Although the implementation deadline for ICD-10 is slated for Oct. 1, 2014, emergency physicians should begin now to prepare for the future implementation of ICD-10-CM coding by improving emergency department documentation. Not only does failure to fully and properly document a patient encounter has many medical, financial, and even regulatory ramifications, it will also significantly impede progress in moving to ICD-10.

Documentation can be vague in some instances when it comes to the more definitive diagnoses. That’s why the increased specificity and detail in ICD-10-CM codes is expected to be particularly relevant for the types of conditions treated by the emergency department and the team’s emergency medicine coding and billing.

The injury chapter in ICD-10-CM is one of the sections revised significantly, and the signs and symptoms chapter was greatly expanded to allow classification of symptoms with much more detail. The table below illustrates the difference in coding descriptions between ICD-9 and ICD-10.

Table 1. Differentiating Documentation for Correct Code Assignment

Other fractures of distal end of radius (alone)
Documentation: site, open or closed
Unspecified fracture of the lower end of left radius, initial encounter for closed fracture
Documentation: site including laterality, open or closed, displaced or non-displaced, episode of care
Sprains and strains of other and unspecified parts of back; neck
Documentation: site
Sprain of ligaments of cervical spine
Strain of muscle, fascia and tendon at neck level, initial encounter
Documentation: site; distinction as to sprain (ligament) or strain (muscle, tendon)

Given the impending documentation gaps for ICD-10-CM coding in the emergency department, preparations should include analysis of current clinical documentation to identify and prioritize ICD-10 documentation gaps. A chart audit will identify specific documentation gaps and help determine where focused interventions will have the greatest impact.

To determine approaches that can resolve documentation gaps, consider where form changes or system prompts might be employed, what operational changes might impact clinical documentation, and where training might be needed.

Training should initially provide an overview of ICD-10-CM, highlighting where additional specificity and detail is available in the new codes. Because emergency physicians treat a broad spectrum of conditions, from minor infections to major cardiovascular events and trauma, it’s important to help physicians understand the impact their documentation has on the coding and reporting process., the experts in emergency medicine ICD-10 training and implementation, has already started the ICD-10 transition for physician practices, including staff training and testing.

ICD-10 Testing is the industry leader in ICD-10 preparation for medical practices. The following is an update on testing to help medical practices be fully prepared by the Oct. 1, 2014 deadline.

ICD-10 functionality for Optum Professional CAC was first released to beta clients in June 2013 and will be generally available to the full client base in October 2013. Beta clients will have access to a dedicated beta system. Details regarding the site configuration updates required for ICD-10 processing, along with billing rule and straight-to-bill migration plans, will be communicated in late summer 2013 in advance of General Availability.

NLP updates of ICD-10 capabilities will be released at regular intervals (8 weeks) to all ICD-10 CAC clients prior to Oct 1, 2014. Release efforts will include focus on beta customer expectations and effectively build towards national engine performance goals. After Oct 1, releases for ICD-10 will follow the normal update cycle for the production LifeCode NLP engine.

This isn’t expertise that’s available anywhere. It’s a niche specialization in emergency revenue cycle management provided by the ICD-10 and compliance experts,

revMD offers superior results in emergency medicine medical coding, billing and collections for splint/cast applications, bedside ultrasounds, critical care in the ED and critical care procedures, and observation status in the ED. For many years, has successfully managed both non-physician and supervising physician billing Emergency Medicine’s revenue cycle management. is the results-proven alternative for physician medical billing, with a niche specialization in emergency coding and billing and ICD-10 preparation that generates unprecedented results and builds profitable medical practices. Leveraging a history of industry wide success spanning 26 years, partners with medical practices throughout the U.S. to optimize revenue for hospital based and community based physicians. For more information, visit

About the Author