Joseph Castranova, president of MD Billings, says that the EMRs are actually doing most of the work regarding coding.

"We have a system that does it automatically," he says. "Our billers are also coders and they double-check it and sometimes there are errors, but it's drastically reduced since EMR came into play."


Another infamous coding problem involves the disease Barrett's esophagus, where researchers at Kaiser Permanente discovered that electronic coding alone overestimates the prevalence of Barrett's esophagus, and most clinical and research uses will require a manual verification of disease status.

Yet, these are rare instances and should not turn anyone off from using an electronic coding system.

Look Out For Change

Of course, the software vendors need to stay on top of any changes or else it can cause major problems with the physician practices.

"The standards are still the same and updated independently, and it's up to the EMR vendor to integrate with those and it's in the software vendor's best interest or else they won't sell any more," says Chris Thorman, a medical writer for Austin, Texas-based Software Advice.

CD-10 is a diagnostic coding system implemented by the World Health Organization in 1993 to replace ICD-9, which was developed by WHO in the 1970s. ICD-10 is in almost every country in the world, except the United States, which will be making the switch in three years.

The reason for the update is that ICD-9 is out of room. Because the classification is organized scientifically, each three-digit category can have only 10 subcategories. Most numbers in most categories have been assigned diagnoses. Medical science keeps making new discoveries, and there are no numbers to assign these diagnoses.

Although originally it was set to be implemented in the U.S. in 2011, the Department of Health and Human Services moved the date back to October 1, 2013.

"Everybody is concerned with the introduction of ICD 10, as you will have a huge expansion in the number of potential codes," says David Henriksen, senior vice president and general manager for Physician Practice Solutions for the McKesson Corporation. "Our physicians do continue to tell us that their documentation and propensity to leave money on the table has vastly improved when they go to an EHR."

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Contributors to this Report

Keith Belton
Nuance
Burlington, MA

Dr. Steven Zuckerman
Baton Rouge, LA

Jason Launders
ECRI Institute
Plymouth Meeting, PA

Peter Beck
Family Care Centers

Joseph Castranova

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