Cypher: Taking the Stress Out of ICD10 Stress Syndrome

Written by on December 1, 2014 in Research & Technology - No comments

Great controversy surround the planned transition from ICD9 to ICD10 and Clinical Documentation Improvement (CDI) initiatives, arousing strong emotions earning the moniker: ICD10 stress syndrome.

By introducing new concepts and definitions, ICD10 greatly expanded its lexicon and alphanumeric codes from 18,400 in ICD9 to almost 145,000 in ICD10.

OfficeMedWEBThe impacts of ICD10 and CDI will be profound: both will majorly challenge an already stressed health care system, but can also produce profound benefits.

Proponents emphasize its potential benefits in harnessing big data for better, more cost-effective, evidence-based population health management paid according to a value-based reimbursement model.

Kathleen Sebelius, secretary of Health and Human services was quoted from her November 2013 letter to Senator Jeff Sessions that: ”ICD10 is foundational for building a modernized health care system that will facilitate broader access to high quality care”. (New York Times, front page business/financial section, 12-30-2013).

Opponents emphasize the direct and indirect costs, cash flow disruptions, and implementation challenges which rely heavily on new and often untested technologies.

The AMA Wire, in an article entitled: ICD10 financially disastrous for Physicians, AMA tells HSS, estimated the cost of implementation to range from $56,639 to $226,105 for small practices. (AMA Wire 2/12/14 ICD10 financially disastrous for Physicians AMA tells HSS).

Each side predicts opposing consequences on access and care:  supporters predict improvements, whereas opponents predict the opposite at an overly burdensome cost.

With health care costing over 30% of the federal budget, and almost 18% of GDP, both sides do agree that the US cannot afford the escalating cost of health care.

Caught firmly in the conflicts’ battleground, are small and middle-sized providers; and critical access hospitals.  Squeezed by declining reimbursements, small profit margins and limited financial reserves, patronized by “insurance-challenged” and aging populations, these groups bear a disproportionate share of these burdens.

Tricia Maddrey Baker, executive officer of the Pitt County Medical Society, responding to criticisms directed at MD’s resistance to ICD10, wrote that the MD’s she serves are professionals passionate about medicine. “They see the plan as competing with time with their patients as well as costing them real money in lost income as well as new expenses”.  Her county’s medical facilities and 865 providers—many of whom are small providers– serve a much broader area of mostly poor and rural communities, where any challenges to resources will have serious repercussions. Her concerns are echoed across the nation.

Consequently, Congress in April 2014 again delayed ICD10 implementation; in July 2014, CMS set the final deadline as October 1, 2015. Ostensibly, delay provides time to fully prepare and test, and likely too, to prevent a repeat like the much troubled ACA rollout.

The EMR’s themselves struggle with regulation, market consolidation, and ICD10 transition.  Almost 750 vendors supplying proprietary, MU certified products, compete for clients. For some, their ICD10 solutions are simple ICD10 “flat files” where diagnosing a single condition condition—such as femur fracture—requires sorting through over 2600 codes.  As the EHR market consolidates–a vast majority use one of 10 EHR vendors—options become increasingly limited.

Many EHRs are criticized as expensive, unwieldy, and reducing productivity. The AMA Wire reported this month that physicians reported spending 46 more minutes a day documenting using an EMR; a burden likely to increase as documentation requirements do as well.

What the market lacked was an inexpensive, nimble, clinical workflow tool that is simple, elegant and harnesses the power of information technology.

Cypher@ by ICDLogic was created to meet that critical need. Cypher is not just a coding tool. It is a Computer Assisted Clinical Documentation Improvement (CACDI) clinical workflow and educational tool that is quick, easy, accurate and intuitive. The entire clinical and administrative team can use it.  In three easy steps, and in less than a minute for most patient records, Cypher accurately generates ICD9, ICD10, and SnoMed codes while also teaching CDI and ICD10 concurrent with care.

Cypher is cloud-based, compatible with most mobile devices, HIPAA compliant, ready to use now, and costs about $1/day! Built on API platforms, Cypher has the potential to integrate with any EHR.

