Preparing for ICD-10: Part 2

The Impact of ICD-10 on Electronic Medical Records

The use of ICD-10-CM in medical record systems will be required by October 1, 2015. Although this transition is mandatory, it will require careful preparation. The first step will be to review your computer hardware, networks and EHR software to determine whether or not it meets industry standards. ICD-10 contains more than 70,000 codes that are much more detailed than ICD-9 codes, along with new terminology and expanded concepts for injuries, laterality and other related factors.

While this expanded database offers a greater level of flexibility to add new codes, as well as increased specificity when it comes to diagnoses and medical procedures, ICD- 10 will require more complex information and EMR software needs to meet the new standards. In addition, most healthcare providers will need to simultaneously run ICD-9 and ICD-10 during the transition period, which will depend heavily on the use of reliable EMR software. Your software should be continually updated as you approach the ICD-10 implementation date, and it should have the flexibility to support a wide variety of vendor requirements and timelines.

Navigating the switch to ICD-10

If your EMR software won’t be able to support the switch, it may be necessary to upgrade or replace it with more sophisticated software designed to help your company navigate the switch through comprehensive training. Your organization should not run the risk of leaving its installation and testing until the last minute, as there is a high chance you may run into some unforeseen issues that need to be addressed. In addition, if you do choose to upgrade or replace your EMR software, it’s important to allow enough time for all of your physicians and coding staff members to learn and adapt to the new system.

The switch from ICD-9 to ICD-10 will affect hospitals, patients and physician practices differently. However, it’s critical that all parties involved become well acquainted with the new code set structures.

First, it is important to understand that the structure of the diagnosis and procedure codes will be slightly different. This new system will need to be accommodated by all other interfaces and databases. Any non-compliant codes used to describe transactions or services after October 1 will be rejected.

Although the new code structures may be more complicated, ICD-10’s larger code database will provide:

• Increase coding accuracy.
• Reduce coding errors and provide much better data analysis for research and the tracking and trending of diseases.
• Facilitate accurate health data exchange with these other countries that have been using ICD-10 for years.

While some health care practitioners have expressed concerns about the new coding system, many others have spoken out about its benefits. In an article published by the National Association for Healthcare Quality, Nelly Leon-Chisen, Director of Coding and Classification at the American Medical Association (AMA), advocates ICD-10’s new coding system: “Clear and accurate diagnosis and procedure code reporting provide valuable information about patient care. Administrative claims data are often used to make decisions, not only about reimbursement, but also for value-based purchasing to evaluate the quality of the care and to conduct bio-surveillance and public health records (Leon-Chisen, “Introducing a Clinically Richer Coding System”).

The ICD-10 manual is still organized using an alphabetic index and tabular listing, just as ICD-9 was. However, one concept completely new in ICD-10 diagnosis coding is the use of a “placeholder,” which is the character “X.” This is designed to take the place of a fourth, fifth or sixth character in a code that requires a seventh character. A code is considered complete if it contains one or more placeholders, which can be replaced at a later time to expand the code database.

While the prospect of dealing with nearly 70,000 codes instead of 14,000 may seem overwhelming, in reality it is quite unlikely that any practice will ever have to work with all of these codes. To help your organization adjust to the new system, it may be helpful to use General Equivalence Mappings (GEMs) to focus on the scope of changes that will demand most of your attention. GEMs were developed to assist with the conversion of ICD-9-CM codes to ICD-10 codes — or vice versa — when transferring large data sets. They are sometimes referred to as “crosswalks” because they provide information that links codes from one system to codes in another. By using GEMs or a similar mapping feature, you can link your current codes to ICD-10 codes to get an idea of the differences in coding structure, documentation requirements, training and education.

Due to the significant number of changes that will accompany the switch to ICD-10, it’s crucial that your practice adopts the right tools to help with the integration process. The most effective software options will help all of your employees adjust to the new system by offering comprehensive staff training, information about ICD-10 integration and assistance with the revenue cycle management (RCM) transition.