“Enormous” Impact When Radiologists’ ICD-10 Codes Sextuple?
By - There are nearly 35,000 practicing radiologists, many of whom rely on referring physicians’ diagnostic information. The amount of ICD-10 codes radiologists handle will increase six-fold come October 1, confirms new research. The future implications of this anticipated switch from about 14,000 ICD-9 codes to ICD-10’s nearly 70,000 imply an “enormous technological, operational and financial impact,” according to a July study published within the Journal of the American College of Radiology by Margaret Fleming, MD, MSc, Dan MacFarlane, BS, CPA, William E. Torres, MD, and Richard Duszak, Jr., MD.
“As the conversion from ICD-9 to ICD-10 will require acquiring and documenting even more detailed clinical information than is currently required for billing purposes – information that remains difficult for many radiology practices to adequately capture – that transition is perceived as a particularly daunting task for facilities, physicians, administrators, and coders alike,” state the authors, who analyzed 2014 claims data among over 588,000 radiology services within a 5-hospital academic health system and affiliated outpatient sites via a Medicare-endorsed tool.
According to the authors’ noted predictions and subsequent recommendations, radiology practices “will need to become sufficiently familiar with [the number of codes] to adequately and compliantly bill for their services.” The authors advise healthcare practices actively prioritize their ICD-10 educational and operational conversion initiatives and primarily focus on those areas that may be hit the hardest come October.
“Of all ICD-9 codes, only 3,407 (24.3%) were used to report any primary diagnosis. Of all claims, 50% were billed using just 37 (0.3%) primary codes; 75% with 131 (0.5%), and 90% with 348 (2.5%). Those 348 ICD-9 codes mapped onto 2,048 ICD-10 codes (5.9-fold impact), representing just 2.9% of all ICD-10 codes,” the authors confirm. “By subspecialty, the conversion impact factor varied greatly, from 1.1 for breast (11 ICD-9 to 12 ICD-10 codes) to 28.8 for musculoskeletal imaging (146 to 4,199). The community division, reflecting a general practice mix, saw a conversion impact factor of 5.8 (254 to 1,471),” they add.
The authors confirm less than 3% of all ICD-9 and ICD-10 codes are used to report the vast majority of collective radiology claims.
Do greater ICD-10 codes mean greater complexity?
Regarding connections to such findings and what may be next around the ICD-10 bend, as RevCycleIntelligence.com reported regarding projected code increases and their greater implications, the Centers for Medicare & Medicaid Services (CMS) advises the healthcare industry to anticipate only using a small percentage of ICD-10 codes come October. Consider, for example, that practices do not use all of ICD-9’s 13,000 available diagnostic codes, says CMS, confirming a greater number of codes should not generate greater complexity concerns. Nonetheless, perhaps identifying those codes which will likely be the most common – as well as maintaining active dialogue with physician practices – will prove beneficial for radiologists once October hits.
