Electronic Health Records

Policy & Regulation News

EHR Optimization a Focus of Upcoming ICD-10 Updates

A new guide aims to prepare healthcare practices for the next phase of ICD-10 implementation, which includes new codes and regulations on unspecified codes that will require certain EHR optimization efforts.

By Jacqueline Belliveau

- Many healthcare providers, whether reluctantly or not, have already implemented ICD-10 coding procedures and continued to provide care with the system in place. However, like many aspects of the industry, providers will need to prepare for upcoming updates and changes to ICD-10 on October 1, 2016.

EHR optimization key to next phase of ICD-10 implementation

To assist healthcare stakeholders, the American Health Information Management Association (AHIMA) has released a guide on how to manage ICD-10 post payment reviews and unspecified codes. Per the guidance, healthcare practices should also evaluate their EHR systems to ensure that coding errors have been reported. Many EHR systems are designed to suggest the correct ICD-10 codes, but some stakeholders have noticed that these systems are not perfect.

“While the correct level of ICD-10 code specificity has always been required for National Coverage Determinations, Local Coverage Determinations, other claims edits, prepayment reviews, and prior authorization requests, physicians were granted amnesty from post payment reviews due to unspecified codes,” wrote Christina Lee, MHS, RHIA, CCS, CPC, in the AHIMA newsletter.

Once the grace period ends on October 1, healthcare stakeholders should realign their ICD-10 resources to focus on unspecified ICD-10 codes, which could cause delays in claims reimbursement, explained Lee. Even though ICD-10 hinges on accuracy, there will be cases where providers will need to use an unspecified code.

  • CHIME $1M Challenge Pushes for National Patient Identifier
  • Achieving EHR Optimization alongside Meaningful Use of HIT
  • What does the CommonWell launch mean to a healthcare CIO?
  • Dentists chew over competing diagnostic code sets for EHR use
  • EHR adoption, use among ambulatory care providers
  • Q&A: ICD-10 success relies on project planning, change management
  • EHR adoption hits 96% in MA; half of patients engage online
  • Provider EHR adoption is only one half of meaningful use
  • Is meaningful use driving eligible providers off course?
  • Advanced EHR Use Shows Potential to Lower Patient Costs
  • AMA, Medical Societies Urge Stage 3 Meaningful Use Delay
  • Inpatient, Outpatient EHR Are Top Provider Buying Priorities
  • How are Stage 2 Meaningful Use, ICD-10 taxing providers?
  • Parents want email chat with docs, but don’t want to pay
  • Tight CEHRT deadlines will cause Stage 2 meaningful use woes
  • Oregon looks to remove legal barriers to e-prescribing
  • Meritus Health Launches $100M Epic EHR Implementation Project
  • PA to create drug database to reduce doctor shopping, ODs
  • AHA challenges proposed Stage 2 rule
  • Blumenthal: Debate over meaningful use success is “premature”
  • Have the EHR Incentive Programs Reached a Stagnation Point?
  • CIO series: Meaningful use lessons, strategies from CIOs
  • Meridian Health Plan joins MiHIN data exchange network
  • Congress Strongly Leaning towards 2015 ICD-10 Implementation
  • MGMA anticipates problems, disruptions with ICD-10: Q&A
  • Why EHR Clinical Decision Support Tools Need More Research
  • CHIME Announces Patient Identification Challenge
  • Five questions to ask before considering EHR replacement
  • Clearwater’s Chaput to address security of ePHI
  • Senate will vote on ICD-10 delay, SGR fix on Monday
  • Mass. Home Care Agencies Partner for HIT Adoption Initiative
  • Why do some hospital revenues rise while others see a crisis?
  • ONC Seeks Improved Interoperability Standards Measurement
  • CMS Clarifies Flexibilities After ICD-10 Compliance Deadline
  • ICD-10 countdown: Will we be ready for takeoff?
  • Are transcription costs still saved with EHR?
  • Integrating care through HIE to benefit mental health patients
  • Slavitt Addresses How MACRA Implementation Supports Medicare
  • Recapping Important HIMSS 2016 EHR Interoperability News
  • How Does a National Patient Identifier Help Cybersecurity?
  • Survey Shows Many Unprepared for ICD-10 Implementation
  • CMS Updates Schematrons for Hospital Quality Reporting for CQMS
  • Healthcare, medicine should take a lesson from the Olympics
  • Healthy Futures funds Washington rural health center
  • Changing of the Guard at ONC, Interoperability Remains Focus
  • Beth Israel announces eMAR roll-out for Stage 2 Meaningful Use
  • HIE notifications help coordinate care, track hospital use
  • Comprehensive portal, microblog promotes patient engagement
  • Walgreens pharmacies complete implementation of Greenway EHR
  • Congress Calls for Stage 3 Meaningful Use Rule to Be Paused
  • Clinical Trial Success Relies on Health Data Interoperability
  • Is Experian now the frontrunner in revenue cycle management?
  • What’s preventing telehealth use by mental health providers?
  • Will patient engagement work without patient incentives?
  • CMS Extends Clinical Quality Measure RFI Comment Period
  • Small, Rural, Specialty Ambulatory Practices Lacking in EHR Use
  • Why don’t first responders have instant access to EHRs?
  • ONC approves ANSI for second term as approved accreditor
  • AHA highlights financial prep needed for value-based care
  • Using APIs in Healthcare to Make Patient Data Actionable
  • FDA to establish final guidance about mHealth apps in 2013
  • What is the future of standards for EHR, interoperability?
  • Epic Systems, Cerner Among 8 Health IT Companies Recognized by EHRA
  • Regenstrief to Develop Automated Patient EHR Matching Solution
  • AMA Continues to Urge Congress to Delay Meaningful Use
  • Participation, transactions increase for eHealth Exchange
  • AMIA Urges Reset on Electronic Clinical Quality Measures
  • E-visits Among Health IT Integration Pilots at Beaumont
  • CMS Modifies E/M EHR Clinical Documentation Requirements
  • National Rural ACO formed across three states
  • How does Stage 2 Meaningful Use challenge rural providers?
  • Tahoe Forest Health System Successfully Launches Epic EHR
  • Study Reveals Prevalence of Copy-Paste in EHR Clinical Data
  • Understanding Interoperability, Value of Health IT Standards
  • NYU Lutheran Launches Epic EHR to Boost Patient Care
  • CHIME: Big data targets population health, revenue cycles
  • What Changes will MIPS, MACRA Bring for Clinical Quality Reporting?
  • Texas Health Information Exchange Shares First Data with HIO
  • After Huge Q2, Health IT VC Funding Drops by Half to $956M
  • Congress will withhold funds from VA, DOD joint EHR project
  • The Week Ahead in Health IT Interoperability: Oct. 26-Nov. 1
  • Updated GA telemedicine guidelines require in-person visit
  • Debating Role of EHR Use in Behavioral Health Integration
  • How Orion Health extends HIE functionality
  • Where did EHR adoption show most growth among docs in 2013?
  • Are Health IT Standards, APIs Too Immature for Stage 3?
  • How Chiropractors Prepare for the ICD-10 Transition Deadline
  • With or without incentives, long-term and post-acute care needs EHR
  • Re-engineering patient safety through EHR, health IT
  • CommonWell Members to Build Healthcare APIs to Expand Service
  • New York HIEs Merge, Bring State Closer to Interoperability
  • CMS Releases Results from ICD-10 Acknowledgement Testing Week
  • HIMSS asks for more telehealth, fewer health IT disruptions
  • Can EHR Connectivity Reduce Medical Errors?
  • HHS looks for entrepreneurs to work on HIE, analytics
  • OIG: Most meaningful use hospitals lack EHR fraud safeguards
  • Health IT Standards: Sequoia Offers Patient Matching Model
  • How Scalability, Usability Hold Back EHR Interoperability
  • HIMSS survey: 80% of clinicians use iPads, smartphone apps to improve patient care
  • Meaningful use attestation tools
  • “When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined),” explained CMS in an ICD-10 Overview document.

