Radiology ICD-10 Readiness

By Robert Kebbekus, President & COO

Oct. 1 is rapidly approaching, and no medical specialty, including radiology, will be exempt from ICD-10’s industry-wide overhaul.

A recent article in the Radiology Business Journal warns physicians to “brace themselves,” citing a Journal of American College of Radiology study which predicts a 6-fold increase in the number of codes used by radiologists.

“As the conversion from ICD-9 to ICD-10 will require acquiring and documenting even more detailed clinical information than is currently required for billing purposes—information that remains difficult for many radiology practices to adequately capture—that transition is perceived as a particularly daunting task for facilities, physicians, administrators, and coders alike,” Dr. Margaret Fleming from the department of radiology and imaging sciences at the Emory University School of Medicine reported.

Although the conversion to ICD-10 is a daunting task, there are many things radiologists can do to “brace themselves” for Oct 1st. Let’s examine what radiology leaders should do to prepare for this challenging transition and avoid any cash flow or productivity-related disruptions:

Confirm Medical Necessity

Confirming and documenting medical necessity for encounters is problematic in today’s reimbursement environment, but this process will become even more of a nuisance come Oct. 1. Add to that, over 40% of radiology studies result in no finding. In these cases, radiology groups are completely dependent on the referring doctor to provide detailed presenting conditions in order to get paid. Put another way, it is not how prepared your group is but how prepared each and every referring practice is for ICD-10. We recommend practices start tracking referring doctor and practices’ poor documentation of patients’ symptoms and condition. In addition, groups should contact their primary referring practices and confirm their ICD-10 readiness.

Please see last month’s blog post for more information.

Alter Findings Dictation

Findings from the reading must be dictated with a greater level of specificity than ever before required. For example, in scoliosis cases, radiologists must now be able to answer when exactly it began, is it acquired or congenital, along with the specific area of the spine affected. Without these key pieces of information, radiologists may face a significant increase in claim denials and a host of other reimbursement and compliance issues.

Medical Economics cites: “Of the ICD-10 codes that do not have ICD-9 counterparts, about half are related to laterality (left, right and bilateral indications), AHIMA says. Another big chunk of ICD-10 codes consists of ‘external cause reporting’ codes, such as what caused a particular injury.” The article continues to describe additional codes radiologists must support with documentation, including those related to linked conditions such as hypertension and heart disease as well as musculoskeletal conditions such as bone fractures. Familiarizing yourself with the codes most relevant to your practice as well as the required information associated with those conditions will ensure appropriate reimbursement and an uninterrupted workflow.

The top five areas radiologists will need to provide additional documentation in their reports are:

1) Fractures:  Radiologists will need to expand their documentation; laterality, type of fracture as well as encounter, is the fracture open or closed, is the fracture pathological or traumatic and in what stage of healing is the fracture.

2) Limb pain: Radiologists will need to document the specific limb and laterality.

3) Abdomen pain:  Radiologists will need to document the specific location of the pain in the abdomen.

4) Congestive heart failure: Radiologists will need to document the type of heart failure, and if it is acute, chronic, or acute on chronic.

5) Osteoarthritis: Radiologists will need to document the specific location and laterality.

Learn the Most Relevant Codes

ICD-10’s addition of 56,000 codes and change in code structure is overwhelming for any physician to absorb. Although all practices will have to do some preparation for and education around these new codes, it is important to narrow in on which codes are most relevant to the practice’s patient population.

According to an RBMA ICD-10 resource, this new system affects diagnosis codes in different ways. For example, the ICD-9 code for headache, 784.0, is only broken into two ICD-10 codes (G44.1 Vascular headache, not elsewhere classified, and R51 Headache). Other diagnoses, however, present a more alarming picture; ICD-10 breaks down ICD-9’s 786.09 Respiratory abnormal NEC into five different diagnosis codes, and ICD-9’s 729.5 Pain in Limb code into no fewer than 30! Many billing groups are looking for simple translations from ICD-9 to ICD-10; although there are many codes for which this will be possible, to address the vast majority of codes in this manner would lead to improper coding and negatively impact both compliance and reimbursement.

It is critical to understand which of these conditions occur most frequently in the radiology practice or imaging center to appropriately allocate ICD-10 preparation time and funds. Radiologists do not need to learn all 68,000 codes, but they will certainly have to familiarize themselves with the additional codes that will affect them the most. Our findings indicate that less than 4 percent of the ICD-10 codes will be used in radiology. In addition, the top 62 ICD-10 codes will cover as much as 65 percent of a radiologist’s primary findings. Physicians need to know not only these top codes, but also what to document in order to provide the specificity required to properly assign these codes. Talk to your coders and find your top ICD-10 codes.

If there is a “silver lining” to ICD-10 for radiologists, it is that the required additional information from the referring doctors for ICD-10 should provide a much clearer picture of what’s actually going on with the patient. Thus, radiologists can more accurately address the presenting conditions of the patient.

Please click here for additional, radiology-specific ICD-10 resources.