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Funny ICD-9 Codes Video – Putting ICD-10 Codes in Perspective

Posted on August 11, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In response to Jennifer Della’Zanna’s post on putting crazy ICD-10 codes in perspective, I wrote about the funny ICD-9 codes over on EMR and HIPAA. I guess ClinicSpectrum liked the post enough that the decided to create a video animation of the post. I thought it was pretty cool. Check it out:

ICD-10 is near. Are you ready?

Crazy ICD-10 Codes? Let’s Put Them In Perspective

Posted on July 16, 2015 I Written By

The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
Jen HIM Trainer
Exhibit A: W55.21XA Bitten by a cow, initial encounter

Exhibit B: Y92.241 Hurt at the library

Exhibit C: Y93.D1 Accident while knitting or crocheting

Exhibit D: W56.22 Struck by Orca, initial encounter

These are the kinds of codes trotted out to “prove” how ridiculous moving the ICD-10 coding system is. What do we need these codes for? Everybody seems to be asking this question, from congressmen to physician bloggers to—now—regular people who have never before even known what a medical code was.

Here are a few things you should know about these codes. Some of you actually should know this already, but I’ll review for those who have been sucked into the maelstrom of ridicule swirling about the new code set.

  1. You’ll notice that all those crazy code examples start with the letters V, W, X and Y. These are all “external cause codes,” found in just one of ICD-10’s 21 chapters (Chapter 20). In my version of the manual, that encompasses 76 pages. Out of 848.

    External cause codes are the only ones ever trotted out as ridiculous. Do the math. They make up 9% of the codes. They are used mainly to encode inciting factors and other details about trauma/accident situations. There are some other uses, but not many. Do most people use them in everyday coding? No. That’s not going to change with the new system. If you’re a coder who is not already using external cause coding on a day to day basis, you will likely not have to start now. Most people never look in this chapter—ever.

  2. The reason there are such funny codes is the system allows you to “build” a code using pieces, which is what makes the book so easily expandable in all the right places (which is the point of the entire code change—the external cause codes just came along for the ride). Let’s look at Exhibit A: Bitten by a cow, initial encounter:
    The first three characters of the code indicate the category. Each additional character adds some detail.W55 is the category “Contact with other mammals”The 4th character 2 indicates contact specifically a cow (although included in this code is also a bull). You can change the animal to a cat by using 0 or a horse by using 1. You get the idea, right?

    The 5th character 1 indicates that the injury is a bite. A 2 would mean the patient was struck, not bitten.

    The 6th character X is a placeholder because this code requires a 7th character extension to indicate what encounter this visit was.

    The 7th character A indicates that this was an initial encounter. You could change this to a D if the patient has returned for subsequent visits or an S if the patient ends up with another problem later that could be attributed to this original cow—or bull—bite.

  3. We can code most of those same ridiculous codes with ICD-9, although most times not quite to the same specificity. I’ll match the ones below to the exhibits we have at the top:
    Exhibit A: E906.3 Bite of other animal except arthropod

    This is what we would currently have to use for “bitten by a cow.” There is no way in the current code set to indicate whether this is an initial encounter or a follow-up encounter for this accident, however. Since the code is so vague, this code could actually also be used to mean “bitten by a platypus” or “bitten by a pink fairy armadillo,” so yes, you can still code that in ICD-9, but not as well.

    Exhibit B: E849.6 Accidents occurring in public building

    Do you consider a library a public building? I do. Yep, you can code that with ICD-9, but not as well.

    Exhibit C: E012.0 Activities involving knitting and crocheting

    This is what we call a one-to-one mapping. A specific code for this already exists in ICD-9 with exactly the same description. Next.

    Exhibit D: E906.8 Other specified injury caused by animal

    This is the code we would have to use to indicate an attack by an Orca. Again, no indication of what encounter it is, but this time there is actually no reason to even use this code because, really, what information is it giving you? The patient was injured by an animal. We have no idea what kind of injury or what animal caused it. I’m all for going to a useful code for those rare occurrences of attacks by Orcas (which, as we all know, do occur from time to time!).

