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ICD-10 TransitionThe delay in transition to the next generation of medical coding, ICD-10-CM/PCS till October 1, 2015 has given both physicians and electronic health record (HER) vendors more time to prepare their systems for the change. ICD-10 offers better representation of disease severity and risk as well as better claim information that provides support to automated processing. In physician practices, a variety of systems such as EHR and billing and practice management need to be customized to support ICD-10. In fact, experts point out that updating their EHR for compliance with ICD-10 is one of the major challenges that physician practices face. Let’s take a look at some of the issues involved:

One main problem is that EHR applications differ in the way they store billing codes. While all systems are designed to capture ICD, CPT, and HCPCS codes to be used for claim submission and healthcare documentation, the methods they utilize to store these codes vary widely. An advanced EHR system would allow smooth transition to ICD-10, ICD-11, or any other required terminology without affecting the user much. Such superior systems use a reference terminology such as SNOMED CT – Systematized Nomenclature of Medicine, Clinical Terms – which can store clinical concepts centrally at a more accurate level than that enabled by ICD-9 and even ICD-10.

The US Department of Health and Human Services has allowed all federal and private developers of EHR systems to freely incorporate SNOMED CT. The vocabulary system offers a vast repository of synonyms that allows physicians to choose their patient’s problems faster and more accurately, and by doing so, improve compliance of their EHR system with clinical practice.

EHR Systems with such fully integrated reference terminology with maps from SNOMED CT to ICD-10 offers many advantages:

  • Allows physicians to send and receive medical data in an understandable and usable manner, speeding up care delivery and helping to minimize duplicate testing and prescribing
  • Comprehensive documentation which improves medical claim submission and reimbursement

These systems also enable the development of outcomes measures and other clinically relevant notes about the patient.

However, not all EHR systems offer such facilities to migrate to ICD-10. Some systems allow ICD-9 and other billing codes to be embedded within templates. In this case, these embedded codes will have to be updated to ICD-10 codes. Only expert medical coders with knowledge of ICD-10 billing requirements can do this. Many clinical conditions that were represented by one ICD-9 code now translate to multiple ICD-10-CM codes based on specific circumstances. For example, for bacterial infections, a secondary code may be necessary to identify the bacterial organism causing the infection.

Physicians with EHR systems that have a standardized core set of patient medical record information terminologies in place, local modifications to clinical content may not be needed. However, if the system is such that codes and supporting documentation in your locally developed or modified clinical content needs to be updated, the best option could be to seek help from a professional medical billing and coding company.