Cracking the Code

The ICD-10 switch presents many uncertainties, but practices don’t need a Rosetta Stone to streamline the transition.


October 2015

Some people had doubts, but it happened. On Oct. 1, the U.S. Department of Health and Human Services (HHS) adopted the latest version of the International Classification of Diseases (ICD) diagnosis coding system, ICD-10.

Many radiology practices have been training and preparing their staffs for the ICD-10 switch for months, if not years. Still, transitioning from ICD-9’s 14,025 numeric codes to ICD-10’s 69,823 alphanumeric codes won’t be easy. “While many other countries implemented ICD-10 years ago, it has not yet been implemented in a health care system like ours, where the code will determine whether the provider is paid or not,” says 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.

Code Compliance

Before the Oct. 1 deadline, many radiology practices held workshops, obtained workbooks, and hired consultants to train their coders, radiologists, and other staff members on how to use ICD-10. Even so, coders will likely take longer to code and submit ICD-10 claims because the codes are completely different from ICD-9.

One way practices can ease the transition is by creating reference sheets that translate the most common ICD-9 codes into ICD-10. Pat Kinsley, RT, CPC, RCC, coding and compliance manager at Suburban Radiologic Consultants, says her group has outlined its top 200 codes in a quick-reference guide.

But a reference guide won’t help if coders don’t have enough patient information to code the claims to the level of specificity that ICD-10 requires. Ideally, referring physicians will order imaging exams through computerized order entry systems that require patient histories. If they don’t, radiologists and their staffs may need to retrieve the information from electronic medical records or contact referring physicians to obtain those details. “Unfortunately, we don’t have great ways of restricting or requiring certain information in imaging orders,” says Margaret Fleming, MD, breast imaging fellow at Emory University in Atlanta.

Radiologists must then include the patient information in their reports so the coders can assign appropriate ICD-10 codes. Kinsley recommends appointing a radiologist as an ICD-10 champion to promote the change throughout the practice. “It’s helpful to have that peer-to-peer encouragement rather than a business office person trying to convince them to do things differently,” she notes.

Cash on Hand

While ICD-10 definitely requires more specificity, it is unclear just how much specificity third-party payers will expect. “Payers could certainly use this as an opportunity not to pay claims, and that’s a big fear,” Engle says. Radiology practices should refer to payer coverage polices and determinations to identify appropriate ICD-10 codes and reduce the chances of rejected claims. To give practices time to acclimate to ICD-10, CMS announced that for the next year Medicare review contractors will not deny or audit claims based on specificity, as long as a valid code from the appropriate ICD-10 family is used. “The only problem with that is you might adopt bad habits in the process, and bad habits are hard to change,” Kinsley warns.

Since delayed payments are likely, practices should manage their cash flow diligently during the ICD-10 transition. Ronald V. Bucci, administrative director of radiology at MetroHealth, a system serving the Cleveland, Ohio, area, recommends postponing unnecessary purchases and expenses for the next few months. “Practices should hold off on purchases that do not impact their normal business operations until they know that they have money coming in,” he says.

Many resources are available to help practices resolve issues during the transition. The ACR and other professional groups regularly post news and references to their websites. Engle notes that the Radiology Business Management Association offers valuable resources, including a listserv, an ICD-10 toolkit, and members’ forum, while CMS has appointed an ICD-10 ombudsman to address physician and provider issues. “The good thing is that radiologists are much more prepared for the ICD-10 switch than many other specialties,” Engle says. “The bad thing is that there are a lot of unknowns, so we have to be ready for whatever hits us and react appropriately.”

What impact will ICD-10 have on practices? Find out from Meg Fleming, MD.

By Jenny Jones, freelance writer for the ACR Bulletin

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