Industry Insider: An Inside Look at Intellicure Inc.

For this month’s feature, Today’s Wound Clinic speaks with Caroline Fife, MD, FAAFP, CWS, FUHM, chief medical officer about the company’s EHR approach to ICD-10-CM conversion.

Today’s Wound Clinic (TWC): What are some of the major differences between ICD-9 and ICD-10?

Caroline Fife (CF): Everyone is probably aware of the basics by now, but for those who may have been marooned somewhere, the basic facts are:

• ICD-10 has approximately 83,000 codes, (more than four times the previous amount of codes).

• The code set has been expanded from five characters to seven characters.

• The new codes use alphanumeric characters in all positions, not just the first position.

• The new code set provides a significant increase in the specificity of the reporting, allowing more information to be conveyed in a code.

• There are 21 “chapters” that represent various diseases or body areas.

• Some problems in ICD-10 require two ICD-10 codes to be complete. For example:

- I87.311, L97.211: Chronic venous hypertension (idiopathic) with ulcer of right calf limited to breakdown of skin.

• The first three digits before the decimal (xxx.) make up the disease category.

- The digit after the decimal indicates the subcategory (eg, site, etiology, manifestations).

- The second and third digits after the decimal indicate the subclassification (eg, location, laterality).

- The last digit can actually change the meaning of the description. (This will make more sense when you see actual examples, but it can indicate whether the condition is active or being treated as sequela.) 

TWC: What have been the challenges to ICD-10 conversion?

CF: One of the most important concerns in the transition is that there is no simple, one-to-one mapping or translation. There are one-to-many, many-to-one, many-to-many, or no correlation at all. There are some tables and “crosswalks” that have been published (such as the general equivalence mapping tables published by the National Center for Health Statistics), but these crosswalks do not fix the problem of getting a diagnosis from ICD-9 to ICD-10.

TWC: How did your company set out to make the transition to ICD-10 easier for your customers?

CF: By now, everyone has made the transition to ICD-10 one way or another. Hopefully the transition was a smooth one. The intended purpose of the International Classification of Diseases was for the statistical tracking of diseases around the world (meaning, epidemiological research). However, in the United States, the codes are used by payers for billing and reimbursement purposes. ICD-9 has been in use in the U.S. since 1979. It is understandable that a 36-year-old system cannot convey the current medical understanding of diseases. Most countries have been using ICD-10 for years. Many electronic health records (EHRs) for wound care handled this challenge by simply licensing a “look up” tool that clinician can use to try to find the closest code. The Intellicure team spent two years doing something quite different, and so far the response from both coders and clinicians has been glowing. 

TWC: What was the Intellicure approach?

CF: Most EHR vendors are simply going to provide a list of the most relevant of the 83,000 codes and clinicians are going to be asked to “pick from the list.” Alternatively, hospital coders are going to interpret the clinicians’ words in the chart, and they will pick the codes. The code(s) chosen by even the best professional coders may or may not be the codes that the Centers for Medicare & Medicaid Services will reimburse for cellular products, hyperbarics, or other critical wound care services. We thought our clients deserved something better. Since its inception, Intellicure saw “structured language” as the direction the government was headed. That’s why, since 1997, we have used a series of dropdown menus that drive clinicians to select the correct code for a wound or an ulcer.  This process is designed to get clinicians to follow a clinical thought process: “Is the problem a wound or an ulcer?” “Is the ulcer a pressure ulcer, a venous ulcer, or some other type?” We have carried that logic out a little farther to help clinicians get to the correct ICD-10 code. While we can’t just “give providers the correct code,” we can help them hone their clinical thought processes to capture the important information about the patient’s condition(s) so that the coding options that best depict the correct diagnoses are presented, allowing providers to select the correct code from these. The system does not force a clinician down a coding pathway based on any underlying medical condition. We’ve found a way to harness the natural clinical logic that practitioners use when evaluating patients. 

TWC: How did Intellicure do that?

CF: As I mentioned, there isn’t a one-to-one map from ICD-9 to ICD-10. For example, there are now 150 codes for pressure ulcers. However, there are a limited number of clinical concepts related to pressure ulcers. Getting to the right ICD-10 code for a pressure ulcer can be simplified using a decision-tree process to narrow down the concepts for each case that correspond to the appropriate ICD-10 codes. As clinicians work through the process, the remaining options begin to narrow so that only a few logical choices remain. No other wound care-specific EHR company has taken this approach. On Oct. 1, Intellicure performed a crosswalk of all ICD-9 codes inside each patient’s electronic chart, in so far as was possible. We used a color-coding system to alert clinicians to the degree to which the ICD-10 code could be crosswalked. Clinicians have to make the final decision regarding the ICD-10 code(s) for the patient, but the tools we provide harness their clinical logic to do this. It only takes a few seconds to complete the “drill down” process in order to completely code every wound/ulcer or comorbid condition that the patient has.

We are incredibly proud of a system that was two years in production and involved coders, computer programmers, and clinical experts. This solution is unique in the industry and the feedback from hospital and physician coders, clinicians, and billers has been pretty effusive. We aren’t charging more for our EHR than our competitors, but our clients will likely see the difference in their revenue stream, not to mention avoiding the time and frustration of trying to find the correct code. If you would like to switch to an EHR that has a novel solution for ICD-10, we’d be happy to talk to you.

For more information, visit www.intellicure.com.