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Will EHRs Solve Your Clients' ICD-10 Challenges?

By Ron Sterling

On October 1, 2014, physician practices – along with everyone else covered under HIPAA – will be required to start using ICD-10 codes in place of ICD-9 codes. This profound change in our industry will be challenging, as the ICD-10 coding system uses a very detailed level of specificity beyond ICD-9 to justify CPT codes. For example, ICD-10 codes may include site and severity information that will have to be consistent with procedure codes and modifiers. How carefully payors will be editing these relationships is unknown at this point; however, payors will certainly improve their edit checks over time.

Coding appropriate ICD-10 codes with applicable levels of specificity will be a challenge for most practices and represent serious training issues for your billing organization's clients and staff. A legitimate question for your billing clients is whether their electronic health record (EHR) systems (or new EHR systems) will help in the transition to the ICD-10 system.

EHR Support for ICD-10 Billing
In theory, EHR systems will make ICD-10 coding tolerable; however, ICD-10 coding still presents a wide range of challenges to EHR vendors and users. At the basic level, many EHR systems provide some tools to match up ICD-9 codes for billing purposes. The EHR billing screen may display previously used ICD-9 codes or even ICD-9 codes that are associated with the chief complaint. Most EHR systems provide some lookup capability for the ICD-9 codes through a general alphabetic search feature. The key question is how well will these tools translate into the ICD-10 world.

Based on the current ICD-9 features in many EHR products, the tools will not solve the ICD-10 code problems. For example, presenting longer lists of potential ICD-10 codes in place of ICD-9 codes may not simplify the ICD-10 transition. Indeed, practices need an alphabetic diagnosis lookup with a smart site selector. Similarly, the EHR system would have to be programmed to differentiate between initial and follow-up visits to assign codes properly.
One would be hard pressed to conclude that the EHR systems that are merely enhanced to support the ICD-10 code structure will also be helpful for coding purposes. In fact, many EHR systems leave modifier coding to the billing system.

EHR Use of ICD-10
A more pressing ICD-10 issue for users of EHR systems is the use and retention of ICD-9 codes to make patient information more accessible and drive patient services.

  • ICD-9 codes are used to organize the patient record as well as support coding of charges.
    • Many EHR systems use ICD-9 codes to classify and access prescriptions, orders, encounter notes, and images. Since many ICD-9 codes map to multiple ICD-10 codes, the EHR systems would have to be enhanced to work with ICD-10 specificity as well as intelligently look back into historic patient records that were coded with ICD-9 codes. The same problems exist with billing systems.
    • The provider will have to search through multiple codes to identify related information about a patient problem. For example, there are different codes for site as well as an ICD-10 code position that indicates whether the visit is an initial visit or follow up.
  • ICD-9 codes trigger patient care items. For example, an ICD-9 code for diabetes may trigger a health maintenance item associated with a periodic lab test. The EHR systems will have to be enhanced to acknowledge the patient care issue for all of the various classifications and sites.

Note that differences between ICD-9 and ICD-10 coding will probably lead to changes to the EHR and practice management systems that you use leading up to the ICD-10 start date. If the Stage 2 of Meaningful Use is any guide, practices and billing services need to monitor vendor progress as well as get on the schedule to meet the October 1, 2014 deadline.

  • Do not be surprised to find out that your vendor plans to release their final ICD-10 version a few months before October 1.
  • Plan for comprehensive testing of the new version. Completely addressing the ICD-10 codes will probably include changes to the EHR database and significant user interface changes.
  • Develop and execute comprehensive testing of the interface between the EHR and practice management systems.
  • Plan training of staff and physicians to maintain the integrity (a HIPAA Security requirement) of the patient records between the ICD-9 and ICD-10 relevant features.

In the final analysis, the changes needed for ICD-10 codes are not just a matter of presenting ICD-10 codes in place of ICD-9 codes for billing purposes. The ICD-10 transition will require significant changes to EHR functionality in order to maintain the benefits of EHR systems using a dramatically different diagnostic coding strategy.

Ron Sterling (800-967-3028, publishes the popular EHR Blog and authored the HIMSS Book of the Year Award winning Keys to EMR/EHR Success. He is an independent EHR consultant. © Sterling Solutions, 2013.

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