EMR Compliance With ICD-10: What It Means for Your Practice

Have you taken the time to think about ICD-10 lately? While your eyes may automatically glaze over at such a prospect -- not to mention the fact that your practice is probably seriously busy at the moment -- it's important that your record keeping is up to date with current standards.

If you need a quick refresher, ICD-10 is the 10th revision of the International Classification of Diseases (ICD), a diagnostic tool created by the World Health Organization (WHO) that monitors the incidence and prevalence of diseases and other health problems. It's used by physicians, nurses, other health care providers, health information-technology workers, insurers, and patient organizations to classify diseases and health problems on several types of health and vital records. All WHO member states use the ICD, and a majority -- 117 countries -- use the system to report mortality data.

The United States implemented the previous version, ICD-9, in 1979, but the system was not robust enough to meet 21st-century health care needs. There are approximately 70,000 diagnosis codes in the 10th revision, compared to just 14,000 in ICD-9. This increase means a greater level of detail will be required in patient-encounter documentation. There are also new concepts that did not exist in ICD-9, such as underdosing and the Glasgow Coma Scale.

After a regulation published by the Department of Health and Human Services on August 4, 2014, delayed the implementation of ICD-10 by one year, the new code set finally went into effect in the United States on October 1, 2015. All covered entities should now be using the new code set -- there is no grace period for implementation. It is important that providers make sure their systems are up to date to comply with the revision and prevent any delays or rejections for claims by insurance companies.

Now that ICD-10 is here, here's what providers should know:

It's Vital to Transition Correctly

Many health care providers implement electronic medical records (EMRs) with the belief that this will take care of the transition from ICD-9, but that's not necessarily the case. EMRs can help ease some of the documentation challenges providers face after moving to the new system by offering templates and allowing them to access a patient's prior visits. Web-based EMRs perform constant automatic updates that ensure the system always complies with the latest rules and regulations, but it is important that providers work with their vendors to ensure compliance.

There Is Some Flexibility

Although all covered entities should have the new code set in place by now, there is a bit of leeway for practices still playing catch-up. The Centers for Medicare and Medicaid Services (CMS) agreed to loosen some of the standards around the revision and said it would not issue penalties for errors that are linked to reasonable mistakes. The CMS also said it would not strictly enforce the specificity of ICD-10 coding for the first 12 months after implementation; as long as codes are from the appropriate family, the CMS will not deny or audit claims for specificity. If providers use a code that is from the appropriate family, the CMS will not penalize them under the Physician Quality Reporting System.

Resources for New Codes Are Available

Because there are almost five times as many codes as there were in ICD-9, providers may need some help adjusting. Fortunately, there are many resources available to assist providers in finding the codes they need to record patient encounters. The CMS provides resources for case studies, concepts, and codes, as well as delving into specialty-specific codes.

If you haven't already, it may be helpful to look at your most commonly used ICD-9 codes and identify their equivalents to make sure they are entered quickly and correctly.

It is inevitable that providers will be faced with an onslaught of information related to these changes, so it is crucial that your EMR system provide tools and content to address future requirements. You should also keep track of the EMR's capability and to regularly communicate with vendors to ensure that the system remains compliant. This will not be an instant adjustment, but know that the eventual consistency across all documentation will benefit everyone involved -- especially your practice and its patients.