Radiologists face unique challenges with ICD-10 because information comes from referring providers. Here are four tips to help avoid denials with ICD-10.
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.
Stay at the forefront of radiology with the Diagnostic Imaging newsletter, delivering the latest news, clinical insights, and imaging advancements for today’s radiologists.
Where Things Stand with the Radiologist Shortage
June 18th 2025A new report conveys the cumulative impact of ongoing challenges with radiologist residency positions, reimbursement, post-COVID-19 attrition rates and the aging of the population upon the persistent shortage of radiologists in the United States.
How to Successfully Launch a CCTA Program at Your Hospital or Practice
June 11th 2025Emphasizing increasing recognition of the capability of coronary computed tomography angiography (CCTA) for the evaluation of acute and stable chest pain, this author defuses common misperceptions and reviews key considerations for implementation of a CCTA program.
The Reading Room: Artificial Intelligence: What RSNA 2020 Offered, and What 2021 Could Bring
December 5th 2020Nina Kottler, M.D., chief medical officer of AI at Radiology Partners, discusses, during RSNA 2020, what new developments the annual meeting provided about these technologies, sessions to access, and what to expect in the coming year.
Mammography AI Platform for Five-Year Breast Cancer Risk Prediction Gets FDA De Novo Authorization
June 2nd 2025Through AI recognition of subtle patterns in breast tissue on screening mammograms, the Clairity Breast software reportedly provides validated risk scoring for predicting one’s five-year risk of breast cancer.