In response to my previous EMR and ICD-10 posts, an EMR vendor recently sent me how they plan to address the transition from ICD-9 to ICD-10. Here’s their plan:

1. We are going to have both the ICD-9 and ICD-10 codes reside in the same file in our application. This will allow the charge entry people to enter either code. There will be a field in the ICD-9 that will map to a single ICD-10.
2. We will provide a report to each doctor showing them the frequency of the ICD-9 codes they used over a period of time that they can specify. This report will show the available ICD-10 codes. The doctor can study it, start to change, or ignore it.
3. The staff can opt to let the software map one ICD-10 to the ICD-9 or manually enter the code of their choice.
4. Our electronic claims software will have a flag per insurance carrier indicating whether or not it will accept ICD-10. For those that will, we will map the ICD-9 to the 10 and send that code. If no map identified, we will generate an error edit.
5. At some point down the road, we will use the information collected from billing to update the doctor’s preferred list of dx codes in the EMR.
6. We will have to augment customized programs at each client site that may be doing reports based on ICD-9.

The push to ICD-10 is rapidly approaching. That’s why I was interested to know how EMR vendors were going to get the ICD-10 code list. However, there are going to be a lot of other nuances for EMR vendors to move from ICD-9 to ICD-10.

The following is a short description of some real data around the move from ICD-9 to ICD-10. It’s from a newsletter sent out by ArcSys including some interesting data from a real clinic. It’s going to be interesting to make the transition to ICD-10 along with all the fun things happening around Meaningful Use.

On October 1, 2013, all claims processing needs to be transitioned to the new ICD-10. As you can well anticipate, this will be a major change for the healthcare industry. As a practice, your biggest challenge will be the re-education of the staff on what the new codes are and their associated nuances. Starting January 1, 2011, CMS will start to accept the 5010 claim definition which will allow for the transmission of the ICD-10 codes.

ArcSys will have the software tools in place to assist you in the transition. We can provide you with reports showing the frequency of which ICD-9 codes have been used by each provider. The major problem is that there is no one-to-one mapping—it is one-to-many for numerous codes.

As an example, from an internal medicine group, the number of times that a diagnosis related to diabetes over a one-year period produced the following part of a report:

250.00 703
250.01 81
250.02 145
250.03 27
250.30 1
250.40 16
250.43 2
250.51 1
250.60 43

If you look at the published mapping files as provided from the Centers for Medicare and Medicaid Services, you will find the following “simple” example:

25000 E119 10000
25001 E109 10000
25002 E119 10000
25003 E109 10000
25010 E1310 10000
25011 E1010 10000
25011 E1011 10000
25012 E1169 10000
25013 E1010 10000
25020 E1101 10000
25020 E1100 10000

Thus, ICD-9 code 250.00 maps to E11.9 (Type 2 diabetes mellitus without complications), and 250.20 maps to either E11.01 (type 2 diabetes mellitus with hyperosmolarity with coma) or E11.00 (type 2 diabetes mellitus with hyperosmolarity without nonkeototic hyperglycemic-hyperosmolar coma). Clearly, some “dusting off” of the old textbooks may be necessary to get a better understanding which code might make the most sense. (The 10000 number is a “computer number” that will be used to identify the degree of association between the the ICD-9 and ICD-10. It is far too-complex to describe in the space allotted here.)