Ready or not, here it comes! October 1st ushers in the implementation of ICD-10. In order to stay ahead of the game, we recommend taking a proactive approach; in this blog, we will discuss how the new codes will affect radiology, how to deflect denials and keep your payments and radiology revenue coming.
Educate and communicate the need for specifics
ICD-10 brings an exponential expansion of codes, giving way to much higher expectations for detail by payers and CMS. For example, under ICD-9 there was one code for angioplasty; now there are over 850!
In ICD-10-PCS, three sections are devoted to radiology. According to an article in Radiology Today, “Radiologists must be much more specific and detailed in their documentation and wording of a completed exam. The coding of the dictation will depend on whether the patient is an inpatient or an outpatient, since ICD-10-PCS codes are only for inpatient procedures.”
Identify frequent diagnoses
In Diagnostic Imaging, Michelle Cavanaugh, RN, CPC suggests identifying the most frequent diagnoses in advance. She urges radiologists to pay close attention to:
- Bone fractures.
- Limb pain.
- Abdominal pain.
- Congestive heart failure.
Ask for what you need from referring physicians
Many radiologists rely heavily on diagnostic information from referring physicians. This practice was risky under ICD-9, and ICD-10 codes complicates issues even more. You will need very detailed and specific information from your referring physicians for procedures to be correctly pre-certified, dictated and billed.
Proactively speaking with referring physicians about ICD-10 will help you determine which physicians are prepared and which ones are not. Ensuring a compliant physician order for radiology tests and procedures is crucial to prevent unnecessary denials, rework and follow-up. Cavanaugh makes an excellent suggestion to create “an order template that includes all of the details necessary for payment” when requesting specific documentation from referring physicians.
In addition, be sure to track and trend your denials so you can understand why you are being denied. Fixing the underlying reasons for denials will enable you to submit clean claims the first time and get your money faster.
Some of the stranger ICD-10 codes
If you think the new ICD-10 codes are for the birds, you’re right. (At least 72 of the new codes are anyway.) Struck by a McCaw? There’s a code for that: W61.12. There are even codes that talk turkey: W61.42, Struck by turkey, or W61.43, Pecked by turkey. If you don’t like the turkey your mother-in-law makes for Thanksgiving, you might be prone to Z63.1, Problems in relationship with in-laws. Chances are, with an expansion from 18,000 ICD-9 codes to 140,000 ICD-10 codes, there’s a code for just about any situation you can imagine!
Final thoughts | Radiology Revenue and ICD-10
While properly coding with ICD-10 is critical to making sure your diagnostic imaging claims are paid, other factors, such as maintaining current accreditation with an accreditation organization recognized by CMS, are also necessary to ensure smooth claims reimbursement. RadSite can help you meet these important requirements by accrediting your facility for CT, MRI, PET and nuclear medicine equipment.