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When it comes to coding, Blair Filler, M.D., has the equivalent of a master’s degree, if not a PhD. He serves as chairman of the coding, coverage, and reimbursement committee of the American Academy of Orthopedic Surgeons. His 20-member committee spans all facets of orthopedic surgery, including specialists in sports, hand and spine. He sees the forthcoming ICD-10 coding system as an enormous change agent in health care. “Its impact will be huge,” he says. “Many physicians have a list of ICD-9 and CPT codes they use and do documentation from memory. But neither the doctors nor the billers know anything about the new codes. The expense to convert will be very large for us. We will need a new computer system for doctors and insurance companies.”

Fuller maintains his own solo practice in Los Angeles. And to date, he uses little automation, even sending in his claims by paper. Like many physicians, Filler uses a super-bill to denote his activities with a given patient, forwarding along the paper form to his biller, who consolidates the information on claims forms for payers. “All that paperwork will need to be revamped,” he says. “I will probably have to change, and put in a practice management system and go to electronic billing under ICD-10.”

In theory, Filler could deploy a practice management system integrated with an EHR, so that his clinical documentation could flow more easily into a claims form. But the surgeon has steered clear of EHRs to date, contending they are designed for primary care and internal medicine physicians, who do few procedures. “EHRs don’t fit our specialty well,” he says. “You have to gerrymander them.”

Regardless of what technology he adopts, Filler figures that he will have to re-evaluate his payer contracts in the aftermath of ICD-10. “Right now, CPT codes are specific and ICD codes are non-specific,” he says. “There is a lot of leeway in tying the two together. That won’t happen under ICD-10. You will need to join them correctly, and if not, the insurance company will turn down the claim, saying these are incompatible codes. They will leave it up to the physician to interpret what they did wrong.”