We’re several days into the transition to ICD-10, and it seems like most folks made it through to the other side just fine. Many of you might even be thinking the new code set isn’t such a big deal. But is this the calm before the storm? After all, we’ve yet to see whether providers coded correctly, and thus, whether their ICD-10 claims actually will get paid. So, between watching the leaves change color and picking a prime pumpkin from the patch, you’ve got to maintain your ICD-10 efforts. While I’m sure you studied and practiced your tail off in anticipation of October 1, you may have overlooked one key part of a successful switch: your EMR. Here are two reasons why your EMR might be leaving you out in the cold (without your North Face jacket):

Automatic Conversions

Be wary of any EMR that claims it can automatically convert all of your codes or pick an ICD-10 code for you. While it may be tempting to “cheat” your way through selecting ICD-10 codes, taking shortcuts likely will come back to haunt you. As the American Health Information Management Association (AHIMA) explains in this post, thanks to “significant differences in language and structure between ICD-9 and ICD-10,” automatic conversions aren’t all they’re cracked up to be. The article explains that while “ICD-10 conversion can be highly automated [they] cannot be fully automated, and they cannot be finalized without review and evaluation by a person familiar with each system being converted.” In fact, AHIMA warns that “autoconverted ICD-10 systems may not work as intended, and skipping a human review can expose an organization to legal and financial risk once the converted systems go live.” If your EMR has automatically converted all your ICD-9 codes, do your due diligence. If you don’t make sure the conversions are accurate and as specific as possible, no one else will.   

Cheat Sheets

Some EMR vendors have created cheat sheets, and those resources might seem like a great idea, because they convert your most frequently used ICD-9 codes to their ICD-10 code counterparts. But according to this resource, that’s exactly the problem. Why? Because “pain codes…are the most commonly used ICD-9 codes for PTs. In ICD-10, though, you shouldn’t use a pain code as a patient’s primary diagnosis if you can help it. ICD-10 requires a far greater degree of specificity; thus, payers want you to code for the underlying injury or condition first and foremost. Only then should you list the pain codes associated with the main diagnosis.”

Plus, even though seventh characters are required for injury codes, cheat sheets don’t account for the seventh character because this character—and the information it represents—doesn’t exist within ICD-9 (hence, part of why we needed to make the leap to ICD-10). Plus, you must use clinical judgement to determine which seventh character best describes the patient’s condition or treatment phase. Don’t waste your time on an EMR that spends its time creating cheat sheets that put your practice at risk.

Working with an EMR that relies on code selection shortcuts is like wearing Uggs with shorts: just plain ridiculous. So, how do you know your EMR can protect your clinic’s productivity and cash flow post-transition? Look for an EMR that offers these three crucial features:

1.) An intuitive ICD-10 code selection tool

Your clinical judgement is critical to selecting the correct ICD-10 codes. An intelligent ICD-10 tool can assist you with making the best choice possible while simultaneously ensuring that you, as the therapist, make the final judgement call.

2.) Built-in alerts and safeguards

Does your EMR let you know when you’ve selected an invalid or non-billable ICD-10 code? If not, you’re leaving your clinic open to a heap of trouble.

3.) Free training, support, and resources

If your EMR doesn’t offer free training, support, and resources, then figuring out how to use the system’s ICD-10 functionality—and understanding ICD-10 itself—is entirely up to you.


Don’t settle for a basic EMR (that doesn’t even like pecan pie-scented candles). When it comes to ICD-10, ensure your EMR isn’t out apple-pickin’ and pumpkin-carvin’ instead of supporting you in your transition efforts. If your vendor is taking shortcuts—or is plain ol’ unprepared—you could be left feeling like someone left the pumpkin spice out of your latte.