Will ICD10s be an EHR Challenge?

In theory, EHR systems will make ICD10 coding tolerable.  However, ICD10 coding presents a wide range of challenges to EHR vendors and users. 

The key problem is that EHR systems are designed for ICD9 codes which dramatically differ from ICD10 codes.  EHR systems use and retain ICD9 codes for a number of practical purposes including:

·         ICD9 codes are used to organize the patient record and support coding of charges.  For example, many EHRs include lists of patient problems based on ICD9 codes.  Prescriptions, orders, and even images can be related to an ICD9 codes.

·         ICD9 codes associate related visits and other information within the EHR.  For example, you can view all exams dealing with a specific ICD9 code.

·         ICD9 codes trigger patient care items.  For example, an ICD9 code for diabetes may trigger a health maintenance item associated with a periodic lab test.

However, the switch to ICD10 codes could have a significant effect on how EHR systems relate information and trigger patient service items.  For example, the seven ICD10 character is different for an initial visit versus a subsequent visit.  ICD10 codes can also include the site and characterize the severity of the patient’s condition.  As a practical matter ICD10 codes can change for the same basic patient problem.

ICD10 structure and characteristics present a number of serious challenges to physician practices as the vendors migrate to ICD10 compliant versions.

• The structure and additional information built into ICD10 codes will require substantial changes to EHR systems to maintain the current functionality.  For example, a wide range of ICD10 codes may trigger patient services items that are driven by a few, or even a single ICD9 code.

•  Mapping previously ICD9 classified information to the ICD10 codes will be problematic.  Many ICD9 codes may map to more than one ICD10 code.  As important patient problems that span encounters over a long period of time may require look back strategies that account for the change to ICD10 code.  Otherwise, physicians may be unable to locate related patient information based on the diagnosis codes.

In the final analysis, the changes needed to ICD10 codes is not just a matter of presenting ICD10 codes in place of ICD9 codes for billing purposes, but will require significant changes to EHHR functionality to maintain the benefits of EHR systems using a dramatically different diagnostic coding strategy.