Where are all the ICD-10 diagnosis coding tools?

For the last couple weeks I’ve been on a search for software based coding tools that are used for coding ICD-10 diagnosis codes for the purpose of claims submission. I’m looking for something better than a glorified text search tool and something less than a high-cost, CAC/NLP-based module that's bundled with an EHR or that must be integrated into an EHR. Something that can be used by coders and physician’s alike. A tool that runs on a tablet; preferably without always needing an internet connection. Something that doesn't cost and arm and a leg. 

BTW, that’d be code S58911A for losing the arm and S88011A for the leg. :)

I’ve scoured the internet. I’ve reached out to some medical coding associates. I’ve queried my followers. I’ve created a blog post outlining the functionality I would like to see in an ICD-10 diagnosis coding tool and repeatedly shared it out to my network. I even created an online survey.

Here’s what I found. I’ve noted why I think they're not what I’m looking for.

Product	Vendor	Impression
AAPC Coder	AAPC	Online only
Code Manager Elite	AMA	Online. Very rudimentary.
Code Search	e-MDs	Simple text search
Codefinder	3M	Fat client
CodeRyte CodeAssist	3M	In the ballpark
Cypher	ICD-10 Logic	In the ballpark
Dragon Medical Advisor	Nuance	New. High end.
Encoder Pro Expert	Optum360	In the ballpark.
Encoder Pro Professional	Optum360	In the ballpark..
ezCAC	ezDI	API? Not standalone. High end
ezCDI	ezDI	API? Not standalone. High end
Flash Code	Flash Code Solutions	Similar to Optum Encoder tools
ICD-10 Coder Ultimate	Super Coder	PC-based
PLATOCODE	eMTS	PC based
Problem (IT)	IMO	API. High end.
Select Coder	Decision Health	In the ballpark.
TruCode Encoder	TruCode	API? Hard to determine

 
My Findings

So I’ve found about five ICD-10 Diagnosis Coding Tools that are “in the ballpark.” But none of these operate on a tablet and all require an always-on Internet connection.

What am I doing wrong? Where am I not looking? Am I being unreasonable? Can someone point me to the ICD-10 diagnosis coding tool I’ve described at the start of this post? If so, please, please, please contact me.

If you can't help me but can share any info about your experience with ICD-9 coding tools, please take my survey.

What would a good ICD-10 coding tool be able to do?

For the past month or so, I’ve been looking for ICD-10 coding tools; preferably an app that runs on handheld devices like smartphones and tablets. And specifically an app which could be used by physicians and coders alike to code ICD-10 diagnoses.

What I’ve found are three general types of applications:
1. Simple text search apps

The most common ICD-10 apps I’m finding are simple text search utilities where the developer took the ICD-10 data files and added some simple text searching. Many don’t even allow wildcard operators and I didn’t find any that have very advanced searching capabilities.

2. Code assignment modules embedded into an EHR

Some EHR vendors have sophisticated ICD-10 code assignment functionality that do in fact address many of what I believe are core requirements of the ideal ICD-10 coding tool. But this is not what I’m looking for. Who’s going to license an EHR just to do code assignment?

3. Sophisticated computer-assisted code assignment tools utilizing artificial intelligence and/or natural language processing

There are some vendors out there that offer standalone, sophisticated ICD-10 code assignment functionality – usually via some sort of API and not via a handheld device. They're very expensive and not something most physicians and coders would use.

So what should a “Good” ICD-10 Coding be Able to Do?
One Size That Fits All

Has a user interface, logic rules and “workflow” that support the competencies and idiosyncrasies of both coders and physicians

A user interface that minimizes the need to key in search terms but is driven from a point and click method – or touch screen

Incorporates medical-specialty specific functionality to filter out anything not related to the specialty of the provider whose claims are being coded

Minimizes the need for coders to know anatomy and physiology

Allows the user to begin a code assignment session by selecting a part of the body

Speaks the Lingo and Holds Your Hand

Incorporates clinical terminologies that reflect more current clinical terminology and standardization of the terms used to diagnose certain conditions and disorders that clinicians and health care personnel use today for patient care and data reporting

Incorporates ICD-10’s coding conventions, general guidelines, and chapter-specific guidelines that must be followed to classify and assign the most appropriate code

Identifies and automatically assists the user with proper handling of “combination code” scenarios

Identifies and automatically assists the user with proper handling of “code first” scenarios

Automatically applies “excludes” rules that specify conditions that cannot occur together

Allows the assignment of manifestation codes

Assists the user with ensuring that laterality is considered when applicable

Assists the user with ensuring that seventh character extension for episode of care is considered when applicable

Uses patient age and gender to automatically preclude inappropriate diagnoses from be selected/assigned. These would include:

• Newborn/Neonate Diagnoses (0 years)
• Pediatric Diagnoses (0-17 years)
• Maternity Diagnoses (12-55 years)
• Adult Diagnoses (15-124 years)
• Female Only Diagnoses
• Male Only Diagnoses

Automatically flags codes designating a borderline condition to encourage coders to query the physician for clarification

Accommodates identification of Present On Admission exempt codes

Flags any codes that are questionable as admission diagnosis

Prevents assignment of codes that are unacceptable as principal diagnosis

Flags duplicate codes

Assists with applying coding conventions and guidelines that reflect more current clinical terminology and standardization of the terms used to diagnosis mental, behavioral and substance use disorders.

Allows the user to identify most commonly coded diagnoses to create a virtual super-bill

Simple and Not Fancy – This is Real Work!