The real point is not what kinds of crazy things are now able to be coded, it’s what critical things can be coded with ICD-10 that could not be coded with ICD-9. The most newsworthy one is Ebola. In ICD-9, we have to use 065.8 Other specified arthropod-borne hemorrhagic fever. In ICD-10, we have A98.4 Ebola virus disease. But there are other reasons to go to the new system. There are new concepts in ICD-10 that didn’t exist in ICD-9, like laterality. We now have the ability to indicate which side of the body an injury or other condition occurs. This inclusion is one of the biggest reasons for the book’s code expansion. Each limb and digit has its own code (but, again, it’s the changing of one number in the overall code that indicates left or right, and which digit is affected). With all the complaints about the increased documentation required for the new code set, one would hope that most physicians already document which hand or arm or leg or ear or eye or finger is affected. As I mentioned above with the seventh-character extension, there is the ability to indicate the encounter and, more importantly, to link a prior condition with a current one with the use of the S character that indicates “sequela.”

There’s much evidence that the ICD-10-CM will help make patient records more accurate and reporting of conditions more precise. This will lead to improved research abilities and a healthier worldwide population. And the ridiculing of ICD-10 codes, which I’m sure will continue long after this blog post has disappeared from your newsfeed? Well, they always say that laughter is the best medicine!

About Jennifer Della’Zanna
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the allied health care industry for 20 years. Currently, she writes and edits courses and study guides on medical coding and the use of technology in health care, as well as feature articles for online and print publications.  You can find her at and on Twitter @HIMTrainer.

5 Features to Look for in a Medical Billing Company

Posted on March 4, 2015 I Written By

The following is a guest blog post by Harold R Gibson, Chief Financial Officer at M-Scribe Technologies, LLC.
Harold Gibson
A full-service medical billing company does more than code and file medical insurance claims. While that may still make up the bulk of a company’s output, a good medical billing company should offer additional services to help a practice achieve both profitability and compliance goals. Look for the following main features in a medical billing company:

  1. With the transition from ICD-9 to the new ICD-10 coding system in place, a billing company’s coding, billing and other EHR staff should be trained and experienced to ensure optimum accuracy – the foundation of compliance, and therefore improved timely payment. Since many practices have less time or budget for training billing staff in all aspects of the newer, more complex coding system, it falls to the medical claims processing service to fill in any gaps in the EHR process. A company which carefully monitors the EHR content entered will improve the accuracy of the codes and therefore ensure better compliance and payment as well as lessen the chances of an audit. Duplicate claims, payments included in a previously-billed service or procedure already adjudicated and non-covered charges are some of the most common reasons for claim denials. Make sure your practice doesn’t make these billing mistakes by letting a professional medical billing services company handle the workload.
  1. Accurate medical documentation is critical to having claims paid on time, with no rejection due to errors or incomplete filings. This is especially true of Medicare claims, whereby a Certificate of Medical Necessity and other required documentation must be correct and current to merit payment without multiple resubmissions. The right medical billing services company should use  technology and experience when entering only claim-relevant content data, correct procedure (CPT) and diagnosis codes (ICD-9 and ICD-10). These should then be entered into the EHR charts, providing convenience, increased efficiency and cost reduction.
  1. Specialty-specific billing services are available to group practices and clinics as well as individual physicians. Whether your practice uses billings systems such as eClinicalWorks, Greenway, Kareo, NextGen or other popular systems, the right service should be able to help. Whether your practice specializes in Surgical, Dermatology, Nephrology, Orthopedic, Radiology or anything else this should not be a problem for your billing provider. As a bonus, full-service billing companies can provide other services to you, including patient scheduling, verification of eligibility, performing patient demographics, coding and claims submission.
  1. Pre-RAC audit-related support: Complying with the complexities of Medicare and Medicaid regulations can be challenging even for an experienced billing staff in many practices – even more so for smaller or solo practitioners, who often have just one or two staffers handing billing as well as other duties. On the other hand, offering pre-audit support can be tricky for smaller, less experienced billing companies.  An experienced medical billing company can help with preparing a pre-audit checklist to supply requested audit information.
  1. Training webinars for billing and coding staff are another service designed to reduce the chance of errors caused by unfamiliarity with the new coding system as well as keeping abreast of regulatory and other changes. Offered free of charge, these webinars explore the history of ICDs, a comparison of ICD-9 and ICD-10, coding guidelines and formats as well as a step-by-step plan for implementation. These webinars can help solve the dilemma of not enough time or money to send busy staff to expensive, days-long ICD-10 training classes.

