Are You Ready for ICD-10?
Find out how practices are gearing up for the big switch.
In 2009, health and human services and CMS dropped their first handful of change into the meter marked ICD-10.
The clock began its countdown to October 1, 2013. However, as the deadline neared, the agencies added a few more coins, pushing the due date back a year and then another. With the latest deadline approaching, the ICD-10 codes are coming — and practices are finalizing their strategies.
The World Health Assembly, the governing body of the World Health Organization (WHO), voted to replace the ICD-9 codes with ICD-10 in 1990. This new set of codes is more specific and modern than the previous version, conveying more information and encompassing more modalities and diseases. Although the former version contains 13,000 numeric codes, the new version contains 68,000 alphanumeric codes. Canada, the United Kingdom, and other WHO-member countries adopted the ICD-10 codes years ago, but the United States, which has used ICD-9 for more than 30 years, has yet to fully adopt them.
In 2009, Health and Human Services and CMS issued the first mandate requiring that all organizations covered by the Health Insurance Portability and Accountability Act (HIPAA) transition to the ICD-10 diagnosis and procedure codes by October 1, 2013. But, at the urging of physician groups, the agencies extended the deadline by one year, to October 1, 2014, and then again to October 1, 2015. Although some members of Congress continue to push for further delays, it remains to be seen if another extension will result.
"We're urging our members to be prepared and not to wait." — Diane Hayek
Despite the uncertainty, experts are encouraging radiology groups to learn the new codes and test their systems in preparation for the switch. "They need to make sure their coders and physicians are aware of the changes and test any newly installed or updated software," says Diane Hayek, director of the ACR's economics and health policy division, which has developed several resources to help practices transition to ICD-10. "We're urging our members to be prepared and not to wait." Access the ACR ICD-10 resources.
Most practices began preparing for the ICD-10 switch in 2013 in anticipation of the October 1, 2014, deadline. But when HHS and CMS extended the deadline to 2015, many groups suspended their training efforts. "The delay was helpful in the sense that we didn't have to implement ICD-10 for another year, but it also delayed our momentum," says Patrick J. Juenemann, MD, FACR, coding and compliance officer at Suburban Radiologic Consultants, a practice with 65 radiologists based in Minneapolis. "Now we're starting all over again."
Train for Change
One of the first things practices should do to prepare for the switch is update their IT infrastructure to ensure it is ICD-10 compatible. Renée Engle, radiology certified coder (RCC), senior vice president of client services at MSN Healthcare Solutions, a billing and practice management company headquartered in Columbus, Ga., cautions that this process may take time, so practices should make it a priority. They should ask their software vendors about ICD-10 upgrades and determine whether their electronic medical records (EMRs), computerized physician order entries (CPOEs), and other systems are capable of supporting the ICD-10 codes. "Groups should work with their facilities to ensure the infrastructure is there to handle ICD-10, and they should find out how the electronic data will be submitted to carriers," Engle says.
Beyond IT updates, the primary way practices should prepare for the switch is through education. Practices can either appoint in-house project teams or hire outside consultants to train their coders. Pat Kinsley, RT, CPC, RCC, coding and compliance manager at Suburban Radiologic Consultants, says she is using widely available ICD-10 workbooks and other tools to lead her group's coder training sessions. Kinsley covers one or two chapters of the books during each hour-long session and cross maps the group's top 200 diagnosis codes from ICD-9 to ICD-10 to help her team better understand how the codes will differ. "We discuss how the disease processes and anatomy will be represented in ICD-10 versus ICD-9," Kinsley explains. "None of the ICD-9 codes correlate directly with the ICD-10 codes, so there is a lot to learn."
Radiologists and technologists must also become familiar with the ICD-10 codes, which require much more specificity than the ICD-9 codes. For instance, rather than simply saying that a patient presented with abdominal pain, the imaging report must describe to the highest level of specificity exactly where the pain was located to ensure the appropriate ICD-10 codes are used. Technologists must be trained to obtain such details from patients, and radiologists must be educated to include that information in their reports.