    AHIMA advised that healthcare practices start by performing internal audits that identify and track patterns in unspecified clinical documentation and diagnosis code assignments.

    If the analysis shows that more specific ICD-10-CM (diagnosis) codes could have been used based on the clinical documentation, then practices should conduct trainings on proper coding techniques. On the other hand, if analysis shows that incomplete medical documentation resulted in unspecified codes, practices should refresh clinicians on appropriate documentation procedures.

    “While there are a few instances where usage of unspecified ICD-10-CM codes may be appropriate, widespread use of numerous unspecified codes should be the exception, not the rule,” stated Lee. “Practices submitting unspecified ICD-10 codes after October 1, 2016 may potentially experience an increase in post payment audits and quality reporting errors. As audits increase, so will payer requests for medical records and clinical documentation.”

    Additionally, healthcare practices may want to consider hiring a certified coding professional to assist with updating ICD-10 coding procedures and compliance policies, explained Lee. A coding specialist can help providers assess EHR code assignments, pinpoint software glitches, and provide ICD-10 training for staff.

    AHIMA noted that many practices may not be able to afford a full-time coding specialist, but there are cost-conscious ways to employ a professional. Practices could collaborate with other providers to share the cost, hire a certified specialist via a contract or a consulting arrangement, allow a current employee to complete coding certification, or employ an interim coding professional.

    The guide stated that common coding glitches include codes for motor vehicle accidents, joint replacements, and traumatic fractures.

    Looking forward, AHIMA predicts that more healthcare providers will experience challenges with the upcoming release of new codes as CMS ends the three-year code freeze. Practices may also face difficulties with statistical reporting because unspecified ICD-10 codes from 2016 will be compared to more specific codes in 2017.

    “A proactive approach to mitigate unspecified documentation, coding, and billing is the best remedy for post-grace period concerns,” reported Lee. “Now is the time for practices to consider hiring credentialed coding professionals and/or partnering with coding consultants. HIM professionals will become increasingly valuable as physicians prepare for the new wave of coding challenges ahead.”

    Assessing EHR systems and ICD-10 capabilities may be a worthwhile task for healthcare providers as the new phase approaches. A recent WEDI survey found that the majority of healthcare stakeholders surveyed stated that EHR and practice management systems facilitated a smooth transition to ICD-10 implementation.

    As the healthcare industry continues to change, ICD-10 is no exception to that rule. However, practices could benefit from AHIMA’s guide on the approaching updates, especially as EHR systems are restructured to accommodate more ICD-10 codes.

    Dig Deeper:

    Impact of ICD-10 on Smaller Provider EHR Use, Reimbursement

    Factors Contributing to Hospital EHR Implementation Success



    Sign up to continue reading and gain Free Access to all our resources.

    Sign up for our free newsletter and join 60,000 of
    your peers to stay up to date with tips and advice on:

    EHR Optimization
    EHR Interoperability
    EHR Replacement

    White Papers, Webcasts, Featured Articles and Exclusive Interviews

    Our privacy policy

    no, thanks

    Continue to site...