If you are looking for a medical billing company, it is important to choose a company that houses the above five features and remember to look for a company that will help with profitability and compliance goals.

About Harold R Gibson
Harold R Gibson is the Chief Financial Officer at M-Scribe Technologies, LLC, an accomplished healthcare professional with extensive experience in the medical billing and coding industry. You can find him on Twitter @mscribetech. He is interested to get your feedback/suggestions. Please email him at

ICD-10 Ebola Infographic

Posted on October 21, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my post on funny ICD-10 codes ruining the ICD-10 brand, I briefly commented how there’s no ICD-9 code for Ebola, but that there is one for ICD-10.

Beth Friedman from Agency Ten22 shared a link to this ICD-10 Ebola Infographic that I thought readers would find really interesting.

Ebola ICD-10 Infographic

One more reason to finally implement ICD-10 in the US.

ICD-10 Frequently Asked Questions (Including Update on Revised CMS-1500 Form)

Posted on March 24, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Dana Deardorff.

Are you concerned about the upcoming changes in coding? The following are answers to frequently asked questions that will help you prepare for the changes ahead. Please note the deadline for the first significant change is April 1, 2014.

What does ICD-10 stand for?

ICD-10 is an abbreviation. It stands for the International Classification of Diseases, 10th Revision. It is used when referring to either the Clinical Modification (ICD-10-CM) or Procedure Coding System (ICD-10-PCS).

How will ICD-10-CM be used?

ICD-10-CM will replace ICD-9-CM codes, Volumes 1 and 2. It will be used when reporting clinical setting diagnoses.

How will ICD-10-PCS be used?

ICD-10-PCS will be used by hospitals to report inpatient procedures.

Who has to convert to ICD-10?

Health care providers, clearinghouses, payers and physicians all are required to convert to ICD-10. This is not optional and includes any HIPAA covered entity.

What will happen if I don’t convert to ICD-10 by the October 1st deadline?

If you submit ICD-9 codes after October 1, 2014, those transactions will not be accepted. Those transactions will be denied. This will cause you to lose out on reimbursements. You may need to apply for a line of credit to prepare for cash flow disruptions that may occur due to noncompliance problems. This will help protect you from negative impact if your medical practice partners do not convert to ICD-10 in time.

What is the deadline for the ICD-10 conversion?

The deadline is October 1, 2014.

What is this April 1, 2014 deadline I keep hearing about?

The April 1 deadline is for the revised CMS-1500 form used for submission of paper claims. The CMS-1500 form is an intricate part of the ICD coding system. The new form (version 02/12) is replacing version 08/05. As of April 1, 2014 providers need to use version 02/12 of the CMS-1500 form. The old form will no longer be accepted.

How is the revised CMS-1500 form tied into the ICD-10 transition?

Physicians will notice that the revised CMS-1500 form provides fields for the new ICD-10 codes. However, your payors may not have made the transition from ICD-9 to ICD-10. Physicians should use ICD-9 codes until you have confirmed that the payor has made the transition to ICD-10. After October 1, 2014, your payors should have all made the transition to ICD-10, and you should be able to use the new codes from that date forward.

What is different about the revised CMS-1500 form?

The revised CMS-1500 form:

* Provides fields and indicators for both ICD-9 and ICD-10 codes

* Provides documentation space for up to 12 diagnosis codes

* Offers qualifiers to aid in the identification of provider roles in the furnishing of services

* Uses letters instead of numbers as diagnosis code printers

You will want to upgrade your practice management software or order 02/12 forms immediately if you have not done so already. Discard any 08/05 forms after April 1, 2014.

When should physicians start using the revised CMS-1500 form?

Providers can start using the revised form on January 1, 2014, but all providers must switch to using the revised form as of April 1, 2014. Your (PM) Practice Management/EMR/EHR practice vendor can help you determine what you need to do to remain in compliance as you transition to ICD-10.

About Dana Deardorff of MediPro
MediPro is a full-service medical billing software company offering practice management (PM) software, electronic health records (EHR) and electronic medical records (EMR) from McKesson and IMS.

Since 1995, MediPro, Inc. has been a nationally recognized, award-winning medical billing software company offering practice management systems and electronic health record solutions. MediPro’s mission is to deliver and support integrated solutions to the healthcare community. MediPro recognizes the need for a comprehensive, interactive and cost-effective suite of applications that are customized to address the specific needs of healthcare offices.

