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The Procrastinator’s Guide to ICD-10


Radiology practices may need to pull all-nighters in the final days leading up to ICD-10 implementation.

When it comes right down to it, radiology isn’t that big of a player in the rapidly approaching ICD-10 implementation. The industry accounts for a mere 3% of submitted claims – at most. But, that doesn’t mean its impact on radiologists isn’t going to be significant.

On average, according to a new study published in the Journal of the American College of Radiology, the number of commonly-used codes will grow by nearly six-fold for most of radiology, but musculoskeletal imaging faces a far heftier load – a nearly 29-fold ballooning. So, whether you’re a musculoskeletal subspecialist working in an academic medical center or a general radiologist who happens to see a lot of musculoskeletal cases, you need to be prepared for a big change.

Regardless of the services you’re providing, it’s imperative that you’re ready for the new, code-heavy system that goes into effect on Oct. 1 – less than a week away, said Richard Duszak, MD, vice chair for health policy and practice in Emory University’s radiology and imaging sciences department.

“If you’ve prepared, the switch to ICD-10 will be like Y2K,” said Duszak, who is also lead author on the JACR study. “You’ll just boot up your computer, and everything will come up like normal.”

The cost of not being ready, however, is considerable. For a large practice with at least 100 providers, the price tag of lost productivity and payment disruption could total between $2 million and $8 million, he said. Even small practices with roughly three providers could lose up to $230,000.

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Unfortunately, not everyone is prepared. According to Renee Engle, senior vice president for client services with medical billing company MSN Healthcare Solutions, the industry is 50-50. Imaging centers, she said, are further along than hospital-based departments and practices.

“Hospital-based entities have been lulled to sleep because they felt like they really didn’t need to get involved – that the hospital was taking care of everything,” she said. “We tell them they have to know what the hospitals are doing and how they will forward information on about symptoms and diagnoses. That’s information radiologists will need for their own documentation.”

In many cases, hospitals have as many as 10 disparate systems that include the details radiologists need, she said, so it’s important for you to talk with hospital leaders to ensure you know how they’re planning to handle implementing ICD-10. Submitting claims without sufficient details included increases your likelihood of receiving denials.

Getting Ready
If you haven’t already invested in strategies that will prepare you for the transition to ICD-10, there are still things you can do make sure you can handle the change, said Len Shepherd, billing director for Tennessee’s Premier Radiology.

• Load the codes: Premier Radiology loaded its RIS system with ICD-10 codes in preparation of meeting its pre-authorization needs. As part of this system, coders could put in ICD-9 codes, press a button, and the code would switch to ICD-10.  

• Practice: Your coders should start practicing with ICD-10 codes as soon as possible. It can take as long as six months to get fully comfortable with the new system, but any preparation will be beneficial, he said.

• Meet: Gather for regular meetings. This gives your coders the opportunity to discuss new codes and how best to integrate them with practice activities. Premier Radiology also cross-walked the most frequently used 50 codes from ICD-9 to ICD-10.

• Download Crosswalks: Download several ICD-9/ICD-10 crosswalks to begin learning how the old codes are connected to the new ones.

• Outsource: If you’re really overwhelmed, consider outsourcing your coding needs for at least the first several months.

• Talk: Have an open conversation with your payers to determine their level of readiness. You need to know if they’re prepared to accept ICD-10 claims and whether you’ll receive your reimbursement on time.

• Consultants: Don’t shy away from bringing in an outside consultant who can discuss with your colleagues and your technicians the best ways to get ready for ICD-10 in the remaining days.

In addition, make sure your colleagues and referring physicians are properly educated on how to use ICD-10, Duszak said. Providers don’t need to know the minute details of how ICD-10 codes differ from ICD-9. Instead, you must be concerned with properly documenting other things, such as laterality, chronicity, and severity. For example, share with everyone the proper way to document a sprained ankle so they know how the documentation and coding will be different under both systems.

In addition to the heavier coding load that will be expected from your submitted claims, the industry faces a different challenge. No one has ever tried to implement ICD-10 the way the United States will, Engle said, so there’s no model to follow.

“We are facing a monumental time in medicine because we’re not just talking about a single payer system. We’re talking about thousands of carriers,” she said. “And, worker’s compensation and automobile liability claims aren’t even required to move over to ICD-10.”

In addition, she said, ICD-10 hasn’t been used to determine reimbursement levels in any other country, so there’s no history on how to correctly and effectively implement this change while minimizing confusion and claim denials.

It’s also unclear whether all private payers will be ready to accept and process ICD-10 claims by the deadline, Shepherd said. So, no one in the industry yet knows how they will pay your claims or if you’ll be forced to wait.

That uncertainty means lost – or, at best, delayed – revenue for you. To offset those potential losses, Duszak recommends you keep at least three months of reserve cash on hand, as well as an open line of credit. These resources could help you meet payroll or absorb unforeseen, major expenses should your payers choke on the increased code volume. It’s possible, he said, that some payers could see their payment time frames sky-rocket from 14 days to 45 days.

Can’t Get Ready?
Less than a week isn’t much time to digest ICD-10 and all the changes it will bring. So, if you can’t get at least minimally ready in that time frame, don’t worry. Not all is lost.

There is a saving grace for those of you who haven’t prepared for the transition, Duszak said. Although implementation goes into effect in less than a week, the Centers for Medicare & Medicaid Services has agreed to give you leeway. As long as you submit claims with the correct code family under ICD-9, you will continue to be paid for the next year.

Be aware, though, that your private payers might not follow the same tactic and could begin denying your ICD-9 claims immediately, he said. And, ultimately, ICD-10 will be in full effect, so buying into the change is vital to your continued success.

“You’re about to jump out of the plane, so be sure you have your parachute,” he said. “Don’t be cavalier that nothing will happen if you don’t make the switch.”

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