Electronic Health Records: The End of the Line for Coders…or a New Beginning?

The global shift in the health care industry from paper-based patient charts to Electronic Health Records (EHRs) has raised concerns in the coding community. With EHRs that automatically generate medical insurance and billing codes, the logical question on everyone’s mind is…will the role of the medical coder soon become extinct?

While this is a very valid concern, expert coding author Carol J. Buck sees the implementation of EHRs not as a cause for alarm, but rather as an opportunity for the field to evolve and grow. Instead of becoming obsolete, the reality is that coders will become more important than ever — as auditors. Buck says, “Auditing is a natural course to implement at this time because of the EHR. Facilities that have switched to EHRs have experienced an increase in the number of coders needed, not a decrease. The fact is that codes still need to be assigned and there are even more rules, not fewer rules to follow. The coder has the necessary level of expertise across the broad areas of reimbursement and coding to ensure compliance when submitting charges.”

When it comes to EHRs, coders bring a set of skills and knowledge to the process that no one else on the health care team possesses. Carol Buck provides an example, “Look at a general surgeon. They perform procedures that require PCS, CM, and CPT. They would have to have a grasp on all those codes and the corresponding reimbursement rules. Traditionally, a coder would review the operative report and translate the services provided into codes. A coder who is an auditor is essential with the introduction of EHRs and ICD-10.” Buck also points out, “An auditor ensures that the proper coding is included for exactly what was provided or performed, and sometimes that requires more detail than what the physician provides.”

Shifting the focus from traditional coding to auditing applies to education as well. “The future of coding is auditing, which requires checking the work of others, reviewing codes with people who haven’t been trained in medical coding, and working faster than ever before. It requires a higher level of knowledge,” says Buck, “so we must ensure that education is changing with the industry.”

As with the transition to ICD-10, Elsevier and Carol Buck have you covered when it comes to the future of coding. Be sure to check out our latest auditing texts, The Next Step: Advanced Medical Coding and Auditing, 2013 Edition and E/M Auditing Step, 3rd Edition.

If you have any questions, ask the Elsevier Experts or contact your Elsevier Education Solutions Consultant today.

Transitioning to ICD-10 by Carol J. Buck

Mandated Transition

Over 99 percent of Medicare Part A (inpatient) claims and over 96 percent of Medicare Part B (outpatient) claim transactions are received electronically (www.cms.gov/Versions5010andD0/downloads/w5010BasicsFctSht.pdf). The 5010 electronic data interchange (EDI) is ICD-10 compatible and the government requires the claims be submitted via EDI. Although some prominent organizations have come out against the implementation of ICD-10, the transition is a mandate that is scheduled to take place October 1, 2014, and health care facilities and providers are in the final stages of gearing up for the transition. Canada has already transition to ICD-10 as have most nations; further, ICD-11 is already in global pilots. The ICD-9 had limited expandability based on the structure of the coding system and literally the system is out of numbers to assign. Unless some unforeseen political event occurs, the ICD-10 is a scheduled mandate that we all need to prepare for.

A successful transition from ICD-9 to ICD-10 is not an impossible task! For the facilities and providers, the transition is expensive and time consuming as there must be software revisions and system integrations, but in the classroom, the revision is the curriculum content, which is not a difficult task. The critical issue for the classroom is the timing of the transition.

More Codes

The primary difference between the code systems is ICD-10 has more codes — approximately five times more codes — and these additional codes provide greater detail. For example, where there may have been two codes from which to choose to assign a diagnosis of a fracture, there may be 20 or more codes from which to choose. The increase reflects laterality (left/right) or incident of service (initial/subsequent), and other key factors. The increased number of codes makes the assignment of the code more specific not more difficult. The medical documentation must, however, reflect all the detail necessary to correctly assign a code.

In addition to having more codes in the ICD-10, and the format of the manual has changed.

The ICD-9-CM was contained in one manual with three volumes:

• Index of Diseases (Volume 2, the index)
• Tabular of Diseases (Volume 1, the codes)
• Procedures (Volume 3 inpatient surgical procedures and therapies)

The ICD-10 is contained in two manuals:

• ICD-10-CM with Index of Diseases and Tabular of Diseases
• ICD-10-PCS (Procedural Classification System)
• The new system is presented in table format and represents the most dramatic change in the entire coding system.

When to Transition

There are two questions to consider before developing an implementation plan to transition to ICD-10:

1.  When is the student entering the job market? 

• Between now and January 2014, the student should have a working knowledge of ICD-9 and a basic knowledge of the ICD-10.
• After January 2014, the student should have a working knowledge of both ICD-9 and ICD-10
• Employers want graduates to have ICD-9 knowledge from January to October, 2014, because transactions will be ICD-9 based until October 1, 2014, when transactions will begin to be ICD-10 based.

2.  Is the student preparing for an AHIMA or AAPC examination? 

• Examinations are to be ICD-10 based as follows:
• AHIMA, April 1, 2014, begins ICD-10 based examinations
• If the examinee takes an AHIMA certification exam prior to April 1, 2014, the examinee must acquire continuing education units (CEUs) in ICD-10 as follows:
• CHPS – 1 CEU
• CHDA – 6 CEUs
• RHIT – 6 CEUs
• RHIA – 6 CEUs
• CCS-P – 12 CEUs
• CCS – 18 CEUs
• CCA – 18 CEUs
• AAPC, January 1, 2015*, begins ICD-10 based examinations
• The examinee that takes the ICD-9 based AAPC certification examination must take and pass a 75-question ICD-10 proficiency examination. The proficiency examination will be available October 1, 2013 through October 1, 2015. The exam costs $75 and is an open book, online examination. The examinee has until 2015 to successfully pass the examination.



*Projected dates based on previous date of when ICD-10 was to be published October 1, 2013.

Delay in ICD-10 compliance date — what does it mean for you?

On February 16, the U.S. Department of Health and Human Services announced its intent to delay the ICD-10 compliance date. Originally set for October 2013, the new compliance date is unknown at this time, with some industry leaders predicting it could be delayed anywhere from several months to a year or longer. So, what does it mean for you and your students?

Expert Elsevier coding author Carol Buck urges educators not to panic, “I have already prepared for this,” she says, “all of the Buck books have both ICD-9 and ICD-10 and will be this way until final implementation. That’s the beauty of our books. You don’t have to buy an ICD-9 version and an ICD-10 version. You can use any of the Buck books and be fine.”

As a leading health care publisher, Elsevier is dedicated to helping make your transition to ICD-10 as smooth as possible with complete curriculum support every step of the way. We closely monitor breaking news and the latest developments in health care legislation, guidelines, and delivery to ensure that the Elsevier educational content you teach today effectively prepares your students for tomorrow’s health care environment.

Be sure to check back for more updates on the ICD-10 delay and how Elsevier can help you stay on track. As Carol Buck recently said, “Please don’t worry. Rest assured we have you covered. We have all the educational materials you need for both ICD-9 and ICD-10.”

If you have specific questions about the ICD-10 delay, ask the Elsevier Experts or contact your Elsevier Education Solutions Consultant today.