Liaison Healthcare has received several inquiries from customers asking about our plans for supporting ICD-10 codes. In this article, we’ll try to answer some questions around the ICD-9 to ICD-10 transition and how EMR-Link is going to help.
The Centers for Medicare & Medicaid Services (CMS) released a rule mandating that Covered Entities, —organizations covered by the Health Insurance Portability and Accountability Act (HIPAA)—must implement ICD-10 for medical coding.
Some basic facts:
- The current date set for compliance is October 1, 2014.
- All Covered Entities must transition to ICD-10. This includes providers and payers who do not deal with Medicare claims.
- CMS is urging everyone to prepare early, but they are also stating that they WILL NOT accept claims with ICD-10 codes until the compliance date. This is an important detail. Everyone must be prepared to send ICD-10 codes prior to October 1, 2014, but you must not actually make the switch until the compliance date.
- Labs seem to be taking the same policy as CMS. They don’t expect to start receiving orders containing ICD-10 codes until October 1, 2014.
- Some EMR/EHR vendors are releasing versions of their software that allow providers to choose ICD-10 codes when placing orders. GE, for example, has already released CPS 11 and will soon be making EMR 9.8 available. Both releases support ICD-10.
As a practice, you may still be wondering how to ensure you are compliant. What happens if a provider does select an ICD-10 code prior to the compliance date—will the lab reject it? What about future orders that are placed using ICD-9 codes that run past the Oct 1, 2014 date—will they be rejected? How can you ensure everything works correctly before and after Oct 1, 2014?
As a lab, your main concern is that the orders sent to you in an HL7 ORM message contain ICD-9 codes prior to Oct 1, 2014 and an ICD-10 code after that date. The same is true for diagnosis codes that show up on the printed requisition.
How EMR-Link Can Help
Since EMR-Link is a connection hub between the EMR/EHR and the lab, Liaison is in a position to add functionality to help both sides transition to ICD-10 at their own pace. Not all practices will want to transition from ICD-9 to ICD-10 at the same time. And not all labs will be ready to transition at the same time either. To accommodate this disconnect, EMR-Link will separately control which code set is used on the front end (practice-facing) and on the back end (lab-facing). The changes include:
- EMR-Link will include both the ICD-9 and ICD-10 diagnosis tables as well as the crosswalks from ICD-9 to ICD-10 and ICD-10 to ICD-9.
- EMR-Link will contain medical necessity rules for both ICD-9 and ICD-10 diagnosis codes.
- When order data is received from the EMR/EHR, the diagnosis information is automatically pushed through the crosswalk and saved. This means that whenever an order comes through EMR-Link, both the ICD-9 and ICD-10 diagnosis codes are available. If the EMR/EHR sends ICD-9, then the ICD-9 to ICD-10 crosswalk is used to create the equivalent ICD-10 codes. If the EMR/EHR sends ICD-10 data, then the ICD-10 to ICD-9 crosswalk is used to create the equivalent ICD-9 codes. Both code sets are saved with the order.
- There will be a new Customer-level setting that allows an organization to select whether they want to use ICD-9 or ICD-10 diagnosis codes in EMR-Link. If ICD-10 is selected, then EMR-Link will use ICD-10 codes for medical necessity checking and billing. It will also cause ICD-10 codes and descriptions to display on the EMR-Link Order Review page.
- There will also be a new Lab-level setting that enables ICD-10 for the lab. If ICD-10 is selected, then ICD-10 codes will be displayed on the printed requisition and included in the HL7 ORM message sent to the lab.
- Orders Anywhere will display both ICD-9 and ICD-10 codes when performing a diagnosis search.
With these changes in place, EMR-Link will be able to accept either ICD-9 or ICD-10 data from the EMR/EHR and still push the appropriate code to the lab even if the practice and the lab are on different code sets.
Example 1: The practice is ready to use ICD-10 codes internally. They use EMR-Link to connect to two different labs. Lab 1 can accept ICD-10 data, but Lab 2 is still on ICD-9.
In this case, the Customer-level setting is set to ICD-10. Lab 1 is also set to ICD-10, and Lab 2 is set to ICD-9. When an order is received into EMR-Link, the ICD-10 codes are cross-mapped to find their ICD-9 equivalents, which are also saved with the order.