Cypher is feature-rich:  It uses intelligent search, proprietary guided navigation and sophisticated filtering.  Special prompts allow capture of additional factors, etiologies, and co-morbidities—all which help define the severity of illness—as well as the much maligned cause and location codes. Importantly, Its ICD10 guidance panels are written in clinical terms not ‘code speak’.

Accurate clinical documentation, concurrent with care, yields better outcomes for patients and the bottom line. But few clinicians have the time to make CDI a frontline workflow priority. Cypher prompts users to document thoroughly while learning the fundamentals of ICD-10 and CDI before it becomes mandatory.

To best illustrate how Cypher works, consider this. Traditional coding and documentation analysis occur at the “back end”, sometimes days after a patient encounter. The opportunity to capture important information is often lost because it was not adequately documented, resulting in queries and denials.

Many EHR’s promote extensive dashboard features that track queries and denials.  Cypher instead helps accurately document the care provided in ICD10 compliant fashion to minimize those queries and denials, and maximize reimbursement.

Cypher’s approach starts at the “front end” with the clinical team and the patient, capturing details on condition, etiologies and co-morbidities. That process integrates into routine workflow; better documentation is produced.  At the “back-end”, the administrative team uses the resultant Cypher summary to complete billing.

Cypher captures details on condition and severity of illness providing real value to hospitals and third party payers to use in risk management and resource allocation. Physicians who best document and code are likely to improve their negotiating position, and their physician profiling: a key component in performance-based reimbursement.

Cypher educates differently too.  Traditional methods train clinicians on code sets, going chapter by chapter, expecting them to retain information that can’t be learned in a classroom. Seminars are expensive, tedious, and often occur remote in time and place to the workflow, and likely unsupported by easy or accessible workflow tools. Without reinforcement, recall degrades drastically over time. Remember: Implementing ICD-10 is not about coding, it’s about improving clinical documentation.

Cypher is the flagship product of ICDLogic, an innovative health information technology start-up company, co-founded by Monique Fayad (CEO), Jackie Morey (CM&SO), and Yigal Ron (CTO) in March 2013 specifically to address the unmet needs created by ICD10 and CDI.

Combined, the founders have over four decades of experience in health information technologies, successfully developing and launching multiple information-driven, healthcare e-solutions across clinical, revenue cycle and regulatory sectors. Supporting them is our Physician Advisory Board, including this author, and our CDI Expert Advisory Board.

To introduce myself, I am Nicole Einhorn MD, an orthopedic surgeon specializing in upper extremity surgery. I practiced for 15 years in a 6 person orthopedic group in northwest Indiana. While co-managing partner, I helped select and implement my group’s first EMR.  Since leaving clinical practice in September 2013, I have been an investor in, and Chief Clinical Content Officer (CCCO) of ICDLogic.

I understand well how difficult it is to mesh a clinical practice and the business of medicine, and how important good documentation is to both.

While clinicians are taught to document our patients’ histories, exams, diagnosis and care in a way that is clinically relevant, we are not generally taught to language to also satisfy the administrative needs that influence our reimbursement.

My interest in computer assisted workflow and documentation tools began in my first days of clinical practice: in 1997.  Confronted by the sheer volume of paperwork, and the unhappy results of a mock audit, I studied E&M coding guidelines, and looked at software solutions to streamline and improve my documentation.  I tried to convert my paper templates to computerized ones with drop down menus which might even work on the newly introduced touchscreen technology.

The technologies I wished for 15 years ago ultimately appeared in today’s more sophisticated EHR’s. The features I wish for now in dealing with the complexities of the impending CDI and ICD10 transitions, appear in Cypher: ease, simplicity, elegance, intuitiveness, accuracy, affordability and user-friendliness.

At ICDLogic, we don’t underestimate the challenge of implementing ICD-10, but with we can help you navigate the complexities of that transition, and harness the power of health information technology in an easy, accurate, and inexpensive way. Cypher helps take the stress out of ICD10 stress syndrome.

Go to for more information  to request a demonstration.

By Nicole EInhorn MD
Chief Clinical Content Officer (CCCO)

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