The ICD-10 codes associated with head CT examinations do not accurately reflect patient complexity, according to a new study published in Current Problems in Diagnostic Radiology. This discrepancy, the authors added, could make a significant impact on radiologists moving forward.
Lead author Melissa M. Chen, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues wrote that patient-facing physicians can bill for different levels of Evaluation and Management (E&M) services, ensuring they are reimbursed for an amount that lines up with the intensity and complexity of each patient encounter. Radiologists, on the other hand, use the same CPT code for a wide range of head CT examinations, “regardless of whether the history for the exam is a 25-year-old patient presenting with a headache versus a 40-year-old patient with head trauma and facial fractures after a major car accident.”
“Thus, during the valuation process, the complexity of patients undergoing head CT is heavily guided by the most commonly associated ICD codes for billed claims for head CT nationally, but is not further differentiated among subsets of patients undergoing the service,” the authors wrote.
Chen et al. explored public Medicare data and found that more than 56% of all head CT examinations performed on Medicare fee-for-service beneficiaries occurred in the emergency department (ED). In addition, 70% of non-contrast head CT exams in the ED were ordered for the most complex (level 5 E&M) patient visits.
The most common non-contrast ICD-10 code for head CT examinations in level 5 patient visits was “dizziness and giddiness.” The most common ICD-10 code for such encounters that did involve IV contrast was “headache.” These symptoms, the authors pointed out, may not necessarily line up with what clinicians would consider level 5 patient visits.
“Head-CT is not only most frequently ordered in the ED, but also during the most complex ED visits, suggesting that the ICD-10 codes associated with such exams do not appropriately reflect patient complexity,” co-author Ryan Lee, MD, a radiologist at Einstein Healthcare Network, said in a prepared statement from the Harvey L. Neiman Health Policy Institute. “The valuation process should also consider the complexity of associated billed patient encounters.”
This ongoing problem, the authors explained, could lead to inaccurate ICD-10 data guiding future radiology and billing policies. It could have a lasting impact on healthcare providers, especially radiologists.
“While it may be quickest or easiest to supply ICD-10 codes based on the most immediately available clinical information rather than on additional information within the medical record that could support a high level of complexity, radiologists and billers may not realize the downstream impact of coding lower levels of complexity on the valuation process,” the authors wrote.
The team did note that its research had limitations, including the fact that they only examined Medicare data.
“Future studies could attempt to devise other approaches for assessing patient complexity,” Chen and colleagues wrote.