Guest Post: Tips for selecting the right ICD-10 encoders for the emergency department

Carl Natale
by Carl Natale

ICD-10-CM will affect emergency departments (EDs) more than any other specialty. Emergency medicine encounters have the potential to utilize multiple specialty codes that have been significantly impacted by the code expansion of ICD-10-CM.

Elizabeth Morgenroth, CPC, Revenue Cycle Business Analyst at T-System, Inc.The ED takes care of everyone who walks through the door, regardless of the condition. ED coders will need to be familiar with all changes because all diagnosis codes in the ICD-10-CM code set have the potential for utilization in emergency medicine.

In addition to the massively expanded code set, another challenge will be learning how to express newly worded concepts and how to apply new rules.

The right encoder tool can provide tremendous benefits in conquering these new challenges.

Pitfalls of some common encoder types

One type of commonly used tool helps you select a code based on how you answer a series of questions. This design can result in leading the coder down the wrong path because an individual not familiar with anatomy and physiology can make critical errors if the questions asked are not properly understood.

Another type more common to outpatient settings relies solely on a textual search. If a tool relies completely on textual search, you must use the correct phrase, which leads to constant rephrasing.

This model also does not prompt for additional codes missed by the coder.

Alternatively, some tools are not real encoders in the true sense. They are computer-assisted in that they use an electronic means to assist you to search and find a code, allowing you to view what is in the book. This requires a more experienced coder but has fewer tendencies to lead a coder down the wrong path.

Specific qualities to avoid in an ICD-10 encoder tool

  • Exact phrase entry: Requiring certain phrases to find the correct code can slow down the coder if they constantly need to rephrase the search.
  • Crosswalking: When testing systems, I have found that attempts to crosswalk from ICD-9 to ICD-10 can result in incorrect codes. While ICD-10 to ICD-9 crosswalks may generate a higher accuracy rate, there is no direct correlation of codes between revisions. Native ICD-10 coding is more desirable than ICD-9 mappings; this is because concepts such as aftercare may require more than one ICD-9 code and do not translate well.
  • Systems devoid of prompts: When additional codes are required to properly code a condition, these systems will not let you know. Also, these systems do not assist in sequencing codes.

What to look for in an ICD-10 encoder tool

  • Flexible searching: A search that allows for many alternative terms will allow a coder to more easily and efficiently find the correct code. Having both the actual code set language and physician language available is a great benefit. This saves the coder time and decreases the need to rephrase.
  • Auto-sequencing of codes: With automated guidelines, coders can be more productive and more confident that the chart has been coded correctly.
  • Natural-language search: A search based on physician documentation and natural language is highly desirable because the coder doesn’t have to rephrase physician documentation in order to find the applicable concept. Having common everyday terms in addition to specific medical language or terminology is beneficial because there’s more than one way to search for a code describing the condition.

Completion assurance: A platform shouldn’t allow a coder to proceed until the highest degree of specificity and correct number of characters are reached. Look for a system that automatically adds placeholders and prompts for the seventh digit to indicate trimester or episode of care when applicable.

The bottom line

The challenge of successful implementation of ICD-10-CM will be to protect revenue while minimizing productivity challenges. Codes that aren’t accurate or specific may result in denied or delayed claims, which adversely impact a facility or practice’s administrative cost. Degraded productivity could result in increased staffing needs to make up for the longer time to code each chart. Collection rates could be lower due to delayed adjudication and reimbursement. The accuracy of the code produced and the efficiency with which it’s provided will have a great deal of influence on the hospital’s bottom line. That being said, the right encoder tool can be the key.

Elizabeth Morgenroth, CPC, Revenue Cycle Business Analyst, has 16 years of healthcare experience in the payer, provider and vendor areas. While with Blue Cross and Blue Shield of Kansas, she provided coding assistance to all professional specialties statewide. Morgenroth was responsible for the entire revenue cycle process for a family practice in Lawrence, Kan. with four physicians and five physician assistants. While working for Clinical Coding Solutions, she performed professional and facility coding for nearly all specialties. In her current position, she is responsible for encoder tool development and ICD-10 readiness for T-System revenue cycle solutions. Morgenroth attended the American Health Information Management Association (AHIMA) Academy for ICD-10-CM and ICD-10-PCS and is an AHIMA Approved ICD-10-CM and ICD-10-PCS Trainer.