Can you trust an EHR to accurately assign a medical code?

Carl Natale
by Carl Natale

If laughter is the best medicine, then the American Medical Association (AMA) is going to keep me very healthy.

Their latest example of unintentional humor explains a study by the Office of the Inspector General (OIG) on how Medicare physicians are using electronic health records (EHRs).

The good news is that 57 percent use EHRs, and 90 percent of that is used to document evaluation and management (E/M) services - "which are visits to assess and manage a patient’s health."

The bad news is that they're not using EHRs to generate medical codes:

"Although EHR systems can automatically assign codes for E/M services, 88 percent of Medicare physicians assigned codes manually in 2011.  The remaining 12 percent had codes assigned manually by staff (e.g., professional coders)."

Why aren't they using EHRs to assign medical codes? Apparently physicians don't trust EHRs to code their diagnoses and procedures correctly. That's the part that makes me laugh. Because physicians are refusing to use tools that can make the non-medicine side of their jobs easier. Now I understand why the AMA is afraid that ICD-10 codes are going to make practicing medicine so difficult. They won't let technology make using ICD-9 codes easier.

So the solution to this is a government certification, according to the AMA. Apparently physicians will trust the same agencies that are are telling them that ICD-10 coding will improve medicine. By the way, I'm guessing accuracy certification is going to add to the cost of EHRs. Which I'm sure the AMA will endorse paying. (This humor is adding years to my life.) But what's really key is that physicians want to be protected from lawsuits and fraud charges if the automatically-generated medical codes are incorrect.

I can't find any studies that question EHR accuracy when it comes to medical coding. That may be a problem, and I may be missing something. The AMA isn't even citing anecdotal evidence that physicians are seeing EHR-generated medical codes that they know are incorrect. Without that information, this study paints an unflattering picture of physicians who are set in their ways and afraid of change. Even change that promises to improve productivity and profitability.

To be fair, physicians aren't the only ones vulnerable to such stubbornness. They see a lot of it in their patients. It's one of the reasons that the AMA opposes meaningful use stage 2 requirements:

"Several meaningful use measures also require a certain portion of patients to use paperless technology offered by a practice for the physicians to make their minimums. There’s only so much guidance and encouragement that physicians can give when it comes to patient behavior, and beyond that, matters are out of doctors’ hands. Physicians have enough trouble getting patients to follow their clinical instructions, and it’s not fair to doctors to demand that they enforce patient adherence in this area as well."

Perhaps the AMA was talking about physician behavior as well.

In the meantime, I'm going to suggest you take two AMA opinions and call me in the morning.