Why ICD-10?

Posted on I Written By

At least half a dozen folks have asked me to explain why HHS is mandating the transition to ICD-10. So I thought I’d write a blog post about the subject.

First, I’ll examine some of the benefits that proponents of ICD-10 site. Then, I’ll examine the cost of transition from ICD-9 to ICD-10.

There are about a dozen frequently cited reasons to switch from ICD-9 to ICD-10. But they can be summarized into three major categories:

1) The US needs to catch up to the rest of the world.

2) The more granular nature of ICD-10 will lend itself to data analysis of all forms – claims processing, population health, improved interoperability, clinical trials, research, etc.

3) ICD-9 doesn’t support the latest diagnoses and procedures, and ICD-10 does.

Regarding #1, who cares? Coding standards are intrinsically arbitrary. Sequels are not necessarily better than their predecessors.

Although #2 sounds nice, there are a lot of problems with the supposed “value” of more granular data in practice. Following the classic 80-20 rule of life (80% of value comes from 20% of activity), the majority of codes are rarely used. By increasing the number of codes six-fold, the system is creating 6x the opportunities to inaccurately code. There is no reason to believe that providers will more accurately code, but the chances of incorrect diagnosis are now significantly higher than they were before. Garbage in, garbage out.

Below are some specific examples of how increasing the number of codes will affect processes in the healthcare system:

Payers – payers argue that making codes more granular will improve efficiency in the reimbursement process by removing ambiguity. There is nothing further from the truth. Payers will use the new granularity to further discriminate against providers and reject claims for what will appear to be no reason. With 6x the number of codes, there are at least 6x as many opportunities for payers to reject claims.

Clinical trials – ICD-10 proponents like to argue that with more granular diagnosis codes, companies like ePatientFinder can more effectively find patients and match them to clinical trials. This notion is predicated on the ability of providers to enter the correct diagnosis codes into EMRs, which is a poor assumption. Further, it doesn’t actually address the fundamental challenges of clinical trials recruitment, namely provider education, patient education, and the fact that most patients aren’t limited to trials by diagnosis codes, but rather by other data points (such as number of years with a given disease and comorbidities).

Public health – ICD-10 proponents also claim that the new coding system will help public health officials make better decisions. Again, this is predicated on accuracy of data, which is a poor assumption. But the greater challenge is that the most pressing public health issues of our time simply don’t need any more granularity in diagnosis codes. Public health officials already know what the top 20 public health problems are. Adding 6x the number of codes will not help address public health issues.

Regarding #3, why do we need to reinvent the entire coding system and make the entire system more granular to accommodate new diagnoses and procedures? Why can’t we continue to use the existing structure and simply create new branches of the ICD tree using alphanumeric characters? Why do we need to complicate every existing diagnosis and procedure to support new diagnoses and treatments? We don’t. There are plenty of letters left to be utilized in ICD-9 to accommodate new discoveries in medicine.

Next, I’ll provide a very brief summary of the enormity of the cost associated with transitioning from ICD-9 to ICD-10. The root of the challenge is that a string of interconnected entities, none of whom want to work with one another or even see one another, must execute in sync for the months and years leading up to the transition. Below is a synopsis of how the stars must align:

EMR vendors – EMR vendors must upgrade their entire client base to ICD-10 compliant versions of their systems in the next couple of months to begin testing ICD-10 based claims. Given the timescales at which providers move, the burden of MU2 on vendors, and the upgrade cycles for EMR vendors, this is a daunting challenge.

Providers – providers don’t want to learn a new coding system, and don’t want to see 6 times the number of codes when they search for basic clinical terms. Companies such as IMO can mitigate a lot of this, but only a small percentage of providers use EMRs that have integrated with IMO.

Coding vendors – like EMR vendors, auto-coding vendors must upgrade their clients systems now to one that supports dual coding for ICD-9 and ICD-10. They must also incur significant costs to add in a host of new ICD-10 based rules and mappings.

Coders – coders must achieve dual certification in ICD-9 and ICD-10, and must double-code all claims during the transition period to ensure no hiccups when the final cut over takes place.

Clearinghouses – clearinghouses must upgrade their systems to support both ICD-9 and ICD-10 and all of the new rules behind ICD-10, and must process an artificially inflated number of claims because of the volume of double-coded claims coming from providers.

