD- 10 Implementation: How
Did It Go? The Results of a NASS
The North American Spine Society
(NASS) provides answers to member inquiries regarding CPT coding
as an educational service. The answers expressed by the NASS Coding Committee are in response to
a specific fact situation presented
and based on their interpretation
of the AMA CPT® code book. The
answers given by the Committee
should not be relied on as official
interpretations of the CPT book.
AMA is the only entity that can
provide an official and binding interpretation of the AMA CPT book,
and should be contacted directly if
an official comment is needed or
desired. For more information,
contact the AMA’s CPT Network
Prior to the implementation of ICD- 10 on October 1, 2015, there was considerable
1. Incorporating ICD- 10 into Existing
anxiety among physicians regarding the
possible negative ramifications of adoption.
Practices went to considerable expense to
provide training for staff and physicians,
purchase new coding manuals, make
changes to forms and install new software.
There was further apprehension regarding
use of the greatly expanded code set and
the logic of searching for codes based upon
epidemiology rather than clinical factors.
Shortly after implementation, the
NASS Coding Committee surveyed NASS
members to determine the effects of
implementation on the practice of spine
care and find ways in which the committee
could assist members regarding ICD- 10. An
11-question survey was circulated to active
US-based members of NASS by email. The
questions involved three major domains:
n Incorporating ICD- 10 into existing
n Selecting ICD- 10 codes and
n Areas for improvement
The following is a synopsis of the ques-
tions, answers, and some specific com-
ments provided by survey respondents:
Scenario 1: My practice has successfully
incorporated ICD- 10.
Response: Of respondents, 63% agreed.
31% agreed in part.
Scenario 2: The implementation of ICD- 10
has adversely affected my practice.
Response: Of respondents, 29% agreed
and 28% partially agreed.
Scenario 3: The implementation of ICD- 10
has adversely affected cash flow or collec-
tions in my practice.
Response: Of respondents, 25% agreed
and 25% partially agreed. These are some
of the submitted comments:
n “I have had to reduce the number of pa-
tients evaluated during on office session.
A four-hour session now has 10 fewer
patients than previous, which is a 30 per-
cent reduction in productivity. I view this
as likely a goal of the government when
implementing such a huge database as
ICD- 10. I also have to spend more time
staring at a computer screen than actu-
ally interacting with my patients.”
n “Just slowed process.”
n “Due to the changes in ICD- 10 coding
some of the specificity requirements
lead to miscoding when coding subse-
quent visits. Frequently, we copy-paste
the previous visit's codes and there is no
easy way to change the initial encounter
code to subsequent encounter code on
our EHR - Athena. This delays submis-