ICD-10 for Radiology Coding, Part 2
By Deborah Neville, RHIA, CCS-P
August 31, 2011
Editor's Note: This is part two of the three-part series authored by Deborah Neville. Part three will focus on the coding aspect of the transition to the ICD-10, including what healthcare professionals should know to prepare. Watch Neville's popular ADVANCE webinar here.
The transition to ICD-10 may appear daunting, with more than 130,000 codes and plethora of new diagnoses and procedures. While radiologists will continue to use CPT coding for outpatient procedures, they will need to have the ability to assign codes that support imaging services and allow ICD-10-PCS coding for inpatient services.
As noted in part one of this three-part article series, 16 new code sections will be added as part of the ICD-10-PCS, and three sections within ICD-10-PCS will be devoted to radiology. Providers should begin by conducting an ICD-10 readiness assessment and taking advantage of webinars and white papers on the topic, as there are many resources out there for use, some of which are free of charge.
Embracing the big picture
The complexity of ICD-10 planning and implementation suggests that organizations adopt a mindset similar to the one applied to tackle Y2K. This will entail a comprehensive, transitional approach to ICD-10 that rejects silo-based thinking and embraces four core principles: taking a system-wide approach; incorporating human and financial considerations; evaluating short- and long-term implications of ICD-10; and identifying the impact on staff functions.
1. Involve all systems and functions: A common misnomer is that ICD-10 involves only health information management and patient accounts. In fact, it affects any staff member who generates or uses coded data, including clinicians who document information to be translated into codes. For the radiologist, this entails providing specific documentation on the imaging study being performed, including the body part.
In today's electronic health care environment, many health information systems or devices perform at least one of the following functions: captures, stores, processes, analyzes, groups, edits, prices, retrieves, reports, or otherwise manipulates coded data. Therefore, it is imperative that radiology departments and practices take an enterprise-wide approach to the impact of ICD-10 on every system and function, from patient registration to delivering the radiology report.
2. Evaluate human and financial resources and competing demands: Many health care providers and facility are still planning for and funding requirements from regulations such as the American Recovery and Reinvestment Act (ARRA). Add to this an era of reduced reimbursement and higher costs--for equipment, staff, and operating expenses--and many hospitals are constrained in the ability to fund new projects. It is important to understand how other initiatives and regulations may reduce available resources for the transition to ICD-10 and how it will impact other initiatives, and vice versa. Identify financial and staff constraints before beginning the transition.
3. Share the short- and long-term potential impact of ICD-10: The good news is that ICD-10 will likely standardize terminology, provide access to detailed clinical outcomes, and facilitate health care transformation and reform. For radiology, this could further propel the movement to evidence-based medicine and radiology-related measures of quality and performance. Industry-wide shifts in the provision and delivery of care will occur, as well as impact certain specialties and disciplines, job functions, and departments or divisions. Discuss these with a near- and long-term view and realign goals and objectives accordingly.
4. Identify how staff members affected by ICD-10 will perform similar functions using ICD-10: Will their role(s) change and what additional steps will they need to perform? For outpatient radiology providers, how will they modify CPT coding documentation to enable ICD-10-PCS coding for inpatient services? Among the possible functions are:
• Claims appeals
• Medical necessity
• Service documentation
• Payer contracts and coverage negotiations
• Disease management
• Fraud detection
• FTE analysis and reporting
• Equipment needs assessment
• Patient education needs assessment
• Procedure and disease management cost analysis
• Charge capture systems
No better time to start than now
Just as health care facilities discovered with Y2K, HIPAA, and now ARRA, a multi-year, phased approach will help lessen the burden on finances and staff. Start planning now; don't wait for the deadline of Oct. 1, 2013 to loom nearer. Claims and other transactions without ICD-10 codes may be rejected or delayed, impacting reimbursement for any claims transaction--not just Medicare and Medicaid. Here are the four phases to ensure a successful transition to the ICD-10.
Phase One: Assess Readiness (Evaluation)
Ideal time to start phase: Now (2011)
Radiology should approach the transition to ICD-10 much in the same way it would implement a new PACS or RIS. First, create an implementation team with representation from different positions within the department or imaging facility. Task the team with identifying affected stakeholders, systems, and budgets for system changes. How will ICD-10 change business operations and workflow? Are there additional requirements, (i.e., clinical decision support or clinical outcomes reporting) that must be budgeted and implemented?
Phase Two: Identify Challenges and Planning Solutions (Planning)
Ideal time to start phase: 2011-2012
Develop a plan to provide foundational education to coding and clinical professionals. Include introductory ICD-10 courses for all staff members who will ultimately function as trainers--similar to the "super users" in a PACS/RIS implementation.
Forge a plan for communicating and sharing information across departments. Assess, budget, and plan for clinician and code set user education. Remember that standards for electronic health care transactions, including claims, eligibility inquiries, and remittance, change to Version 5010 on Jan. 1, 2012.
Phase Three: Go Live Preparation (Action)
Ideal time to start phase: 2012-2013
Finalize and test system changes simultaneously with the initiation of intensive ICD-10 education coordinated with the requirements of meaningful use, quality measures, patient outcomes, and clinical decisions support requirements. Implement policy development, trending, and projection analyses and changes to billing records and templates. Monitor the impact of coding accuracy on reimbursement and identify areas for improvement.
Initiate a documentation improvement process, including evaluating existing documentation practices, during the implementation of system changes and database conversions.
Phase Four: Evaluate Measurement and Milestones (Management)
Ideal time to start phase: Post-ICD-10 conversion
Key to success will be the ongoing evaluation of the implementation. Measure coding accuracy and productivity and the subsequent impact on reimbursement and revenues. Equally important is monitoring documentation improvement and the impact of data use on factors such as patient outcomes and quality measures. Continuing education on coding also must continue.
Preparation, planning, and adherence to an agreed-upon timeline for a phased transition to ICD-10 offer the best approach to addressing this complex implementation. Radiology is well-suited to this challenge after years of leading the transition to information technology and electronic patient data in health care. With many hospitals on their second generation PACS and RIS, the lessons learned from implementation, data migration, and communicating patient data enterprise-wide are well-suited to helping ensure a smooth transition to ICD-10.
Deborah Neville, RHIA, CCS-P, is the director of revenue cycle, coding, and compliance for Elsevier/MC Strategies where she directs the writing and production of a comprehensive catalog of online education curricula for coding, revenue cycle, and compliance.