AHRA webinar: Transition to ICD-10 revolutionary for rad administrators
The U.S. adoption of ICD-10 will prove to be "one of the largest changes in the modern day" for medicine, leading to greater accuracy and specificity in medical reporting, declared Association for Medical Imaging Management (AHRA) speaker Melody Mulaik, president of Coding Strategies, during the Nov. 17 webinar What Radiology Administrators Need to Know about ICD-10.

With the addition of 55,000 codes and enhanced specificity, Mulaik touted the new system's benefits while insisting on the need for all departments within the hospital to cooperate to meet the U.S. Government's Oct. 1, 2013 "drop-dead" deadline for ICD-10 implementation.

The ICD system is used to classify patients' conditions and care, with three to five character codes identifying both diagnoses (ICD-CM) and procedures (ICD-PCS). But the present system is outdated. With many categories vague or full and with obsolete language and practices signifying the system's 30 year-old development, ICD-9 leads to inaccurate and limited recording of patient information, Mulaik argued. The U.S. remains the only country in the world which has yet to switch to ICD-10.

According to Mulaik, radiology departments and imaging centers need only focus on the diagnostic portion of the coding system, ICD-10-CM (clinical modification), as ICD-10-PCS (procedure coding system) will apply only to non-radiologic sections of the hospital. Some of the modifications coming under ICD-10 include codes that will distinguish between right- and left-sided medical conditions, combination codes that will identify both the underlying condition and its manifestations and whether treatment had previously been administered for the injury.

With changes come challenges

With the benefits of the new system clear and adoption long overdue, Mulaik underscored that ICD-10's greater accuracy will demand heightened attention to detail by physicians and staff. Radiology administrators need to ask, given the more stringent requirements of the new system, would currently documented reports provide hospital billing, registration, scheduling and other staff members with enough information to translate the medical diagnosis to ICD-10 coding? If not, the hospital runs the risk of rejected claims from payors that demand more specific information.

Mulaik emphasized coordination and education. Radiology administrators should connect with their hospital's ICD-10 implementation projects, either by joining the boards or ensuring that their department is specifically considered in the process. Given radiology's use of at least three to five electronic systems (PACS, RIS, scheduling, order entry, registration, etc.), the specialty represents a major stakeholder in the ICD-10 transition. Mulaik recommended that each department or imaging center take an inventory of which of their systems relate to diagnoses and will therefore be affected by the transition.

Radiology administrators also need to educate radiologists and technologists to document all necessary details. For example, negative findings will need to be reported so that they can be properly billed, while all details on a patient need to be documented so that referring physicians can proceed with full information. Poor documentation could jeopardize a radiology department or clinic's referral rates, Mulaik cautioned. Likewise, radiology documentation will require symmetrical information from other physicians and departments.

The biggest changes for radiology will come in trauma. Diagnoses of fractures will require more detail, including whether the break was open or closed; displaced or non-displaced; comminuted, spiral, oblique, greenstick, etc.; delayed or routine healing; nonunion or malunion; and other specifications. Whether the patient is being seen as an initial or subsequent visit or encounter will also be required information, as will additional codes across all medical conditions and specialties.

While Mulaik noted that most of the planning required for the ICD-10 transition will be out of radiology's control, aside from staying connected, Mulaik recommended that radiology departments create their own plans outlining areas for improvement prior to implementation. Most of the changes will be to systems, rather than with personnel, but Mulaik did not let this diminish the importance of educating radiologists and technologists about all necessary modifications.

All in all, the speaker highlighted the point that to start now is to start early. In addition to early planning, adopting a strategy of cooperation with all sections involved will make the "revolutionary" transition from ICD-9 to ICD-10 a fruitful one.