4 Key Items for Radiologists Preparing for ICD-10 Implementation starting October 2015

ICD-10 coding system has been the talk of the town for quite a while. The latest deadline for its hospitals and practices to upgrade from ICD-9 to ICD-10 is October 01, 2015. Despite the deadline being delayed a couple of times previously, the impact of its implementation of ICD-10 is clear.

Radiology is one the many aspects of healthcare that will feel the effects of the upcoming ICD-10 implementation. It can present a significant challenge to providers in terms of documentation workflow. Each claim not only needs the appropriate updated codes but also the clinical documentation (from the patient visit)to support the submitted ICD-10 codes. In a way, ICD-10 is not much different than ICD-9, other than the fact that it will be lot more detailed.

One of the most complicated issues in radiology is that radiologists rely heavily on diagnostic information from referring physicians. ICD-9 had its fair share of shortcomings regarding insufficient information, which means it’s going to be trickier with the initiation of ICD-10.

Here’s a list of 4 key items for radiologists to keep in mind in order to better communicate with referring physicians and prepare for the upcoming mandatory implementation of ICD-10 in October 2015.

• Updating physicians/ practices inventory

Updating the list of practices/ physicians who most likely refer you the patients will speed up a lot of things. Questions to consider include: what is the quality and level of detail of the diagnostic reports sent by these physicians? What are their plans of implementing ICD-10? Restate the importance of physician orders to carry out radiology tests and be as specific as possible in all their diagnostic information. This will lead to fewer denials and prevent unnecessary follow-up.

• Identifying and examining diagnoses

Identify most frequent occurring diagnoses. List down their documentation requirements and examine how they differ in ICD-9 vs. ICD-10. Some diagnoses such as limb pain, abdominal pain, bone fractures, osteoarthritis etc. require closer attention than others.

• Focus on obtaining specific documentation

Referring physicians may already have the necessary information for implementing ICD-10. But most of the time, radiologists may need to consider updating their order templates to includes all the new fields that capture all the information required.

• Check denial rate

Close monitoring, tracking and analysis of denials is important for any type of specialty post implementation. It’s important to understand the root cause of these denials. Is this being caused by referring physicians who constantly provide insufficient information? Radiologists need to figure a way of scoring higher success rates on first-time submissions.

It’s imperative that radiologists/ practices work with referring physicians to ensure all the necessary information is available such as laterality and anatomical specificity for smooth ICD-10 transition. If such information is unavailable for some reason, practices need to devise strategies to gather the data and have that rectified. It is unlikely for Payers to approve the claims for the radiology tests that are carried out without specific diagnostic codes, causing issues in further treatment and proceedings.

Non compliance may lead to reduced revenue and cash flow. It is very important for practices to spend some time and evaluate the diagnostic information they receive from physicians for quality and consistency.

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