ICD-10: The One-Year Countdown

With less than a year to go until implementation of ICD-10, the next iteration of healthcare’s coding system, radiology leaders are urging providers and practices to start planning and preparing for the switchover now. The change will be a large one with no grace period, they said, but there are steps you can take to ease the transition. Scheduled to go live on Oct. 1, 2014, ICD-10 will replace the existing ICD-9 coding system, expanding the number of available codes from just slightly more than 14,000 to 69,000. The increase will allow providers and referring physicians to be more specific in their diagnoses and documentation, but keeping up with the plethora of new codes could be a daunting task. Still, said Diane Hayek, director of economics & health policy for the American College of Radiology (ACR), ICD-10 will have several positive effects. “ICD-10 is going to be more specific, so measuring the quality safety net efficiency of care will be a benefit,” she said. “It will help in the designing of payment systems and the processing of claims for reimbursement, as well as electronic health records and conducting research studies.” Still, there are many practices and facilities unprepared for ICD-10 implementation. Talk of the new coding system began early, leading many in the industry to feel they had ample time to prepare. However, she said, the final countdown has begun, and everyone must be ready.  What’s New About ICD-10? Unlike many previous coding updates, ICD-10 will not include many specific changes to coding groups that radiologists frequently use. Most of the alterations affect process more than content. For example, the current ICD-9 system uses three-to-five digit codes, but ICD-10 expands code lengths to up to seven digits. A dummy place holder has also been added to allow for further code length expansion in the future. The ACR is concerned about this change, Hayek said, because current coding systems weren’t designed to accept longer codes, so practices and facilities will need to update or upgrade their systems in order to properly adhere to ICD-10. Providers will now be required to provide much more documentation of their patient encounters than they have in the past, placing more of the onus of proper coding on their shoulders. In addition to documenting initial encounters, they must submit details about subsequent treatments, routing or delayed healing, and disease relationships. How Will ICD-10 Affect Radiology? According to Melody Mulaik, president of CSI Coding Strategies, ICD-10 will affect radiology differently from other specialties. Because reimbursement for radiology services largely requires proof of medical necessity, providers are heavily dependent upon referring physicians to provide proper and adequate documentation.  “There is a differentiator with other specialties. Physicians will code or they have a coder looking at their documentation,” Mulaik said. “But because radiologists are so dependent on the hospital or other systems for information, problems can easily arise if a radiologist doesn’t receive enough documentation from the referring physician.”  Recognizing that insufficient documentation could cause future issues presents an enormous opportunity for both the technical and professional sides of the hospital or radiology practice to design workflow processes that will minimize the risk for reduced reimbursement. No plan will be perfect, she said, but everyone must agree to follow it. In terms of actual coding, ICD-10 doesn’t change much for radiology, Mulaik said. Providers will, however, be required to record more details about each patient encounter, especially with traumas, injuries, or fractures.  How Can Radiologists Prepare? Because ICD-10 more than quadruples the number of codes, getting ready for and feeling confident about implementation can be daunting. To help practices, facilities, and providers prepare for the switch, the Radiology Business Management Association created its ICD-10 ToolKit. Each kit includes a physician presentation, a coder presentation, examples of commonly performed radiology exams with the types of documentation challenges that could arise with ICD-10, and a list of services that could require additional details. The physician presentation focuses on key clinical areas involved in typical radiology encounters. It doesn’t teach radiologists how to code, but it does teach them about the additional information they’ll need to record to satisfy ICD-10 requirements. The coder presentation is somewhat similar, discussing the guideline changes between ICD-9 and ICD-10 and highlighting some of the technical changes, such as the move to lengthier codes. The kit also includes a coder assessment with a separate answer key, as well as implementation guide and timeline that provides step-by-step preparation directions. The Centers for Medicare & Medicaid Services has also provided guidance via a conversion document that helps providers and coders navigate the ICD-9/ICD-10 transition. Not only does this resource include a translation between the two coding systems, outlining how they line up, but it also includes examples of how various services are currently and will be coded. According to Hayek, the ACR plans to release a bi-monthly ICD-10 coding and reimbursement newsletter that will offer links to several helpful resources, such as the Anerican Aaociation of Professional Coders, the American Medical Association, and the Anerican Hospital Association. "The goal is to give providers access to whatever they need to have to prepare themselves," she said.  Challenges That Remain With less than a year remaining to implementation, there are still many practices and facilities that haven’t fully embraced what must be done to be ready for ICD-10, Mulaik said. Coders must be trained; system must be altered to accept codes with more digits; systems must be upgraded; protocols must be tested. Any and all steps must be taken to mitigate financial risk. “One of the biggest problems we’ll have is that we don’t know what will happen when ICD-10 is implemented,” Mulaik said. “There isn’t a road map that says, ‘If you do these 10 things, you’re good.’” In addition to providers, no one knows whether payers will be ready to process ICD-10 claims when the system goes live. Most payers, including Medicare, haven’t completed a dry-run to ensure they’re able to meet ICD-10 requirements. Before the Oct. 1 deadline, Mulaik said, payers must run a trial end-to-end test - they must receive a submitted claim, adjudicate it, and process it accurately, and then send payment or a valid rejection reason.  “This lack of information from payers about their level of preparation is concerning,” she said. “It doesn’t matter how great you code or document - if your payers don’t process it accurately, that affects your cash flow.” Consequently, Mulaik recommended that practices and facilities reach out directly to their payers and vendors to see whether they’re ready to make the ICD-10 switch. “No one has the extra staff to do this, so they’ll have to do things as part of their regular day-to-day work. It’s a whole extra workload, and a lot of people have underestimated the time it will take to do it,” Mulaik said. “We’ll see a lot of people, as we hit the first quarter, who won’t be ready for ICD-10. There will be a lot of panic in the second and third quarters of next year.” ICD-10 does present providers with several challenges - new codes, expanded documentation responsibilities, and additional training - but success is possible, Hayek said. They ultimately control their degree of achievement by how proactive they are willing to be, however. “Putting it off to the last minute isn’t going to help them,” she said. “If they take time to prepare and see what needs to be done in their specific areas, they will be able to minimize the impact that the transition will have.”