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Prepping Your Radiology Practice for ICD-10


The shift to ICD-10 will force radiologists to improve their documentation. Coding Strategies’ Melody Mulaik explains ICD-10’s impact and how to prepare.

The deadline to implement the ICD-10 coding system has been pushed back several times, but that doesn’t mean radiologists shouldn’t start preparing for the change.

The most recent deadline of Oct. 1, 2013, for practices and hospitals to shift from ICD-9 to the updated version, is likely to be delayed again. CMS is expected to provide guidance sometime this fall.“Most are betting it will be October 1, 2014, but we don’t know that as a fact,” said Melody Mulaik, president of Coding Strategies and a member of the Healthcare Billing and Management Association.

Despite the deadline uncertainly, the impact of ICD-10 is clear. While the new system is intended to provide far more detail, the change will require radiologists to improve their documentation. Diagnostic Imaging spoke with Mulaik about how radiology practices will be affected and what they should be doing now to get ready for the shift.

Knowing there is that uncertainty around the deadline to implement ICD-10, how has that affected practices making the necessary changes getting ready?

Physicians historically lag behind hospitals in terms of technology and this just makes it worse. Except for physician practices that are affiliated with or part of an academic center or a larger health care system, the vast majority of practices haven’t done anything of significance to get ready. They have many other pressing issues they are dealing with - quality measures, electronic medical records. But they are just waiting to see what the date is going to be.

So let’s back up. What are the major differences with ICD-9? And what are the benefits of the new codes?

There are two components of ICD-10. The PCS component, which only the hospitals are going to use, provides a tremendous amount of additional data related to procedures that are performed. They are out of room for Volume 3 codes now in ICD-9, so they really need this to capture what procedures are being done that drive the [diagnosis-related group] for the inpatient side.

On the physician side and the diagnosis side for the hospital, many of the ICD-9 CM codes are very antiquated and do not reflect the way clinicians currently classify some conditions. They also lack the level of detail needed to accurately describe a patient’s condition in some cases. We’ve been on this version of ICD since the early 1980’s and it doesn’t contain enough granularity in the codes for use in a 21st century healthcare system.

Another consideration is that everybody else in the world is on ICD-10. ICD is owned by the World Health Organization. We have been coding our death certificates in the United States in ICD-10 for the last ten years so we can submit data to the World Health Organization.

ICD-10 contains a lot more detail. We are going from about 16,000 codes to 68,000 codes. If you have someone with diabetic peripheral neuropathy, for example, you’ll have a single code that embodies both the diabetes and the neuropathy, which will communicate a lot to the insurance companies. This gives you a lot more information about the acuity of the patient and captures more about the disease process. For radiology the fracture codes will be in a lot more detail, which limb it is, is the fracture displaced, non-displaced, for example. This is detail that right now you just don’t have.

How will the change to ICD-10 impact radiologists?

They will have to improve their documentation. The beauty of radiology is they have been electronic for a long time, so all the systems issues [that must be upgraded for ICD-10] don’t impact them as much. There are many things that will have to be documented for I-10 that don’t have to be documented for I-9. Even if someone is a great documenter today, there will still be things they will have to change about their documentation for I-10. Injuries for a radiologist will be the biggest challenge; fractures are a really good example.

The other thing that comes into play is the encounter with that patient. Is it the initial encounter where they are diagnosing the patient or a subsequent encounter where the patient is coming in for a follow up visit? Right now we don’t capture any of that.

What should radiology practices being doing now to prepare?

A lot of radiologists outsource to billing companies, and some of the billing companies are starting to do a fair amount to prepare for ICD-10 implementation. I just talked to one of our billing company clients that does a lot with radiology. When we’re doing their compliance audit, we’re talking about incorporating a component of clinical documentation improvement where we can look and see what the physician needs to do so that we can assign codes in I-10. Even though it may be a couple years to go, we can already look at their documentation and see what changes need to be made.

Providers are also looking at doing things that have I-9 value, meaning making improvements in the quality of patient data that give us benefit today. We need those improvements today; that’s not only an I-10 thing. Anything that has ‘I-9 value’ is a great prep for I-10.

What are you hearing from radiology practices? Are they thinking about this?

Yes and no. I think radiology is more tuned in than some of the other specialties. And part of it is that radiologists don’t do their own coding. Because of that they either have a billing company that is supporting them, or they have their staff that is tuning into it. Most in primary care practices don’t have coders. The doctors are checking off charge tickets or doing electronic charge capture, and it’s on them and they aren’t thinking about it now.

I work with radiology groups that are already doing training sessions for I-10 and already talking to the doctors. We are just trying to do change management so that it’s not a big shock a few months out.

One of the big problems for radiologists is sometimes we beat the radiologists up because they don’t document well for the clinical side, but a lot of times they don’t get the information from the hospitals. One of the things they can work on now is ensuring they are getting good strong clinical information from the emergency room and for inpatients.

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