Intergy EHR 9.0 Deep Dive: ICD-10
IEHR changes to 9.0 for ICD-10
Diana Dodds, Lorrie Lance, Dan Dobbs
Confidential and Proprietary Information of
Vitera Healthcare Solutions, LLC. Presentations
are for informational purposes only.
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INTRODUCTION
● Diana Dodds (Dede)
– Application Development Manager
– 16 years with Vitera
– Twitter: @Dede_Vitera #Vibe2013 #ICD-10
● Lorrie Lance
– Designer
– 20 years with Vitera
● Dan Dobbs
– Application Development Manager
– 15 years with Vitera
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ICD-10: GETTING THERE TOGETHER
• During this presentation, we will help you understand:
• EHR Setup for ICD-10
• EHR workflow changes due to ICD-10
• How to test ICD-10 workflows in the product
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INTERGY EHR 9.0 DEEP DIVE: ICD-10
Overview
●ICD-10 Overview
●Setup
●Advanced Diagnosis Search
●IEHR Workflow
●Test
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ICD-10 OVERVIEW
Making the transition to ICD-10 is not optional
●October 1, 2014
●No plans extend the compliance date
●Date of service
●ICD-10 training
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ICD-10 OVERVIEW
ICD-10-CM Structure
● The basic structure of the ICD-10 consists of seven characters:
‒ Characters 1-3 (disease category)
‒ Character 4 (etiology)
‒ Character 5 (location)
‒ Character 6 (laterality)
‒ Character 7 (placeholder for extension of the code to increase
specificity)
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ICD-10 OVERVIEW
ICD-10 TRANSLATION TOOLS FROM CMS
• General Equivalence Map (GEM)
• Provides a translation from ICD-9 to ICD-10
• Most ICD-9 codes map to multiple ICD-10 codes
• The basis for users to help choose an ICD-10 for ICD-9 codes they are used to billing
with
• Reimbursement Map
• Intended to help payers who might not be ready in Oct 2014
• Provides a translation from ICD-10 to ICD-9 that should result in an equivalent
reimbursement amount
• Most ICD-10 codes map to a single ICD-9 code
• The basis for the products to “translate” ICD-10 back to ICD-9
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ICD-10 OVERVIEW
Intergy ICD-10 Development Progression
• Maintain current version for
supportability
v9.x
v8.x
v7.x
v6.x
- Database
- Fields, reports,
screens
- Full billing
support
- Code setup
- Transition tools
- Advanced search
- Clinical workflows
- Orders, Charges,
Problems, Rules
- 5010 support
- Core billing
engine
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ICD-10 OVERVIEW
Vitera Intergy 9.0
• A configurable system/practice level effective date of Oct, 1 2014
• ICD-10 Diagnosis Importer
̶
All ICD-10 codes, a range or
̶
Corresponding ICD-10 codes for your current ICD-9 codes
• Ability to change payer effective date for individual plan/carrier
• Advanced search criteria
• Multiple layers of validation in clinical and billing workflows
• Minimal impact to provider current workflow
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INTERGY EHR 9.0 DEEP DIVE: ICD-10
Setup
Workflow
Test
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INTERGY EHR 9.0 DEEP DIVE: ICD-10
Setup
Workflow
Test
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SETUP
Setup Overview
• Early setup
– Macros
– Favorite Lists
– Health Management Care Conditions
• Just in time setup
– Convert Patient ICD-9 based Problems to Findings as used
– Health Management: Default diagnosis for Guidelines
– Immunizations: Default diagnosis for Immunization Schedules
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SETUP
Macros
• User can add both ICD-9 and ICD-10 Macros
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SETUP
Favorite Lists
• eEncounter Lists have been renamed Favorite Lists and moved to the user level
• Favorite Diagnosis Lists are maintained under Favorite Diagnosis List window in
Intergy Practice Administration and can also be accessed from IEHR
• Favorite Lists can contain both ICD-9 and ICD-10 codes and will be filtered
accordingly when displayed
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Advanced Diagnosis Search
ADVANCED DIAGNOSIS SEARCH
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ADVANCED DIAGNOSIS SEARCH
Advanced Diagnosis Search
• Same user experience for from
both Intergy PM & EHR
• Multiple Search Criteria: ICD-10
Code, ICD-9 Code, Short & Long
Description
• Displays ICD-9 or ICD-10 Code ,
based on service or encounter
date
• Search for an ICD-10 based on
the ICD-9 code using GEM
mappings
• Intergy users now have access
to Favorite Diagnosis lists and
Patient Diagnosis
• If diagnosis doesn’t exist in
practice list, can search the
entire ICD-10 master list
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ADVANCED DIAGNOSIS SEARCH
Date of Service Prior to effective date
• If the date of service or encounter date is before the system/practice ICD-10
effective date, the search will default to show ICD-9 codes
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ADVANCED DIAGNOSIS SEARCH
Patient Diagnosis
• The user can choose to show only the diagnoses that have been used for
the current patient
• The most recently used patient diagnoses will be listed first
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ADVANCED DIAGNOSIS SEARCH
Favorite Diagnosis
• The user can choose to show Favorite Diagnosis
• The user can further refine the Favorite Diagnosis to a specific category
• For both the “Patient” and the “Favorites” filters, the lists of diagnosis
codes will be filtered by ICD-9 or ICD-10 depending on the effective date
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ADVANCED DIAGNOSIS SEARCH
Setup Mode
• Can now setup ICD-10 codes in Intergy and IEHR Setup windows when the
System/Practice ICD-10 effective date is in the future
• From these setup windows, the Diagnosis Search will have the options to show
ICD-10 codes regardless of the ICD-10 system effective date as long as the
practice parameter “Use ICD-10 Diagnosis Codes” is set to Y
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ADVANCED DIAGNOSIS SEARCH
IEHR Setup windows that allow user to use Setup Mode
• IEHR - Flowsheets
• IEHR - Health Management
• IEHR - Immunizations
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INTERGY EHR 9.0 DEEP DIVE: ICD-10
Setup
Workflow
Test
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INTERGY WORKFLOW
Overview
●IEHR Workflow
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Problems
Encounter Note / Assessment
Orders Charges
Favorite Diagnosis Lists
Macros
Orders from POM Tab
Prescriptions
Labs
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Workflow
IEHR WORKFLOW
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IEHR WORKFLOW
Problems
● ICD-9 based Problems are converted to finding based problems as the Problem
is used
– Orders/Charges – Selecting Problem to add to the shopping cart
– Patient Chart - Right click on ICD-9 problem – “Convert to Finding’
– Encounter Note – “Copy Problem to Assessment” context menu option.
