Death By Documentation

In my work with hundreds of over stressed and burned out physicians, one thing is constant. Documentation is always one of their biggest sources of stress.

In fact, if you ask the average working doctor to make a list of their top five stresses, documentation chores will take up three of the five slots.

1. EMR – especially if you use multiple EMR software programs that don’t talk to each other

2. Dealing with lab reports and refill requests

3. Returning patient and consultant calls and documenting them adequately and all the other places information streams have to be forced together by the sweat of your brow.

The average doc is walking the cliff edge of overload on a significant number of office days in any given month. Now comes ICD-10 and my biggest fear is the extra work of the new coding system will push many physicians over the edge into burnout.

How much more time will ICD-10 take?

I have talked with several ICD-10 implementation experts who toss out comments like, “Only a couple minutes per patient”, as if that were no big deal. If you see 25 patients a day, that is 50 minutes added to your office day starting October 1st. That amount of additional documentation work will drive many docs over the edge if you don’t start preparing now.

ICD-10 Highlights

– Expands the ICD-9 code set of 14,000 to 68,000
– ICD-9 is 3-5 digits
– ICD-10 is up to 7 digits including ones for severity, location and cause

Here is the CMS website detailing the differences between ICD-9 and ICD-10


First, recognize doctors fall into two groups with regards to coding. Each group has a different challenge and a different learning curve.

1) You code your own charts

You and your staff probably have one or more dog eared cheat sheets of your most common codes lying around the office. These cheat sheets won’t work under ICD-10. The additional codes for severity, location and cause will need to be added in manually. Your task – master the lookup software and do it now.

If you code your own charts, there is ICD-10 lookup software you will use instead of your cheat sheets. Figure out what code lookup software your organization has built into your EMR. Then dedicate yourself to becoming a power user. When you or a member of your team can look up complete, accurate codes on the fly with the software you will have mastered many of your new ICD-10 coding challenges. And once you have coded a number of charts to ICD-10 standards and see some patterns emerging, you may be able to create some new cheat sheets using the latest codes.

2) Someone else codes your charts

Do not think you are out of the woods here. In fact, my consultant contacts tell me this is likely to be an even more difficult transition for you for one simple reason. Your current documentation is inadequate for someone else to select the proper, complete ICD-10 code.

Remember the new codes for severity, location and cause? If you don’t change your documentation so that information is present in all your charts, two things will happen starting 10/1.

  1. a) Your coder will probably bring every single chart back to you for clarification
  2. b) You will need to go back into the chart to change your documentation in addition to telling your coder what they need to do their job

That double whammy will certainly tear your day to shreds if you don’t get started beefing up your documentation now.

Your task – raise your documentation game to ICD-10 standards now.

Learn the additional information you must put in your chart notes to allow your coder to perform to ICD-10 standards. It is up to you to give them the information they need to do their new and more difficult job.

No matter what, start to prepare now or your quality of life will suffer.

First, learn everything you can about ICD-10 and how it will be implemented within your EMR in your practice.

– Create your own ICD-10 implementation action plan. This will guide your preparations between now and 10/1/2015. Here’s the Road to 10 website from CMS to guide you through the process.

– Get with your IT team and EMR vendor and take the trainings on ICD-10 ASAP so you are ahead of the curve.

– Make your cheat sheet of most frequent codes – there are a number of situations where a new ICD-10 cheat sheet will still be useful. Remember to include the new severity, location and cause modifiers

– Master the ICD-10 lookup software that will be built into your specific EMR program for the patients who don’t fit into your hot list. Know how it works and the quickest path to a final answer.

– If someone else codes for you, learn the specific severity, location and cause requirements for full coding. Start adding them to your routine documentation habits now.

Most importantly – start documenting and coding to ICD-10 standards now so you don’t have to spend an extra hour in the office starting October 1st

Don’t let ICD-10 drive you over the edge.


What are your favorite ICD-10 coping strategies and online resources?

Dike Drummond is a family physician and the author of the Burnout Matrix Report with over 117 ways doctors and healthcare organizations can work together to prevent physician burnout. He provides stress management, burnout prevention and leadership development. Learn more about his work at TheHappyMD.com


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2 replies »

  1. “I have talked with several ICD-10 implementation experts who toss out comments like, “Only a couple minutes per patient”, as if that were no big deal.”

    Say, uh, 2 min/pt x 24 pts/day x 5 days/wk x 48 wks/yr.

    48 min/day x 5 days/wk x 48 wk/yr, divide by 60 to convert to hrs.

    Stick this in the Google search window: “(2*24*5*48)/60=”

    192 hrs. OK, assume the doc’s time is only “worth” $125/hr.

    $24,000 per year at 2 minutes per chart.

    No biggie? That’s about 14% of the avg PCP’s income. Just for the “excess” coding.

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