ICD-10 and your EMR: Ready or not

A peek at a few of the transition tools vendors provide.

ICD-10 and your EMR: Ready or not

A peek at a few of the transition tools vendors provide.

By Darla Shewmaker

Need you be reminded yet again: The ICD-10 deadline is almost here. If you accept Medicare patients, you must bill valid claims with an authorized ICD-10 code beginning Oct. 1. Most providers are looking to their electronic medical record (EMR) to help them through this transition. They want to know if there is an easy way to look-up an ICD-10 code, if their existing ICD-9 codes for a patient will automatically convert to ICD-10, and if their exam findings can produce suggestions for the appropriate ICD-10 code.

Ophthalmology Management heard you and surveyed some leading EMR vendors to find out if they are ready for ICD-10 and what resources and tools they can offer physicians. (See table, “Where the EHR vendors stand,” page 70)

Finding your new code

Ophthalmology Management invited 18 vendors to respond; 11 did. Most said their products offer a search option to locate the ICD-10 code. Some of these look-ups only relate to exam findings; others offer look-up services via third parties.

Christine Archibald, CEO at Management Plus, explains. “We have mapping capabilities based on findings of the physician’s examination. We also compiled a list of the top 200 ophthalmology diagnoses from the American Academy of Ophthalmology and we created a mapping for every condition, so the physician enters [his] findings and the system will pull ICD-10 diagnosis codes that [he] can choose from.”

Several vendors, such as Medflow, display the ICD-9 and ICD-10 codes in tandem for each patient diagnosis. This will give providers two advantages: One is a head-start because they can compare the codes side by side, and the second is the opportunity to understand the codes’ relationship.

“Most of our users have been seeing ICD-10 for over a year so they are used to seeing the correlation of ICD-9 to ICD-10,” says Jim Messier, vice president, Sales and Marketing, Medflow. “Our system also includes a customizable notification system for ICD-10 to alert users about special conditions or additional notes about certain ICD-10 codes.”

But look-ups and translation tools take time, possibly adding extra minutes to patient visits or producing inaccurate codes — which means rejected claims, notes Candice Davis, vice president, Revenue Cycle Management at Eyefinity. To get around these potential problems, some vendors offer an alternative to look-ups. In both of Eyefinity’s EHR solutions, Eyefinity EHR and ExamWRITER, ICD-10 is automated. “Both provide true built-in coding that will generate ICD-10 codes based on the doctor’s exam notes,” she says. “You can just tap, touch or click.”

Compulink’s system also will suggest an ICD-10 code based on the physician’s exam findings.

Modernizing Medicine’s EMR, EMA Ophthalmology, has designed technology that collects structured data using touch-and-type functionality on an iPad or desktop. Users can zoom in and out of the company’s proprietary interactive 3D “Anatomical Atlas” to touch on those areas of the eye in question. “This structured data generates ICD-10 codes along with exam notes and populates them onto the super bill,” says Jonathan Criss, MD, Modernizing Medicine’s medical director of EMA Ophthalmology. “The data captures the necessary level of granularity, specificity and laterality,” without look-up.

Where the EHR vendors stand 1
Do you have an ICD-10 lookup available for doctors inside the medical record?
What functionality do you offer to match ICD-9 to ICD-10 and vice versa? General Equivalence Mappings (GEMS), or an alternative?
Do the findings in the medical record suggest possible ICD-10 codes for the patient?
Does the medical record translate the prior list of ICD-9 codes to ICD-10 codes for each patient?
Can this translation combine multiple ICD-9 codes into a single ICD-10 code where applicable?
Can the translation relate an ICD-9 code with a modifier (example: RT, LT) to a specific ICD-10 code?
Eyefinity (Eyefinity EHR and ExamWRITER) N/A Alternative: Eyefinity EHR and ExamWRITER provide built-in auto coding that will generate ICD-10 codes based on the physician’s exam notes. YES NO NO NO
EyeMD EMR Healthcare Systems Yes GEMS plus alternative Yes Yes Yes Yes
First Insight YES Alternative: Proprietary mapping system with selection tool to generate appropriate billing codes, plus information required to meet Meaningful Use YES YES NO YES
Integrity YES GEMs plus “additional proprietary logic” to compensate for the lack of a 1:1 relationship between the ICD-9 and ICD-10 code” and increase accuracy YES YES YES YES
Management Plus YES Alternative: Crosswalking and a capability based on the physician’s exam findings. YES YES YES* YES*
Modernizing Medicine YES Alternative YES YES YES YES
* In some instances, according to the company.
For more detailed information of these EHR systems, please go to the vendors’ websites.

General equivalence mappings

CMS defines the General Equivalence Mappings (GEMs) as tools that convert data from ICD-9-CM to ICD-10-CM and ICD-10-PCS, and vice versa. They also are known as crosswalks, as they provide information that link codes of one system into codes into the other system. This comprehensive translation dictionary can translate any ICD-9-CM-based data, including:

    • Tracking quality

    • Recording morbidity/mortality

    • Calculating reimbursement

    • Converting any ICD-9-CM-based application to ICD-10-CM/PCS such as:

      - Payment systems

      - Payment and coverage edits

      - Risk adjustment logic

      - Quality measures, and

      - A variety of research applications involving trend data.

Many EMR systems offer GEMs. If yours doesn’t, the American Academy of Professional Coders offers a great GEMs tool on its website that allows you to search codes bidirectionally:

GEMS’ alternatives

Mapping, however, is not possible or not perfect in some situations. “With a simple GEMS conversion table method, there is not normally a 1:1 relationship between the ICD-9 and ICD-10 codes,” says Brent Michael, executive vice president, Sales and Marketing at Integrity Digital Solutions. To address this, some vendors have taken an alternate approach or a combination of options in addition to GEMs. Integrity, for instance, allows custom mapping. “We have multiple areas where the physicians can look up and update the suggested coding,” Mr. Michael says. “Our system further highlights where additional clinical information is needed.”

VisionWeb’s Uprising also features prompts to get around the lack of 1:1 correlation between the coding systems. The EHR asks for specifics such as eye location, severity and status to determine the appropriate ICD-10 code.

In most cases, your EMR vendor will provide tools via a look-up or suggested coding. Make sure to take advantage of them. OM

About the Author

Darla Shewmaker has spent 17 years on the front lines of EHR design and implementation. She recently left her position as VP of product development at Compulink and is focusing on ophthalmic practice consultations, education and compliance. Email her at