How to Deal If Your EHR/EMR Doesn't Support ICD-10

So, you need to code using ICD-10, but your EHR or EMR didn’t upgrade to the new code set? The solution here is simple—and absolute: You need new software. (Don’t act like you didn’t know that was coming.) Sure, the CMS grace period allows you a small amount of flexibility, but it definitely doesn’t provide you with a get-out-of-ICD-10-free card. If you’re currently working with an out-of-date vendor, you’re probably already losing revenue due to denied claims, which means you’re up a creek. The good news? We’ve got a paddle. To correct your course, here’s what to look for in your new software:

An intelligent ICD-10 tool

Your EHR/EMR doesn’t need to be smarter than a fifth grader (unless you know any ten-year-old medical coders), but it does need to be highly intelligent when it comes to ICD-10. Here are a few questions to ask potential vendors to ensure your new software gets an A for more than effort:

  • Does it prompt you to document specific details of the patient’s injury or condition?
  • Does the code selector prompt you to choose more specific codes when greater specificity exists? (And let you know when you’ve selected an invalid or non-billable code?)
  • Does the EMR base its ICD-10 code library solely on GEMs? (That’s bad, BTW.)
  • Does the EMR claim to have an automatic one-to-one crosswalk from ICD-9? (Also bad.)

A library of both ICD-9 and ICD-10 codes

Some non-HIPAA-covered entities (like auto and workers’ compensation companies) weren’t required to make the switch to ICD-10. If you ever have to submit claims to these payers, you may still need the ability to use ICD-9 codes, so make sure your new software is equipped with both code sets.

Free system updates

ICD-10 is not the last code set update we’ll ever see—not by a long shot. In fact, the World Health Organization plans to endorse ICD-11 in 2018. And there are updates coming to ICD-10 in October 2016. Plus, the government frequently releases regulatory updates to HIPAA, PQRS, FLR, AEIOU, and sometimes Y (just kidding). But seriously—there are tons of reasons why your new EHR/EMR could slip behind the times, and you don’t want to get stuck footing the bill for any mandatory changes. That’s why you should pick a vendor that updates your system:

  1. automatically,
  2. at no charge to you, and
  3. with as little downtime as possible.

Not sure how much downtime is acceptable? Take a look at this article from PTEMR.net.

Free ICD-10 training, support, and resources

You can’t put a price on great customer service—and if your EHR/EMR vendor truly is invested in the success of your practice, it won’t, either. Look for vendors that offer educational resources and a support team ready to assist you via phone and email—all for the low, low price of $0. (P.S. The best EHR/EMR companies make this kind of support available on all topics, all year round.)

PT-Specific Design

Of course, ICD-10 functionality isn’t your only consideration when picking a new EHR/EMR vendor. You’ll want to make sure your new software comes complete with all the other features that make it easy for a physical therapist to succeed in business, including:

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Without a solid EHR/EMR partner in this ICD-10 world, your financial outlook may be fairly bleak right now. But if you find a system that’s the right fit for your practice, then pretty soon you’ll be rowing your boat gently down the revenue stream once again. Keep in mind that once you select your new software, you’ll still need to develop your game plan for a smooth switch; check out the tips in this article to ensure a headache-free transition.