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  • ICD-10: Are You Prepared for the October Transition?

    Radiologists are vigorously preparing for the transition to ICD-10 on October 1. By Mike Bassett

    August 1, 2015

    In 2009 the U.S. Department of Health and Human Services published a final rule establishing ICD-10 as the new national coding standard, with an implementation date of October 1, 2013.

    Since then the implementation date has been delayed twice—first to 2014, and then to October 2015. Barring another last-minute Congressional delay, ICD-10 will go into effect on October, 1, 2015, which means that radiology practices and departments should be vigorously preparing for the transition.

    “If you go back a couple of years when it was supposed to be implemented, there were definitely people who weren’t going to be ready,” said Ron Bucci, administrative director at the MetroHealth System in Cleveland. “But since it’s been delayed twice, people have had enough time to get with the program. They’ve been working on it long enough that they should be ready to go.”

    If they haven’t already, radiologists should be taking steps such as training coders and allowing them to practice with ICD-10 by giving them the opportunity to dual code with ICD-9 and ICD-10, says Melody Mulaik, president of Coding Strategies, Inc., Atlanta.

    “This should give coders a good comfort level with the new code set,” she said.

    Mulaik also said that radiology groups should be working with their referring physicians on the ICD-10 transition. “A lot of groups are saying that while they can control things within their own practices, they don’t get a lot consistency from their referring physicians,” she said.

    A similar point about the need for radiology groups and referring physicians to get on the same page was made by Pat Kinsley, coding and compliance manager for Suburban Radiologic Consultants in the Minneapolis-Saint Paul area, and a member of the Coding Subcommittee of the Radiology Business Management Association.

    “Because ICD-10 has such a high level of specificity in assigning diagnosis codes, it’s going to be important to get better clinical information from ordering physicians in order for radiologists to code signs and symptoms or any underlying disease that could have an impact on the findings from an imaging study,” she said.

    Consequently, Suburban Radiologic Consultants has revised its patient information sheets to reflect the fact that the information gathered will be more ICD-10-focused, Kinsley said. “Radiology practices should talk to their high-referring groups to make sure they understand there are going to be more specific questions asked at the point of scheduling.”

    Radiologists Should Understand Coding

    As for radiologists themselves, Kinsley said that while they won’t be coding, it is important to have them on board concerning preparations for the ICD-10 transition since they will need to understand the key factors they must include in their dictation, such as laterality, the severity of a finding, and whether the finding is due to an underlying condition or postoperative complications.

    When it comes to the transition from ICD-9 to ICD-10, radiologists have one thing working in their favor. “Radiology is in a better position than many other specialties,” Mulaik said. “There is a support structure in place for radiology because radiologists don’t code—they have relied on either medical coders or computer-assisted coding for support.”

    While they aren’t doing the actual coding, radiologists do play an integral role in improving the clinical documentation that is critical to ICD-10, said Naveen Garg, M.D., an assistant professor of diagnostic radiology at The University of Texas MD Anderson Cancer Center, Houston, who serves as a radiology representative for the facility’s ICD-10 transition.

    “Radiologists should pay attention to the metadata automatically imported into the history and indication fields from the Radiology Information Systems and add as many of the five details (laterality, anatomy, episode or care, etiology and acuity) as they can,” Dr. Garg said.

    Nevertheless, radiologists are likely to have questions, such as: Should the five details be included in the history/indication or in the findings/impression category? Should it go in multiple places?

    “It’s the same issue we have now with structured reporting,” Dr. Garg said. “I am sure more reports will bounce back from billing for added clarification until we get used to the ICD-10 way of doing things.”

    As for those radiology groups that have yet to start preparing for the transition to ICD-10—and according to Malaik, there are several of them still out there—they are rapidly running out of time and could be in trouble if they don’t start moving immediately.

    “They can do the ‘let’s hurry up and try to do it all in the summer’ kind of thing, which is what I think some of them are doing,” Mulaik said. “The challenge comes when we get to August and September and practices will need training and implementation help and there will be no one available because everyone is already scheduled with other organizations.”

    Countdown to October 1

    So what will happen when October 1 hits? Possible problems could be relatively benign. For example, Kinsley pointed out that the fact that ICD-10 codes have more characters than ICD-9 codes, which could result in data input delays because it will simply take longer to type in the codes.

    Other problems could be more serious. For example, what will happen if practices start experiencing serious reimbursement delays because of problems transitioning to the new coding system? With that in mind, organizations such as the American Medical Association are strongly urging groups to set aside enough in cash reserves or lines of credit to mitigate cash flow disruptions.

    Mulaik said that any problems won’t be apparent on October 1. In fact, Mulaik has heard that many payers don’t intend to have their tightest edits in place at first, but instead expect to be flexible.

    “But eventually, I think things will tighten up,” she predicts.

    One-year Grace Period Aids ICD-10 Transition

    ICD-10 Illustration

    Radiologists working to meet the Oct. 1 transition deadline to ICD-10 have been granted a grace period to aid adjustment to the enormity and complexity of the new coding standard.

    On July 7, the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) jointly announced a one-year grace period under which healthcare providers will not be penalized for certain coding errors under ICD-10.

    During the grace period, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.

    Physicians also will not be penalized under the quality reporting programs for errors related to the additional specificity of the ICD-10 diagnosis code, as long as a code from the correct family of codes is used.

    To further aid the transition, CMS is offering webinars, onsite training, educational resources and two ICD-10 coding videos and a quick-start guide outlining steps healthcare providers need to take to prepare for ICD-10. CMS has also scheduled a National Provider Call for Aug 27.

    CME also plans to set up a communication center to monitor ICD-10 implementation to quickly identify and resolve issues and problems. The center will feature an ICD-10 ombudsman to help receive and triage physician and provider issues.

    Among many other resources, the CMS website features Physician Perspectives, including insights from physicians across the country making the transition to ICD-10.

    Access all CMS resources at www.roadto10.org.

    Ron Bucci

    Naveen Garg, M.D.

    Melody Mulaik

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