Payers – payers must upgrade their systems to receive both ICD-9 and ICD-10 claims, process both, and provide results to clearinghouses and providers about accuracy to help providers ensure that everyone will be ready for the cut over to ICD-10.

The paragraphs above do not describe even 10% of the complexity involved in the transition. Reality is far more nuanced and complicated. It’s clear from the above that the likelihood that all of the parties can upgrade their systems, train their staff, and double code claims is dubious. The system is simply too convoluted with too many intertwined but unaligned puzzle pieces to make such a dramatic transition by a fixed drop-dead date.

Lastly, switching to ICD-10 now seems a bit shortsighted in light of the changes going on in the US healthcare system today. ICD-10 is already a decade old, and in no way reflects what we’re learning as we transition from volume to value models of care. It will make sense to change coding schemes at some point, but only when it’s widely understood what the future of healthcare delivery in the US will look like. As of today, no one knows what healthcare delivery will look like in 10 years, let alone 20. Why should we incur the enormous costs of the ICD-10 transition when we know what we’re transitioning to was never designed to accommodate a future we’re heading towards?

At the end of the day, the biggest winners as a result of this transition are the consultants and vendors who’re supporting providers in making the transition. And the payers who can come up with more reasons not to pay claims. Some have claimed that HHS is doing this to reduce Medicare reimbursements to artificially lower costs. Although the incentives are aligned to encourage malicious behavior, I think it’s unlikely the feds are being malicious. There are far easier ways to save money than this painful transition.

The ICD-10 transition may be one of the largest and most complex IT coordination projects in the history of mankind. And it creates almost no value. If you can think of a larger transition in technology history that has destroyed more value than the ICD-9 to ICD-10 transition in the US, please leave a comment. I’m always curious to learn more.

HIM Professionals Focus on Job Creation, ICD-10 at AHIMA

Posted on October 5, 2011 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

A number of themes have been prevalent at this year’s AHIMA show, taking place this week in Salt Lake City. Healthcare information management professionals have a number of big priorities – the transition to ICD-10 being the most prevalent, at least from what I’ve seen on the show floor so far. Recruitment is a close second. With a number of colleges and healthcare systems present as exhibitors, it’s obvious there is a need for trained HIM professionals. In speaking with folks from the Region D Health IT Workforce Development Program, part of the Community College Consortia Program, which hopes to train more than 10,500 healthcare IT professionals by the end of this year, it is evident that there are resources out there to train folks, and they are willing to get the word out about it.

AHIMA has recognized this need for job creation. It announced at the show on Monday that it has created the HIM Jobs for America Initiative, and has entered into a public-private partnership with the Department of Health and Human Services and North Shore Medical Labs.

In announcing the initiative, Bill Rudman, vice president, educational visioning at AHIMA and executive director of the AHIMA Foundation, explained that “AHIMA wants to build a partnership with business, academia and the federal government to create the estimated 40,000 jobs required to properly build and maintain a national electronic health records initiative.”

As part of the initiative, AHIMA will provide six hours of free healthcare IT training to healthcare professionals in underserved communities, first focusing on physicians in small practices in North Carolina, Mississippi and Alabama. The program will provide 100 participants with EHR licenses for one year. North Shore will donate electronic health record software and services via Nortec Software, a provider of EHR technology, as well as medical billing and transcription services.

As I mentioned above, the transition to IDC-10 has been THE big theme in the exhibit hall. I’ve noticed solution after solution exhibited at booth after booth created to help physicians make the transition. As John Lynn mentioned in an earlier post, some companies are taking a light-hearted approach in marketing their ICD-10 solutions. Take QuadraMed, for example, which kept attendees happy Sunday night during the evening reception with special ICD-9 and ICD-10 cocktails. Or, as John mentioned last week, Conifer Health, which has quickly run out of its ICD-10 stickers.

All kidding aside, the transition to ICD-10 and the impact the new codes will have on patient care is no joke. Paula Lawlor, RHIA, President of Clinical Revenue Cycle Services HIM at Conifer, spoke with me briefly about what Conifer is doing in the area health information management and clinical revenue cycle services:

I’ll be walking the show floor today, and hope to have a wrap-up of EMR-related technologies for next week’s post.

