Wednesday, September 30, 2015

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.

AAPC Coder
Online only
Code Manager Elite
Online. Very rudimentary.
Code Search
Simple text search
Fat client
CodeRyte CodeAssist
In the ballpark
ICD-10 Logic
In the ballpark
Dragon Medical Advisor
New. High end.
Encoder Pro Expert
In the ballpark.
Encoder Pro Professional
In the ballpark..
API? Not standalone. High end
API? Not standalone. High end
Flash Code
Flash Code Solutions
Similar to Optum Encoder tools
ICD-10 Coder Ultimate
Super Coder
PC based
Problem (IT)
API. High end.
Select Coder
Decision Health
In the ballpark.
TruCode Encoder
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.

Monday, September 21, 2015

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!

Monday, September 14, 2015

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

Behavioral & Mental Health Tip Sheet for ICD-10

Cardiology & Cardiothoracic Medicine Tip Sheet for ICD-10 

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

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

Hematology & Oncology Tip Sheet for ICD-10

Infectious Disease Tip Sheet for ICD-10

Intensivists & Hospitalists Tip Sheet for ICD-10 

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

Quick Reference ICD-9 to ICD-10 Crosswalk for Nephrology

ICD-9 to ICD-10 Conversion: Commonly Used Neurologic Diagnosis

Neurology& Neurosurgery Tip Sheet for ICD-10 

Obstetrical & Gynecological Tip Sheet for ICD-10

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

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

Physical and Occupational Therapy Tip Sheet for ICD-10

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

2014 Urology Coding Update and ICD-10

Urology Tip Sheet for 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.