What your EMR Vendor Should Provide in the ICD10 TransitionJulie Lundberg

March 27, 2014

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“As an independent physician, Dr. Ragland must carefully devise strategies to keep her three-person practice afloat amid rising overhead, flat or dropping reimbursement rates, and new federal rules, many of them related to the health care law.”

“If you don’t code properly, you don’t get paid.”

“Some physicians may end up paying nearly three times more for ICD-10 implementation than had been predicted just five years ago, according to a new report from the American Medical Association.”

Small practices: up to $83,290 (2008), now up to $226,105

Medium practices: up to $285,195 (2008), now up to $824,735

Pressures Applied From Multiple Directions

AgendaTechnology Platform• Software Updates• Code Selection Tools• Clinical Documentation Tools

Education/Expertise• Practice Portal• Webinars• Quick Guides

Consulting Services• Impact Analysis• Chart Audit• Historical Claims Analysis

Technology Platform

Certified EMR

Practice Management Software

ICD-10 code library

ICD9 & ICD10 Selectors in Charge Entry

837 electronic claim output in updated ICD10 compliant format

ICD10 Claims Testing

Submit test claims to your clearinghouse with ICD10 codes

If your vendor tests and passes with your current version, you may not need to go through this process!

EMR Software

DxCPT screen accepting both ICD-9 and ICD-10 [system guides the user per the setting dates]:

Here is an example of how other areas in the system will accept ICD-10. [Clinical Decision Support]

Transition Date

Global: Knows the date of service and presents proper code set to biller and provider

Payer Level Override: Set transition date at plan level to allow for those payers not ready on 10/1

May add setting to not respect payer override for doctor (so as to not distract away from new focus on ICD10)

Clinical Documentation Tools

ICD10 requires greater specificity in documentation. What charting tools can help?

Tags

Voice Recognition Dictation Software

Templates

ICD10 Code Selection Help!

GEM: Generic Equivalent Mapping: Maps from ICD9 to ICD10 (and possibly even Snomed)

PFT: Provider Friendly Terminology: Allows the clinician to say what he/she wants to say, then maps that to the proper ICD10 code

NLP: Natural Language Processing: Index free text and map provider terms to proper codes

Alert provider to need for greater specificity, present attributes (Encounter type, Severity Type, Laterality, FX healing) to guide selection of proper ICD10 code.

Education

Practice Portal

Just in time training

Learn at your own pace

Choose the learning style that works for you!

Webinars

Web-based seminars presenting industry and product knowledge in an interactive format

Pose questions to vendor experts

Documentation

Step-by-step instructions demonstrating key workflows

Services

ICD10 Consulting

Impact Analysis

Chart Audit

Is your charting specific enough for ICD10?

Services: Historical Claims Analysis

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Determine most commonly used codes

Convert to ICD10

Case Study

Case Study: Turf Toe?

• Hallux Rigidus, right big toe• ICD9: 735.2• ICD10:M20.21

• Onycholysis• ICD9: 703.8• ICD10: L60.1

• Hammer Toe• ICD9: 735.4• ICD10: M20.41

Case Study: Place of Injury

ICD10:M20.21 (Squash Toe?)

E849.4 Accidents occurring in place for recreation and sport

Y92.311 Squash court as the place of occurrence of the external cause

Case Study: Place of Injury

ICD10:M20.21 (Cricket Toe?)

E849.4 Accidents occurring in place for recreation and sport

Y93.07 Cricket pitch as the place of occurrence of the external cause

Case Study: Place of Injury

ICD10:M20.21 (Curling Toe?)

E849.4 Accidents occurring in place for recreation and sport

Y93.2 Activities involving ice and snow