ICD-10 Boosts Appeal Of Computer-Assisted Coding Tools

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Computer-assisted coding tools help to automatically generate medical codes for billing from clinical documentation in EHRs and transcription systems. These tools are frequently used in outpatient settings, but now interest in the software is growing in inpatient settings, especially as the transition to ICD-10 promises to make the jobs of medical coders more complex.

A new report released this week by research firm KLAS found that nearly half of healthcare providers surveyed plan to purchase an inpatient CAC product within the next two years.

Much of that interest in CAC is driven by worries about the effect ICD-10 will have on staff productivity and efficiency. The U.S. transition to ICD-10 means that diagnostic codes will jump to 68,000 from 13,000 in ICD-9, while inpatient procedure codes will grow to 87,000 from only 11,000.

[ Despite the ICD-10 deadline extension, it's important for healthcare organizations to keep the momentum going. See Don't Hit Snooze Button On ICD-10. ]

The new codes in ICD-10 provide greater clinical detail and cover medical treatments and technologies not reflected in the older ICD-9 codes. However, they'll make work for medical coding related professionals more difficult.

CAC tools don't eliminate the need for human medical coders, but they can make it easier for professionals to review and look up codes and intricate code-related processes involved with billing and financial systems. The tools take structured text and unstructured text from EHRs, and can use natural language processing with transcription systems to create codes used for billing and reporting systems.

CAC greatly reduces the process of assigning codes, according to Graham Triggs, a senior research manager at KLAS and author of the new report, Computer Assisted Coding: A Glimpse at The Future of HIM Technology.

Even with the Centers for Medicare and Medicaid Services' recent proposal to delay for one year the compliance deadline of ICD-10 to Oct. 1, 2014, from Oct. 1, 2013, interest in CAC is growing, though actual use of the products is still very limited in inpatient settings, Triggs said.

"Now that ICD-10 has been postponed, [healthcare organizations] have more breathing room," said Triggs. This gives organizations more opportunity to evaluate tools that will automate processes to help make up for lost productivity in the transition to ICD-10, as well as help make coding more precise for reimbursement and reporting.

While CAC has been used mostly in outpatient settings, pressure and concerns about ICD-10 are pushing more inpatient organizations like hospitals to evaluate CAC tools. Coding processes, workflow, and cost structures in outpatient setting are very different from inpatient settings, so CAC products sold into out-patient environments like clinics and doctor officers "aren't easily translated" for inpatient use, Triggs said. "The marketplace for inpatient CAC products is young but growing."

KLAS found that among the CAC vendors being considered by inpatient organizations are 3M, whose 360 Encompass is an integrated, all-in-one product featuring an encoder, grouper, and CAC; OptumInsight, which recently acquired A-Life, a vendor of CAC products for outpatient and inpatient settings; and Dolbey, which offers a speech-recognition CAC product. Other vendors include Precyse, QuadraMed, Platocode, M*Modal, Cerner, and CodeRyte.

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