ICD-10 Is Coming: How to Ensure an Optimal Transition

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Once again, there is an official implementation date for ICD- 10: October 1, 2014. In some circles, there is still much discussion as to whether this date, too, will be moved. While no one can predict the future in the ever-changing healthcare regulatory environment, it is highly unlikely that the date will be pushed further into the future, given that CMS (arguably) overstepped its bounds by pushing it out to 2014. Responses to the one-year extension for implementation have been mixed. Many hospitals and vendors have stated that they would have been ready on October 1, 2013, so they are using the additional year to expand their preparations—with the goal of an even smoother transition. Physicians, in many cases, tell a different story, with some still choosing to delay preparation while others embrace the opportunity to prepare their practices better for the expected impact on the coding process. Many radiology practices have either dedicated staff or a supporting billing company to help them through the transition. Radiologists could be in a better position than many other specialists in terms of what steps they must take in order to be 100% ready for ICD-10 implementation. ICD, the International Statistical Classification of Diseases and Related Health Problems, is a list maintained by the World Health Organization and used throughout the world to report clinical information for a variety of purposes. The United States is the only country that also uses ICD, in the form of the US Clinical Modification (ICD CM), for reimbursement purposes. This creates many operational challenges. In imaging, ICD CM codes are used to report either definitive findings or the patient’s signs/symptoms (if no definitive findings are present). The current US version, ICD-9 CM, has been in place since 1977; it is limited in terms of the number of codes used, as well as in its ability to describe modern care and to communicate important details about the patient’s condition. This is one of the many reason that the United States is joining the rest of the world with the implementation of ICD-10. A Whole New World With ICD-10 CM, the number of diagnosis codes increases from approximately 13,000 to 68,000, and with this increase comes much greater detail in diagnosis-code descriptions, along with the creation of diagnosis codes that combine conditions, manifestations, and complications into a single code. With the overall increase in the specificity of diagnosis codes, the level of detail provided by both the ordering physician and the interpreting radiologist becomes crucial. Currently, an order for a lower-extremity duplex study for deep-vein thrombosis might be received with the diagnosis of leg pain, which is coded as limb pain in ICD-9 CM. In ICD-10 CM, limb pain has been further divided into specific anatomic sites (upper limb: axilla, finger, forearm, hand, or upper arm; lower limb: foot, lower leg, thigh, or toe), along with laterality designation (left or right). In order to assign the most specific diagnosis code, the treating physician now needs to indicate that the pain is lower-leg pain occurring in the left leg, right leg, or both legs. Keep in mind that although the diagnosis code is assigned based on the findings in the final report, when the results are not definitive (or are negative), the code is assigned based on the diagnosis provided on the order. If the information provided on the order is too general or unspecific, assigning a diagnosis code for the procedure will be difficult. It is likely to require additional staff time to contact the treating physician and research the medical record. Greater specificity will also be needed in radiology reports to assign diagnosis codes to the findings. For example, a patient might be sent for radiography of the forearm for a suspected fracture of the ulna. The requisition simply states ulnar fracture due to motor vehicle accident. The radiology report documents that the fracture is in the shaft of the ulna. With the current ICD-9 CM codes, this information is enough to assign the specific diagnosis code, but in ICD-10 CM, more information is required. Not only is the location of the fracture necessary, but also the type of fracture and the side involved (right or left). For example, the radiologist needs to indicate whether the fracture is greenstick, oblique, spiral, comminuted, or segmental, along with the side involved. There are three main areas about which radiologists need