Are We Ready for Round Two of ICD-10?
It’s time for every radiology practice to identify its ICD-10 champion.
We survived round one of the ICD-10 implementation. As you've probably heard, ICD-10 is the revised system for diagnosis coding.
In anticipation of the Oct. 1, 2015 transition, many experts predicted that the transition from ICD-9 would be a disaster. They feared the billing cycle would come to a halt, asserting that the new diagnosis codes would be too complex and the computers would not be ready. Well, we survived.
Claims processing continued, cash flow was maintained, denials proved manageable, and coder productivity remained relatively unblemished. But we cannot relax. Round two commences on Oct. 1, 2016, and is equally complex. As this next stage approaches, we cannot rely on our billing entities to coordinate the transition on their own. Radiologists must be leaders in this effort. The ACR Commission on Economics stands ready to provide the tools and guidance that radiologists will need in order to succeed.
So what changes on Oct. 1, 2016? First, the ICD-10 grace period ends. Medicare and most private payers granted a one-year grace period during which less-specific ICD-10 codes are accepted. For example, assigning a general “fracture” ICD-10 code (rather than a more specific code indicating location, mechanism, and severity) was sufficient. Effective Oct. 1, 2016, greater detail in our codes will be required, or claims denials could follow. Second, the ICD-10 code set will expand and evolve with over 3,000 new ICD-10 codes coming into effect and hundreds more being revised. Recall that while policymakers waffled over ICD-10 implementation for five or so years, no new ICD codes were added. Accordingly, this widespread revision is a phenomenon that we have not experienced in years.
What should we do? First of all, we must not view round one of the ICD-10 implementation as being a one-and-done exercise. We must stay engaged and improve our diagnosis coding, documentation, and reporting. This will require direct radiologist engagement, as this effort demands more clinical acumen than most coders and billing managers possess. Radiologists should serve as a bridge to our referring physicians, practice partners, and coders. In fact, every practice should have a radiologist serving as its ICD-10 champion.
As an example, let’s consider a shoulder MR. Our ICD-10 champion would help educate referring physicians to indicate more than just “pain” when ordering examinations. The order would indicate acute vs. chronic and whether there has been prior surgery or trauma. In fact, instead of a blank space on our ordering interface, what if we included a decision tree to guide the ordering provider? Our reports would translate this diagnosis information into a more actionable and relevant report. And the coders would look to our ICD-10 champion for help assigning the proper codes based on the complex clinical information in the report.
Reviewing our ICD-10 claims data for the last year is equally important, and radiologists can lead this effort as well. We can help our billing managers identify the most common ICD-10 codes in order to find any shortcomings. Are there certain referring physicians or radiologists whose reports more commonly yield less specific ICD-10 codes, resulting in more denials? Are there facilities where the transmission of information could be improved with better data interfaces? We will not be able to answer these questions unless we know where to look and how to interpret what we see — or don’t see.
Round two of the ICD-10 implementation is here. With our grace period ending and thousands of new codes being created and revised, we must remain proactive. The ACR Commission on Economics provides resources on the new radiology diagnosis codes, largely through our Radiology Coding Source™ (find it at bit.ly/CodingSource).
While our billing entities will largely lead the transition effort, they cannot do it without the engagement of radiologists. In fact, future payment models, such as those forthcoming under MACRA, will rely heavily on proper diagnosis coding. Our practices will need to be adept at handling coding for items like clinical episode groups and patient relationship codes, so proper diagnosis coding now will serve us well in the future. Through education, improved point-of-ordering guidance, data sharing, and internal auditing, we will be well prepared, ensuring that round two proves just as uneventful as round one. At the same time, we can make certain that the quality of our radiology reports improves and our relevance to patient care expands. With the support of the Commission on Economics, our ICD-10 champions can move ahead with confidence.
By Ezequiel Silva III, MD, FACR, Chair