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!


  1. I'm a software engineer and not in the medical industry. Your description sounds self contradictory in parts. You want simple but also highly customizable. You want basic functionality but also patient and aggregate history.

    You also want offline operation, and I suspect there's a HIPAA issue with that in case your device dies or wanders away. Where do you find a HIPAA-trained tablet repair technician to repair a cracked screen?

    1. Besides "simple" interface, I didn't mention simple anywhere. Nor did I mention "customizable" or configurable. Where do you get that?

      And "patient history" is very simple: just track all final selections made by the user so they can go back and see what they selected: Date of Service,Patient Id & Diagnosis.

      Encryption solves HIPAA concern over lost devices.

      Now "HIPAA Trained Tablet Repiar. HAHAHAHA - that's a new one on me.

      With all due respect, Ive been in IT with heavy software development - both myself and teams I've managed - for over 30 years.

      Thanks for your comments and I hope I've addressed them.


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