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Payment is Keyed to Coding — Practice makes perfect

Back in 2001 a prominent healthcare attorney, Alice G. Gosfield, stated, “Physicians need to listen up about the importance of proper coding… I understand that our coding system is not the easiest thing to learn. But look, [physicians] got A’s in organic chemistry, they can handle this.” And, as they learned in medical school, physicians need more than good grades to succeed. Understanding medical coding rules is now about to get more complex, as two new important coding systems will be impacting physicians in the next couple of years. It is the responsibility of your EMR/EHR vendor to assist you in becoming more familiar with the new coding systems, and at MediTouch® we take that responsibility seriously. We have just released innovative updates to our Web-based, cloud computing software that give providers new ways to practice coding with these new vocabularies and the ability to begin to convert problem list codes to the newer coding nomenclatures.

If you practice medicine you would have to have your head in the sand to not know that the ICD (Diagnosis) coding system is changing. The move to ICD-10 from ICD-9 is now scheduled for October 2014, one year later than what was originally proposed. The current ICD-9-CM diagnosis codes are 3-5 digits in length and number over 14,000. The move to ICD-10 will increase the number of diagnosis codes designated for use in documenting diagnoses to 68,000, and those codes are 3-7 characters in length.

Moving to ICD-10 is expected to impact all physicians. Due to the increased number of codes, the change in the number of characters per code, and increased code specificity, this transition will require significant planning, training, practice, and intelligent EHR/EMR and Practice Management software. According to the American Medical Association (AMA), the reason for the switch to the new ICD-10 coding system is because, “The ICD-9 code set is over 30 years old and has become outdated. It is no longer considered usable for today’s treatment, reporting, and payment processes. It does not reflect advances in medical technology and knowledge. In addition, the format limits the ability to expand the code set and add new codes.” In addition, many countries have already transitioned to ICD-10, and this change will bring the U.S. up to date on this international standard. Finally, there is no one-to-one match between ICD-9 and ICD-10 since there are almost five times as many ICD-10 codes when compared to the ICD-9 system. Choosing the proper ICD-10 codes to describe your healthcare claim will significantly impact how your bills are adjudicated by the payer and will significantly impact your revenue!

Another less talked about coding system that will soon become part of most every provider’s daily workflow is the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) coding system. In the proposed rule for Stage 2 of Meaningful Use, scheduled to start in January 2014, the structured problem list can only be coded using the SNOMED-CT coding system. Essentially, if you want to be a meaningful user of EHR technology it’s time to learn more about the SNOMED-CT coding system.

The SNOMED-CT coding system is reported to be the most comprehensive vocabulary to express clinical terms, and therefore the best way to report patient “problems” in the structured problem list. It is not a system devised for billing, such as the ICD system, instead it is a systematically organized, computer-processable collection of medical terms providing codes, terms, synonyms, and definitions covering diseases, findings, procedures, microorganisms, and substances. It helps organize the content of electronic health records systems, reducing the variability in the way data is captured, encoded, and used for clinical care of patients and research. It provides for consistent information interchange and is fundamental to an interoperable electronic health record. There are over 300,000 SNOMED codes, but the National Library of Medicine provides scaled down versions of the codebase to make choosing codes easier for users of EHR/EMR technologies.

SNOMED-CT codes include terms or synonyms relating to a clinical concept, as well as links between different concepts. Most providers will not need to use all of the codes and understand all of the linkages, but below is an example of how to visualize SNOMED coding for a case of hypertension.

SNOMED-CT blood pressure reading concepts and attributes

Currently many users of EMR/EHR technology use ICD-9 codes to code the problem list. Since Stage 2 of Meaningful Use mandates SNOMED-CT, it is important for providers to begin to transition their patient problem lists to SNOMED-CT.

Practicing with ICD-10 and converting patient problem lists to SNOMED codes is simple with the newest version of the MediTouch Problem List interface.

Select a Diagnosis from the Patient’s Problem List
Select a Diagnosis from the Patient’s Problem List

Click on the ICD/SNO Map Button
Click on the ICD/SNO Map Button

Suggested Mapping Codes are Displayed (only a partial SNOMED list is visible)
Suggested Mapping Codes are Displayed (only a partial SNOMED list is visible)

Map Your Codes (see the highlighted buttons)
Map SNOMED-CT and ICD Codes

Now the ICD-9 Code Is Mapped to the ICD-10 and SNOMED Codes — Simple!
ICD-9 code is Mapped to the ICD-10 and SNOMED Codes

Most EMR/EHR vendors don’t “think ahead” on behalf of their providers. The MediTouch team is always considering, “What can we do today to make life easier for our providers in the future?” We are always trying to anticipate new regulatory requirements and build them into the workflow of our EHR. If we are thinking about ICD-10 over two years ahead of the start date, then it’s a good bet that we will be compliant and proactive when October 2014 rolls around, which will make your transition smoother. The same holds true for SNOMED coding — convert your patient problem lists slowly over the next year and half and become problem list compliant for Meaningful Use Stage 2 gradually.

Remember, when selecting an EMR/EHR vendor, choose one that’s always ahead of the curve; choose MediTouch!

Seth Flam DO


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