Guest Post: Dig deeper than 'ICD-10 Compliance' for ED systems

Carl Natale
by Carl Natale

The anxiety regarding ICD-10 will soon enter its logarithmic growth phase as we reach the one year countdown date on Oct. 1, 2013. 

Guest Post by Dr. Tom WardIncomplete ICD-10 readiness plans will require quick finalization so that adequate training and testing can be done before the switch is flipped Oct. 1, 2014.  During that countdown financial forecasting which incorporates the ICD-10 transition will be revisited and refined as more information becomes available regarding the impact of ICD-10 on clinical productivity and claims reimbursement.

For vendors that provide products affected by the ICD-10 transition, the stream of requests by clients for verification of their readiness will soon enter flood stage.  And the life raft many in that flood will seek is the reassuring term “ICD-10 compliant.”  Utterance of those words by a vendor could provide a calming effect that many drug manufacturers wish they could capture in the anti-anxiety medications they bring to market.

A word to the wise – don’t end your questions when you hear that declaration.  If your vendor assures you that their product is ICD-10 compliant, dig deeper and gain an understanding of exactly what that means.

The real definition of 'ICD-10 compliance'

Hospitals will soon learn that “ICD-10 compliance” has a very broad range of meaning, and may not be what they envisioned – or need.  The definition of “ICD-10 compliance” for any given product may have substantial financial, clinical and productivity implications.

Part of the definition will depend upon the function of the product – whether it’s used for documentation, data extraction, coding, billing, reporting, etc.  The nature of the product (e.g., paper or computer software) will also affect the meaning of the term “ICD-10 compliant.”

As an illustration, let’s consider the meaning of ICD-10 compliance for an ED information system (EDIS).  In the most liberal of interpretations, it may just mean that a specific vendor’s EDIS generates a text-based clinical report that includes a diagnosis – either by picking it from a list or just free texting it.  That diagnosis could then be coded by professional coders using ICD-10, just as it is done today for ICD-9.  In this example, there would not be any ICD-10 related changes to the existing software, but it may be branded by the vendor as “ICD-10 compliant.”

What to look for in an EDIS that professes 'ICD-10 compliance'

A basic parameter of ICD-10 compliance in a vendor’s EDIS would be the provision of clinical diagnoses that are more consistent with ICD-10 terminology.  An example would be refining the term “left-sided abdominal pain” into the more detailed descriptors of “left upper quadrant abdominal pain” and “left lower quadrant abdominal pain.” These latter terms are associated with specific ICD-10 codes, making it easier for the coders to apply the correct code.  Currently in ICD-10, no specific code exists for the more general term “left-sided abdominal pain.”

Likewise, clinical descriptors of a patient’s mental status would be more quickly and easily coded in ICD-10 when terms such as “somnolence” or “stupor” are used in the diagnosis rather than “decreased level of consciousness” or “obtunded.”  The latter terms aren’t as easy to quickly associate with the appropriate ICD-10 code, requiring some judgment on the part of the professional coder, or a query to the physician.

In addition to using clinical terminology that is “ICD-10 friendly” in a vendor’s EDIS, it is also very important that an adequate level of detail be present in the clinical content.  ICD-10 codes have far more detail than ICD-9 codes. Assigning a specific ICD-10 code that doesn’t contain the term “unspecified” requires a level of clinical detail that ED physicians may not typically provide.  Clinical content in an EDIS that offers that level of detail makes it easier for clinicians to document the desired ICD-10 specificity.

The computer software function that many think of when they hear the term “ICD-10 compliant” is the actual generation of ICD-10 codes based upon the clinical documentation.  There are a variety of ways in which this could be accomplished – perhaps a topic for future discussion.  Different approaches have varying degrees of benefit and detriment – especially as it relates to productivity and clinical accuracy.

In addition to the items mentioned above, the full embodiment of the concept of ICD-10 compliance for an EDIS would be the ability to provide the ED physician with ICD-10-specific feedback regarding the diagnoses documented in the clinical record.  This would help the clinician to quickly understand what additional information would be beneficial in assigning the most specific ICD-10 code possible. This could be of significant value, especially since it currently remains unclear whether all payers will reimburse for ICD-10 codes containing the descriptor “unspecified.”

Of course, varying degrees of useful feedback could be provided to the clinician by the EDIS software.  Exploring the nature, extent and timing of information provided to the clinician may be useful in determining what is most beneficial in a given clinical setting.  As with other alerts or warnings in EDIS software, the method of presentation can significantly impact its usability and effectiveness in the clinical environment.

So, when your vendor – current or future – describes their software as “ICD-10 compliant,” be sure to delve deeper before giving that exuberant sigh of relief.  Their answers to those extra questions may give you true peace and comfort – or you may be making an appointment with your doctor to talk about those anti-anxiety medications.

J. Thomas Ward, M.D., FACEP, has authored nationally published medical content, including a text for emergency medical services. He has served on emergency medicine-related committees at the state and national level, receiving honors in recognition of his contributions. Ward received his medical degree from Southwestern Medical School in Dallas and completed his residency in emergency medicine at the University of Cincinnati Medical Center, where he served as chief resident. He is board certified in emergency medicine and has nearly 20 years of experience as a practicing emergency medicine physician and EMS medical director. As CMO at T-System, Ward provides clinical insight and innovation to the company’s clinical content and electronic solutions. In this role he serves as the company’s ICD-10 clinical expert, leading solution design and providing expertise to emergency departments across the country.