The medical necessity check is performed using the ICD-10 data. The Order Review page displays ICD-10 codes and descriptions, and any billing messages generated through EMR-Link include ICD-10 data.
Any orders pushed to Lab 1 use ICD-10 codes and descriptions on the printed requisition and in the HL7 ORM message. Any orders pushed to Lab 2 use the ICD-9 data that was returned as a result of the cross-mapping that was done when the order data was received from the EMR/EHR.
Example 2: The practice is still on ICD-9 data, but the lab wants to start receiving all order data with ICD-10 codes.
In this case, the Customer-level setting is set to ICD-9. The lab is set to ICD-10. When an order is received into EMR-Link, the ICD-9 codes are cross-mapped to find their ICD-10 equivalents, which are also saved with the order.
The medical necessity check is performed using the ICD-9 data. The Order Review page displays ICD-9 codes and descriptions, and any billing messages generated through EMR-Link include ICD-9 data.
Any orders pushed to the lab use ICD-10 codes and descriptions on the printed requisition and in the HL7 ORM message.
Example 3: The practice and the lab both use ICD-9 codes until the compliance date of October 1, 2014, at which point they both switch to ICD-10. The practice created several future orders while the ICD-9 code set was in use, but the draw is scheduled to occur after the October 1 compliance date.
When the order was transferred into EMR-Link, the cross-map lookup was done to get the equivalent ICD-10 code, which was saved with the order. Since the practice and the lab are both set to ICD-10, that code set is used rather than the original ICD-9 diagnosis code. As a result, any future orders are sent to the lab using ICD-10 codes, even though they were originally ordered with ICD-9 codes.
Does EMR-Link work with CPS 11 and EMR 9.8?
These are the Centricity releases that include ICD-10 support. The answer is yes. We already have several customers using CPS 11, and we have tested early versions of EMR 9.8 internally. The current version of the Process Orders Form already handles the addition of an ICD-10 code in the order data.
How will EMR-Link deal with future orders?
There will be cases where orders are placed before the compliance deadline with a draw date that is after the October 1, 2014 compliance date. This will not be a problem, because EMR-Link saves the ICD-10 equivalents when the order is first received, so the ICD-10 codes are available at the time of the draw.
When will EMR-Link be ICD-10 capable?
EMR-Link will be ready to support ICD-10 orders by the end of this year. This includes the ability to perform ICD-10 medical necessity checks as well as sending ICD-10 codes to the labs and billing systems. OrdersAnywhere has already been updated to show both ICD-9 and ICD-10 codes in the diagnosis search dialog. All orders that route through EMR-Link are already being stored with both the ICD-9 and ICD-10 codes.
Unfortunately, many of the labs have not been proactive about incorporating changes to support ICD-10 diagnosis codes. Liaison will continue to work with each lab vendor in our hub to ensure they are prepared to receive ICD-10 diagnosis codes in the orders we send them.
What does our practice need to do to prepare?
If your EMR is ICD-10 capable, then most of the functionality is covered with the planned changes. EMR-Link will pick up the ICD-10 codes from the EMR and ensure they are used in the order message as well as any billing messages.
If your clinic uses EMR-Link to generate billing messages, then you should contact Liaison and provide us with information regarding any format changes needed in the FT1 segment of the HL7 DFT message.
When should our practice switch to using ICD-10 codes?
Liaison will make an announcement via the monthly release notes or possibly a newsletter or bulletin to let our customers and partners know that we’re ready to start testing ICD-10 compatibility. Once that announcement is made, you can choose to move to ICD-10.
What does our lab need to do to prepare?
Here are some things that labs should do to ensure a smooth transition. First, contact Liaison and provide us with information regarding any format changes needed in the DG1 segment if it needs to be different for ICD-10 codes. It may be that the format is identical, but some labs prefer to include a diagnosis code identifier to indicate ICD-10 vs. ICD-9.
For example, here’s a DG1 segment showing the ICD-9 coding and the equivalent ICD-10 diagnosis:
DG1|1|I9|v20.2^Routine infant or child health check
DG1|1|I10|Z00.129^Encounter for routine child health examination without abnormal findings
Note that in addition to the change in code and description in DG1.3, there’s also a change in DG1.2 to indicate which code set is used.
It would also be helpful for Liaison to have the date on which you plan to start receiving ICD-10 data.
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