ICD-10 Controversy in Wall Street Journal

Posted on September 30, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In case you missed it, I wrote an entertaining (at least I thought it was) post about some of the amazingly specific ICD-10 codes that are out there. I’m headed to AHIMA which starts on Sunday and I’ve had a preview of a vendor, @coniferhealth, capitalizing on some of these codes with some stickers they’re handing out. I’ll embed a picture of one of these stickers at the bottom of this post.

Turns out that not everyone is happy with this light hearted approach to discussing what amounts to a major major shift from ICD-9 to ICD-10. The Wall Street Journal posted some of the responses they got to their original article. Here’s one sample response:

Having a different code for every single artery or the specific bone that’s fractured helps improve continuity of care. A patient who is hemorrhaging can get lifesaving care more quickly when the physician can immediately identify precisely where the broken suture is located. In addition, including the specification that the patient was “bitten by turtle” justifies the patient receiving additional tests or treatments, as turtles carry different bacteria than, say, parrots or turkeys. This and other tidbits of information will support more efficient and effective reimbursement processes.

The benefits we will derive from our global health-care community are tremendous. Once the U.S. finally transitions to ICD-10, we will again be able to share important data with every other civilized country

Although, not everyone is so serious. Arthur Broaderick, M.D. offered the following question, “Doctors closing their practices in droves; is there a code for that?”

When Meaningful Use Isn’t That Meaningful

Posted on March 1, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As you know, I regularly like to highlight some of the best and most interesting comments on my various websites. Especially since I know many of you don’t read all the comments (shame on you). This comment on meaningful use comes from someone who identifies themselves as SoftwareDev and works for an EMR vendor:

Coincidentally, I actually came up with the exact same conclusion [see original post] when reviewing the specs the other day. What I mean is, I identified that the way that we track “problems” in our software serves our customers well, but doesn’t really meet the measurement method of Meaningful Use.

In my app, I can record a “problem” using an ICD-9 code on the patient record (chronic) as well as on the visit (acute/episodic, based on Dx attached to the charges posted for that encounter). I also track descriptive (non-standardized) phrases in our Medical History. The former is good because it meets the standardized terminology requirement, but it fails because I don’t keep a “history” of active, or inactive problems. The latter is good because it is more “all encompassing”, including problems that the patient isn’t actually being seen by this particular doctor for, but also fails because it isn’t recorded by ICD-9 code and descriptor.

Either way, I have to revise the software’s method of recording “problems”, both for historical purposes and for proper coding, and ONLY to meet the Meaningful Use requirement. Not a single customer has ever voiced a request remotely like this to me in my 12 years of handling software in this sector.

Descriptions like this is why I’m concerned about the impact of meaningful use. There’s little doubt that the EHR incentive money has stimulated interest and even purchasing of EMR software. I just wonder what unintended consequences will come from meaningful use and EHR certification. Sadly, the above description may meet meaningful use, but doesn’t sound like meaningful patient care.

Meaningful Use Efforts Holding Back HIPAA 5010 Transition

Posted on February 7, 2011 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While it’s all well and good to prepare for Meaningful Use compliance, IT departments may be going a bit overboard.  A new survey by HIMSS has concluded that providers are being diverted from critical efforts like the HIPAA 5010/ICD-10 transition by efforts to capture MU bonuses.

It’s hardly surprising, given the tempting candy MU incentives offer, but it’s a bit worrisome too.  After all, preparing for 5010 transactions requires a mountain of work, touching electronic claims, eligibility verification, claim status, referral certification and more.  This is NOT something you can afford to ignore, particularly given the risk of incurring CMS’s wrath.

Consider this:  a full 35 percent of the providers responding to the HIMSS survey this summer said they had no plans at all in place to implement a 5010 readiness project. This despite the fact that they were supposed to begin testing by January 1 of this year.

Instead, HIMSS found, providers are spending much of their time working to qualify for MU money, neglecting the 5010 transition for now.  The HIMSS folks hypothesize that providers are laying low on 5010 now, hoping to squeeze in under the January 1, 2012 final deadline. Hey, maybe if IT leaders stick their heads in the sand long enough, the deadline itself will go away!

In reality, we all know what will happen — the same thing that happens whenever an enterprise punts on a critical initiative. Over the next several months, expect facilities to dump truckloads of money on vendors and tech help. Consultants, start your engines!