It’s only a matter of time before the leaves start changing and the pumpkin spice lattes start flowing—and that means the October 1 transition to ICD-10 is just around the corner. But rather than kicking their preparations into high gear, many providers are kicking back and relaxing—because their EMRs already have everything handled, right? Right? Anyone? Bueller?
Unfortunately, not all EMRs are created equally—and not all are equally prepared for the impending ICD-10 transition. So, how do you make sure your system is in fighting shape for ICD-10? For starters, nail down the answers to the following questions:
1. Does your EMR prompt you to document specific details of the patient’s injury or condition?
One of the biggest reasons the medical community is transitioning away from ICD-9 is that the old code set doesn’t allow providers to accurately—and specifically—represent patient diagnoses through the use of diagnosis codes. And to encourage—er, force—healthcare professionals to move away from the now-common practice of submitting generalized or unspecified diagnosis codes, payers will require a high level of coding specificity as a condition of payment. As this HIMSS page explains, “With the expansion of diagnosis codes comes a greater level of detail; therefore a greater level of detail will be required in the encounter documentation in order to assign an appropriate diagnosis code.”
Of course, detailed diagnosis coding goes hand-in-hand with detailed documentation—especially if the clinician (e.g., the physical therapist) isn’t the one submitting claims. How is a biller or coder supposed to select and/or verify a diagnosis code if the supporting documentation isn’t detailed enough to inform that choice? Unless your practice’s coder moonlights as a psychic, he or she won’t be able to pull that one off—at least not 100% of the time. So, if you want to receive 100% of your payments—and I’m no psychic, but I’m betting that you do—you better cross all your t’s and dot all your i’s within your documentation, and make sure your EMR allows you to do so, too.
2. Does your EMR’s code selector prompt you to choose more specific codes when greater specificity exists?
Maybe you’ve already called up your EMR vendor and asked whether the system has—or will have—an ICD-10 code selection tool. (If you haven’t, stop what you’re doing and pick up the phone. I’ll wait right here.)
Okay, let’s assume your vendor has assured you that the system absolutely, positively will have functionality that allows you to select and document ICD-10 codes. That’s fantastic—but your investigative work shouldn’t stop there. Sure, your EMR might have all the applicable codes loaded into its system—and you might even be able to search for the right code by diagnosis or anatomic site. But just because you can find codes doesn’t necessarily mean you’ll find the right ones, especially when specificity comes into play.
For example, let’s say you’re searching for a code to express the diagnosis of patellar tendinitis. The code M76.50 (Patellar tendinitis, unspecified knee) might appear at the top of your search results, but it doesn’t account for one very important diagnostic detail: laterality. However, if your EMR prompts you to code for laterality when that specificity exists, then you’ll land on either M76.51 (Patellar tendinitis, right knee) or M76.52 (Patellar tendinitis, left knee). And by using a more specific code, you’ll greatly decrease your chances of receiving a claim denial.
3. Did your EMR base its ICD-10 code library on GEMs?
Despite this acronym’s sparkly association, there’s nothing precious about GEMs—a.k.a. general equivalence mappings. As this blog post explains, “…GEMs were never intended to serve as single-code translation dictionaries. Because of the way they’re structured—in clusters of two to four related codes—GEMs may map one ICD-9 code to several ICD-10 codes and vice-versa.” While GEMs can be useful for converting large batches of data, they’re not reliable mechanisms of one-to-one code translation. So, if your EMR simply used GEMs to map each of its existing ICD-9 codes to an ICD-10 substitute, then you could be in for a rude awakening come October.
4. Does your EMR claim to have an automatic crosswalk from ICD-9?
Like an ill-prepared college student desperately searching for a cheat sheet the night before the big test, healthcare professionals who have put off their ICD-10 prep work until the eleventh hour are desperately searching for a magic bullet that’ll make all their ICD-10 worries fade into oblivion. Some EMR vendors have capitalized on that desperation by claiming to offer solutions that automate the ICD-10 code selection process or produce accurate ICD-10 matches for all of the ICD-9 codes you know and love. The problem is, no such tool exists—at least not one that actually works. Why? Because, as this blog post points out, “…when it comes to translating ICD-9 codes into the language of ICD-10, there’s no technology sophisticated enough to do the thinking for you.” Furthermore, “the new code set wouldn’t function the way it’s supposed to without the human decision-making factor.”
5. Will your EMR allow you to practice coding with ICD-10 prior to October 1?
As the old saying goes, practice makes perfect. Attempting to code in ICD-10 with zero practice would be like showing up to run a marathon with zero training mileage under your belt. And with payment at stake, this definitely isn’t the time to wing it. The same goes for your coding tools: If your first time using your EMR’s ICD-10 functionality is October 1, 2015, then you could be fighting an uphill battle fraught with frustration, claims backup, and workflow disruption. So, make sure your EMR will release its ICD-10 coding tool before the go-live date. That way, you and your staff can train in a relaxed, no-pressure environment. Plus, you’ll be able to run internal testing programs and participate in external testing opportunities.
Technology will play a huge role in the transition to ICD-10, and if you arm yourself with the right tools, you can greatly ease the shock of the shift. But while Ferris Bueller seemingly can navigate any sticky situation relying on wit and charm alone, no amount of charisma can make up for an EMR with a sub-par ICD-10 solution. So, before you put your feet up and enjoy the last of the summer sunshine before the fall chill sets in, make sure your EMR is truly ready for October 1.