Michelle Cavanaugh, RN, CPC

Radiology is one of many specialties that will feel the effects of ICD-10. The tricky part, though, is that radiologists often rely on diagnostic information from referring physicians. This information may or may not be sufficient today in ICD-9, which means it will only be more complicated in ICD-10. Consider the following tips to better communicate with referring physicians and prepare for the added specificity inherent in the new coding system:

1. Create an inventory of all referring physicians/practices. What physicians refer patients to you most frequently? How thorough is the diagnostic information that these physicians provide? Ask all physicians/practices about their plans to prepare for ICD-10. Reiterate the importance of the physician order for radiology tests and procedures and how all diagnostic information must be as specific as possible. This will prevent unnecessary denials, rework, and follow-up.[[{"type":"media","view_mode":"media_crop","fid":"38317","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_8321987181841","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3800","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: 173px; width: 160px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Michelle Cavanaugh, RN, CPC","typeof":"foaf:Image"}}]]

2. Identify the most frequent diagnoses for which patients undergo studies. What are the documentation requirements for these diagnoses in ICD-9 vs. ICD-10? Pay close attention to the following diagnoses:

a. Bone fractures-Many require documentation denoting whether the fracture is pathological vs. traumatic, the anatomical site, type of encounter, laterality, alignment of the fractured bone, open vs. closed, type of fracture, and stage of healing.

b. Limb pain-Document the specific limb and laterality.

c. Abdominal pain-Document the specific location of the pain.

d. Congestive heart failure-Document the type of heart failure as well as whether it’s acute, chronic, or acute on chronic.

e. Osteoarthritis-Document the specific location and laterality.

3. Create a plan for obtaining more specific documentation. In many cases, referring physician offices may be prepared to provide information necessary for ICD-10 without your having to ask for it. In other cases, you may want to consider creating an order template that includes all of the details necessary for payment. For example, when a physician orders an abdominal ultrasound, the order template should prompt him or her to document whether the ultrasound is performed for abdominal pain in the right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant, or whether it is epigastric, periumbilic, or generalized.

4. Keep tabs on denials. As with any specialty, it’s important to monitor, track, and trend denials post implementation. What is the root cause of these denials? Do certain referring physicians constantly provide insufficient information? What can be done to ensure clean claim submission the first time around?

You need to work with all referring physicians to ensure that you receive the documentation necessary for ICD-10. This primarily includes laterality and anatomical specificity. If referring practices don’t provide this information, you must devise strategies to rectify this. Payers will likely not accept unspecified diagnoses for radiology tests that are performed. In the absence of specified diagnosis codes, medical necessity will be problematic.  

Take the time to assess the quality of the diagnostic information you receive. Also review ICD-10 changes as they pertain to common diagnoses. If referring physicians don’t provide this information, don’t be afraid to ask for it directly. Otherwise, your revenue and cash flow may be in jeopardy. That’s a risk that no practice can afford to take.

Articles

Radiologists face unique challenges with ICD-10 because information comes from referring providers. Here are four tips to help avoid denials with ICD-10.

Michelle Cavanaugh, RN, CPC

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4 Tips to Prepare Radiologists for ICD-10