Doesn't contain fancy graphics that slow down performance

Displays a bread crumb/trail of the pathway the user took to arrive at a diagnosis

Retains a history of all patients and diagnoses selected on a user-specific basis and allows the user to browse code assignments made in the past

Runs on a smartphone or tablet

Can operate offline without an internet connection

Can receive software and ICD-10 code updates without the user having specialized technical knowledge

Provides an XML based or other “standardized” output that contains all coding information needed for downstream EHR storage and billing processes

Eliminates or at least minimizes the tension between coders and physicians that can result from excessive coder queries to the physician

Where are these ICD-10 Coding Tools?

What else should a good ICD-10 coding tool do? Send me your ideas. And if you know of any tools that do most or all of what I've listed above, please contact me so I can share with others. Thanks!

Medical Specialty-specific ICD-10 Tips Sheets (All PDF format & all free)

Here's a list of specialty-specific ICD-10 tip sheets and ICD-9 to ICD-10 crosswalks.  The "Tip Sheets" are organized by diagnosis and specify the unique ICD-10 coding considerations for each diagnosis. These are all PDF's that can easily be downloaded and printed out for ease of reference.

Anesthesiology Tip Sheet for ICD-10

Anesthesia ICD-10-CM Coding Tip Sheet

Certified Registered Nurse Anesthetist 

Behavioral & Mental Health Tip Sheet for ICD-10

Cheat Sheet ICD 9/ICD 10: Mental and Behavioral Health Comparison

Cardiology & Cardiothoracic Medicine Tip Sheet for ICD-10 

Cardiology

Cardiology ICD-10-CM Coding Tip Sheet

Critical & Urgent Care Tip Sheet for ICD-10

ICD-10 Dental Diagnosis Codes

ICD-10 Codes for Orthodontics

Emergency Medicine Tip Sheet for ICD-10 

ICD-10 Documentation Tips for Emergency Medicine and Trauma
 
ICD-10-CM and the Emergency Physician
 
Family Practice Tip Sheet for ICD-10

Family Practice

ICD-10 Diagnosis Codes for Gastroenterologists
 
ICD-10 Documentation Tips for Gastroenterology
 
General Surgery Tip Sheet for ICD-10
 
CDI ICD-9/ICD-10 Comparison Topic: Gestational Diabetes 
 
Gynecology Tip Sheet for ICD-10

Hearing Services ICD-10-CM Coding Tip Sheet

Hematology ICD- 10 CM Coding Tipsheet & Overview of Key Chapter 3 Updates

Hematology & Oncology Tip Sheet for ICD-10

Home Health ICD-10-CM Coding Tip Sheet

 
Infectious Disease Tip Sheet for ICD-10
 
Intensivists & Hospitalists Tip Sheet for ICD-10 
 

Internal Medicine

ICD-9-CM /ICD-10-CM Codes for Medical Nutrition Therapy (MNT)

Musculoskeletal ICD-10-CM Coding Tip Sheet

Quick Reference ICD-9 to ICD-10 Crosswalk for Nephrology
 
ICD-9 to ICD-10 Conversion: Commonly Used Neurologic Diagnosis

Neurology Coding ICD-10-CM Coding Tip Sheet

Neurology& Neurosurgery Tip Sheet for ICD-10 

OB/GYN

Building an ICD-10 cheat sheet for obstetrics

Obstetrical & Gynecological Tip Sheet for ICD-10

Ear, Nose & Throat (ENT) and Ophthalmology Cracking the ICD-10 Code - Ophthalmolgy

Orthopedics

Orthopedic Medicine Tip Sheet for ICD-10

Pathology ICD-10-CM Coding Tip Sheet

ICD-10-CM: Practical Guidance for Pathologists and Labs

The above is not a cheat sheet but nonetheless good information. Including it for "Anonymous" below.

ICD-10 Diagnosis Documentation Tips - General Pediatrics
 
ICD-10 Diagnosis Documentation Tips - Pediatric Neonatology
 
ICD-10 Clinical Concepts for Pediatrics

Primer for Pediatrics Clinical Documentation Changes

Pediatric ICD-10-CM Coding Tip Sheet

Frequently Used ICD-10 Codes for Physical Therapy 

Top Ten ICD-10 Codes for Physical Therapy

Physical and Occupational Therapy Tip Sheet for ICD-10

Podiatry Specialty ICD-10-CM Coding Tip Sheet

ICD-10-CM and PODIATRY

Top 20 Podiatry ICD-9 to ICD-10 Code 

Top 20 Pulmonary ICD-9 to ICD-10 Codes

ICD-10 Internet resources for Pulmonary, Allergy, and CCM

Radiology Tip Sheet for ICD-10

Radiology ICD-10-CM Coding Tip Sheet

Rheumatology ICD-10-CM Coding Tip Sheet

Speech Therapy ICD-10-CM Coding Tip Sheet

Hospital-based SNF Coding Tip Sheet: Top 25 codes and ICD-10 Chapter Overview

Freestanding SNF Coding Tip Sheet: Top 25 codes and ICD-10 Chapter Overview

2014 Urology Coding Update and ICD-10

Urology Tip Sheet for ICD-10

ICD-10-CM Coding Documentation Tips for Wound Care Infectious diseases(A00-B99)

Wound Care Reimbursement Code Converter

Wound Care: ICD-10

Required ICD-10 Data Elements for Orders /EMR Template

For more information on ICD-10 and healthcare information technology in general, consider following me on Twitter.