October 2014

Imaging Informatics: Is Your CPOE Ready for ICD-10?
By David Yeager
Radiology Today
Vol. 15 No. 10 P. 7

Will your current CPOE system capture all the data you need for next year’s transition to ICD-10? While training physicians and coding staff for the changes captures the bulk of the attention, there are also some IT-related concerns. Although there may be yet another reprieve in the transition to the new coding system, but don’t plan on it.

“Don’t put off preparing for this until next year because it’s going to take a lot of preparation,” says Geraldine McGinty, MD, chair of the ACR Commission on Economics. “Get working on it now, and use the extra time productively.”

In an effort to educate radiologists and radiology professionals about ICD-10 coding, the ACR has partnered with Coding Strategies to develop a series of podcasts explaining the new documentation requirements. Ranging in length from 5 to 10 minutes, the ICD-10-CM Physician Documentation Improvement Training audio and video podcasts are available online and offer coding details for 20 different topics, including arthritis, mammography, osteoporosis, and myocardial infarction. Although ICD-10 requirements have been postponed until October 2015, those involved with the podcasts’ development say it’s never too soon to get ready.

Podcast narrator Karna W. Morrow, CPC, RCC, CCS-P, a senior consultant and an AHIMA-certified ICD-10-CM trainer who specializes in radiology coding for Coding Strategies, says the increased level of specificity required with ICD-10 will be most apparent in two areas: trauma and oncology. But those won’t be the biggest changes. Whereas, until now, diagnoses have been assigned based on what pays for the scan, such as “headache,” for a brain MRI, ICD-10 will require a lot more detail.
“What is going to be most unlike the current environment is not so much the coding number but the fact that we’re going to report a clinical story, not a single component,” Morrow says.

For example, she says, an oncology diagnosis with accompanying brain metastases will need to include the primary cancer and the treatment method. For a lung cancer diagnosis, it will be required to note whether the patient is or was a smoker and whether second-hand smoke is a suspected cause. In the case of end-stage renal disease, coding will be required for each kidney.

One change that is particularly troubling to Morrow is the way pregnancy codes will be handled. She says the way the rules are written, a pregnant patient who’s seen for any injury must have pregnancy listed as the primary diagnosis code, which could lead to reimbursement problems if, for example, the patient needs a shoulder MRI for an injury that occurs independently of the pregnancy. She strongly recommends that all radiology practices brush up on pregnancy codes, even if they don’t do many obstetric exams.

Perhaps the biggest challenge for radiologists, however, will be found in referrers’ coding. Codes from referrers will be incorporated into the clinical story and, if the codes are incomplete, radiology coders will not be able to attain the necessary specificity, which has the potential to affect radiology groups of all sizes.

“Our concern is that if any referring practice doesn’t provide the required level of specificity, radiology groups are going to have problems collecting reimbursement for what they’ve done,” McGinty says. “Delaying the reimbursement might be more significant and more damaging for a smaller practice, but I don’t think any institution is going to want to see a delay in payment because, obviously, they need to be paid to continue to do the good work that they do.”

Cover the Gap
Although these changes may seem daunting, Morrow says the key to a smooth transition is to identify which of the 65,000 codes matter most to the department or practice and do a gap analysis to find out where their incomplete data are coming from. A frequency report will let them know what codes they need and show them which referrers are not providing the necessary data. This will guide the improvement process.

Morrow says it’s essential for practices to reach out to referrers and assist them in determining what additional information will be necessary. In some cases, the imaging organization may need to improve their CPOE system (or paper forms) to ensure that they receive the data they need. More than likely, though, they will also need to provide some education.

Historically, Morrow says, radiology groups have been reluctant to raise data quality issues with referrers for fear that the referrers would switch radiology groups. Now, she says, every imaging group will require the same level of specificity. She recommends taking the time to help referring offices, especially the smaller ones, understand ICD-10, which will build good will and help everyone get over the inevitable bumps in the road. Ultimately, a relatively hassle-free switch to ICD-10 will depend on preparation and cooperation.

“The best thing [imaging organizations] can do is arm themselves with the portion of the code set that matters to them and then be a little bit more proactive in building relationships with their ordering physicians so that those physicians will share the information and the relationship will not be adversarial,” Morrow says.

— David Yeager is a freelance writer and editor based in Royersford, Pennsylvania. He writes primarily about imaging informatics topics for Radiology Today.