Suburban Radiologic Consultants has updated its patient worksheets to help its technologists gather the required information, and Juenemann is leading efforts to educate the group's radiologists about ICD-10. "I'll send out an email about chest pain, for example, and say, 'Here is the ICD-9 code for chest pain, and then here are the dozen ICD-10 codes related to chest pain and the information needed to assign the codes,'" Juenemann explains. "I also hold informational sessions during our partnership meetings, just to ensure everybody is aware of what is going on with the transition."
Procure the Particulars
ICD-10 education must go beyond the radiology practice or department itself, however. Groups should also encourage their referring physicians to provide in-depth patient histories in their orders so the radiologists have those details readily available when dictating their reports. "Historically, ordering physicians have not given enough information for the radiologists to know the whole scope of what is going on with the patient, and ICD-10 requires that information," Engle notes. "Our recommendation is that facilities start making order-specific information required now."
The George Washington University Medical Center's radiology department is leading an effort to redesign the outpatient CPOE in the center's 800-member multi-specialty medical group to collect more detailed patient information for ICD-10. Robert K. Zeman, MD, professor and chair of radiology at George Washington and chair of the ACR Carrier Advisory Committee, says the new system will link a patient's condition directly with the reason for the exam and will include fields where ordering physicians will enter additional patient history, such as other diagnoses that may be pertinent to how the exam is conducted. Although such systems will help radiologists capture the required ICD-10 information, increased communication between radiologists and referring physicians will be necessary as well, Zeman says. "We ought to be communicating more with our referring base and patients anyway," he says. "This ties in well with the steps that we need to be taking to better show our value in the continuum of patient care," one of the central tenets of Imaging 3.0™.
Test the System
Practices that fail to prepare for the ICD-10 switch face significant financial consequences. Once the switch takes effect, most payers will deny claims that do not have ICD-10 codes or that have inadequate or missing codes. The exceptions might be auto insurance companies, workers' compensation insurers, and other non-HIPAA covered entities, which are encouraged but not required to adopt ICD-10. "Delayed reimbursements should be a big concern for radiology practices," Hayek says. "They want to make sure their claims processing goes as smoothly as possible and that claims are not held up." Some practice leaders recommend that groups extend their lines of credit enough to cover their operating expenses in case their payments are delayed.
"Remain aggressive with your preparations so that when the ICD-10 switch happens, it's just another day." — Renée Engle, radiology certified coder
To ensure they are prepared for the switch, practices should perform trial runs. CMS is looking for volunteers for end-to-end testing, but groups might also conduct tests with their payers, Kinsley says. As part of their testing, practices should audit their imaging reports to ensure their radiologists are providing adequate information for the ICD-10 codes. Juenemann recommends sending the results of those audits to all of the radiologists, letting them know not only the number of insufficient reports but also the amount of money the practice stands to lose as a result. It's a method Juenemann uses throughout the year to encourage better reports. "I used to send out emails about our denials without any dollar amounts, and I'd get a lukewarm response. But once I started putting in how much it was actually costing us, I received a much better response," Juenemann says.
From updating their IT systems and educating their employees to engaging their referring physicians and working with their business partners, practices have a lot of work to do to prepare for the ICD-10 switch. That means that despite previous delays, practices cannot afford to become complacent. "Remain aggressive with your preparations so that when the ICD-10 switch happens, it's just another day," says Engle.
ICD-10 Survival Guide
Be sure to check off the following as you gear up for the upcoming switch:
- Work with vendors to ensure all IT systems are updated and ICD-10 compatible
- Train coders to master the ICD-10 code set, focusing on the most relevant codes first
- Educate radiologists about the need to include detailed patient information in reports
- Work with referring physicians and other partners to procure patient histories
- Perform testing with payers to ensure all systems are ready and claims will be paid
By Jenny Jones, freelance writer for the ACR Bulletin