● A dialog will display the list of MEDCIN findings that are mapped to that ICD-9
code
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IEHR WORKFLOW
Encounter Note / Assessment -> Orders / Charges
● In Encounter note, select assessments as you do now and they will flow to
Orders/Charges as they did in ICD-9 mode
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IEHR WORKFLOW
Encounter Note / Assessment -> Orders / Charges
• If the Assessment is specific it may have a single mapped ICD-10 code
• If the Assessment is too general, you will be prompted to pick an ICD-10 code
• Quick filters are available to reduce the number of selectable diagnosis codes
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IEHR WORKFLOW
Favorite Diagnosis List
● IEHR will display only the relevant of diagnoses code based on encounter date
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IEHR WORKFLOW
Macros
● When
selecting a
Macro in
IEHR, the
system will
use the
procedure
codes that
contain the
correct
version of
diagnoses
codes
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IEHR WORKFLOW
Orders from POM Tab
● After the ICD-10 effective date, the POM data will be stored based on ICD-10
● When using Patient-centric data the system will assist in converting to ICD-10
– When a selected
item contains an
ICD-9 code the
edit dialog will
be displayed
along with the
Select Diagnosis
dialog pre-filled
with the ICD-9
code
– This is
applicable to
following items:
• Medications
• Orders
• Charges
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IEHR WORKFLOW
Prescriptions
● If an Rx renewal or authorization contains an ICD-9 code and the system is
ready for ICD-10, the Select Diagnosis dialog will display on top of Rx Pad
filtered to display the ICD-10 codes for the ICD-9
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IEHR WORKFLOW
Labs
● Lab Order Entry window from IEHR
is now available in Intergy
● The Lab Order diagnosis list
contains encounter assessments
and patient problems
– Assessments and Problems that do
not match the current ICD version
are displayed but not selectable
● There is a new user / practice
preference, “Default Diagnosis
Favorite List for Lab Orders”, that
allows the user to setup an override
for the favorites lists that are
displayed on the Lab Order screen
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INTERGY EHR 9.0 DEEP DIVE: ICD-10
Setup
Workflow
Test
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TEST
9.0 ICD-10 Readiness
• Set System/Practice ICD-10
effective date prior to the
Industry date
• When the practice date is
prior to the industry date, all
diagnosis entry can be ICD-10
• The system will translate to
ICD-9 codes when sending
the diagnosis out
electronically to Labs,
Pharmacies, HL7 Remotes,
and Insurance Plans
• Assures your practice is
comfortable with ICD-10 prior
to the industry date
Plans
ICD-9
HL7
ICD-9
Intergy
ICD-10
Labs
ICD-9
Pharmacies
ICD-9
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TEST
9.0 ICD-10 Readiness: Diagnoses sent to Pharmacies
• When electronically issuing prescriptions, the system will use
the reimbursement map to send an ICD-9 code for the ICD-10:
– New Rx
– Renewal
– Authorize and Quick Authorize
• The RX Pad displays the ICD-9 code that will be sent
• ICD-10 diagnosis code will be saved in Intergy for the Rx
• An Rx note “ICD-9 sent on Electronic transmission was ___” will
be created or appended to an existing Rx note to record what
ICD-9 code was sent.
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TEST
9.0 ICD-10 Readiness: Rx Pad Change in IEHR
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TEST
9.0 ICD-10 Readiness: Diagnosis sent to Labs
• Labs has been updated
to send an ICD-9 code
when an ICD-10 code has
been provided and the
encounter date is before
the Industry Date.
• Even though we are
sending out an ICD-9, we
will save the lab order in
our system using an
ICD10.
• A note is created letting
the user know which ICD9 codes were sent.
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TEST
9.0 ICD-10 Readiness: CCD
• Generated CCD’s will include ICD-9’s if they exist
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INTERGY EHR 9.0 DEEP DIVE: ICD-10
QUESTIONS?
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