Julie Pekarek

The latest edition of the International Classification of Diseases and related Health Problems codes, more popularly known as ICD-10, may not be taking effect for another year, but medical imaging providers should be careful not to take the delay as a license to put off preparing for the new codes.

Whether radiologists realize it or not, ICD-10 will have widespread impact on the entire radiology practice. Does everyone in your organization, from the receptionist and the radiologists to the billing administrator, know everything they need to know about protocols for the new codes? Are current IT systems ready for the new code sets?

If not, now is the time for imaging providers to ensure they’re doing everything they can to prepare their practice - from front-desk and imaging-suite personnel, to the very tools they employ - with the foundational knowledge and updates to ensure a smooth transition.


ICD-10, which is expected to take effect October 1, 2015, after being delayed earlier this year to give healthcare providers more time to prepare for the new codes, will expand the current list of 13,000 diagnosis codes to more than 68,000 codes that break down diseases, conditions and the treatments used to address them into unprecedented detail and specificity.

As a result, it is critical for everyone working in medical imaging to know their role and responsibilities in regards to implementing ICD-10. Indeed, no one is immune from having to work with the new codes. In medical imaging, that means:

• Front office staff will need to know what to look for on incoming orders from referring doctors. They must be able to identify why the procedure is needed. And if the information is not present, they will need to know who to talk to at the referring physician’s office to get the information prior to the patient visit.

• Technologists will need to be aware of the greater level of clinical detail needed to perform procedures as missing information will need to be added at the time of the scan. 

• Radiologists will have to become acquainted with a host of new data pieces required by ICD-10 and ensure they accurately dictate it all into their reports.

• Coders will have to make sure all the information is present and that they code every procedure absolutely correctly. To this end, coders will need to know the new code sets as they relate to the individual specialties, as well as obtain new certifications ensuring their understanding of the updated code set.

• Billing staff could face updated reimbursement policies and will need to review these policies, in addition to closely examining returned payments and follow up on possible denials or payment reductions. 

• Managers for both the clinical and billing workflow will need to address how to handle the ICD-10 changes from training for software changes and any policy and procedure updates.

Mistakes made anywhere along this continuum can and will lead to delayed or even denied reimbursements. It’s important to have the whole team involved from the onset for a seamless transition – and no missing links.

Yet, staff preparation for ICD-10 isn’t the only aspect medical imaging providers should be concerned about at their practice. They should also be sure to address ICD-10 preparation from a technological perspective, including preparation with IT vendors.

As a starting point, imaging providers can-and should-expect their technology vendors to be able to collect and transfer ICD-10 information across all applications, from inbound ordering and patient portals through patient encounter, billing and reporting. Vendors should also be able to clearly state the changes they have made to address ICD-10 within their own applications and any third-party applications they might employ. As with any new upgrade, thorough user training is a must.

Some companies host ICD-10 trends or status pages on their websites that outline changes being made to each product to meet ICD-10 requirements, along with FAQs that address such issues as when customers can expect to see coding changes released, whether  crosswalks will be provided, how the ICD-9 code sets will be maintained and other product-specific information. This can be a great source of information to anticipate which applications will need to be upgraded, and the expected timing of each.

With regard to applications, a radiology information system (RIS) that can collect ICD-10 data throughout a patient encounter, as well as generate charges and reports, is key. If coding is done in the RIS, an ICD-10 crosswalk tool is important, too. A billing system with an ICD-10 crosswalk tool permits dual coding through implementation of the code set for correct claims submission and accounts receivable follow up, as well as business intelligence reporting customized to fit each imaging provider’s needs, is critical to success. In addition, medical imaging providers may want to consider leveraging all applications for ICD-10 such as an online referral portal where referring physicians can enter orders and a patient portal that can allow for more complete patient history. [[{"type":"media","view_mode":"media_crop","fid":"27083","attributes":{"alt":"The following example shows a fraction of diagnosis code mappings when transitioning from ICD-9 to ICD-10.","class":"media-image media-image-right","id":"media_crop_5866621008936","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2602","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 257px; width: 401px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]


Taking a hard look at new processes and procedures that follow the application upgrades can help any practice identify opportunities for improvement and become more efficient. Comparing current, overall workflow to the necessary changes for ICD-10 can ensure all departments are properly prepared when the new code set goes into effect. It is important to have new applications in place and working in a test environment far ahead of October 1, 2015. In addition to core claims submission testing, practices can examine workflows for all efficiencies gained in the new technology, as well as provide feedback to vendors on any improvements they see.

Moreover, it is essential to start obtaining more clinical detail from patients on their reason for an exam. Not only does this help train staff on ICD-10 changes, but it can also improve procedure selection, protocoling and interpretation. As a result, clinical detail can enable better relationships with referring physicians, who will be able to work with a greater level of transparency to provide higher-quality care. From an operational perspective, having better information upfront translates to reduced rescheduling and fewer last-minute cancellations.

Even though moving to a new code set may seem time consuming, there are many clinical benefits that ICD-10 can bring. If implemented in a timely and thorough manner, practices should see better clinical data with limited workflow impact. Since most of the world has been using the ICD-10 code set since the 1990s, there is a huge dataset to prove that the new codes are successful. In fact, the World Health Organization is already at work on ICD-11, which has been in beta since 2012 and should be ready for official approval in 2017.

Setting up a smooth transition process now will only make future changes easier.

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Radiologists and imaging professionals need to start preparing for the 2015 implementation of ICD-10.

Julie Pekarek

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