While the deadline to convert to the International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) is still about two years away, experts say that many healthcare and most radiology groups are far from prepared for the Oct. 1, 2013, deadline.

Thorwarth

Richmond

Flint

"Radiology groups are not even close to being prepared, particularly small and medium-sized providers," said Dennis Flint, director of consulting and educational services for Complete Medical Solutions, a Louisiana-based software company that specializes in practice management software, hardware, consulting and education services.

ICD-10 is a diagnostic coding system implemented by the World Health Organization (WHO) in 1993 to replace ICD-9, developed by WHO in the 1970s. The U.S. is one of the few countries that have not adopted ICD-10. The looming conversion is mandated by Congress under the auspices of the U.S. Department of Health and Human Services and administered by the Centers for Medicare & Medicaid Services (CMS).

A September podcast by ICD10monitor.com (see sidebar), an online source covering ICD-10 news, noted that 69 percent of 589 participating healthcare facilities said they have not initiated any education efforts relating to ICD-10 implementation. Radiology is among the specialties not fully prepared for the transition, said Donna Richmond, B.A., a radiology certified coder (R.C.C.) and senior healthcare consultant for Medical Learning, Inc., in St. Paul, Minn. Richmond has more than 20 years of experience in radiology billing, coding and compliance. "I'm afraid ICD-10 is not on radiologists' radar at all," she said. "It's something they see as being way in the future, and they aren't doing a whole lot to prepare because most radiology coding and billing is done by billing services and not by a practice's employees."

Radiology leaders agree the industry could be underestimating the size and scope of the project before them.

"Radiologists and their business personnel must recognize that this is a major undertaking and not a 'tweak' to ICD-9-CM," said William T. Thorwarth Jr., M.D., a nationally recognized expert on radiology economics and reimbursement and RSNA Board Liaison for Publications and Communications. "To use an automotive analogy, this is a complete motor overhaul, not just an oil change.

"The Center for Medicaid and Medicare Services has made clear that they will not extend the implementation date, so all physicians—including radiologists—need to be sure they are prepared," continued Dr. Thorwarth, an interventional radiologist with Catawba Radiological Associates, Hickory, N.C.

HIPAA Deadline Looms Even Larger

Along with concerns about the Oct. 1, 2013 deadline, a more immediate problem is meeting the Jan. 1, 2012, deadline for converting from the Health Insurance Portability and Accountability Act (HIPAA) version 4010 to 5010 transaction standards—a prerequisite for the 2013 conversion to ICD-10.

"Practices have to make sure all of their business partners, such as billing services and vendors, are ready for Jan. 1, 2012, and I think some of them are going to be unpleasantly surprised when that date comes and they find out that their vendors aren't ready," Richmond said.

As for ICD-10, Richmond and Flint both noted that delays in preparing for October 2013 could severely impact radiology groups. "Radiology tends to use unspecified radiology codes, and the whole idea of ICD-10 is for greater specificity," Richmond explained.

Experts say radiologists are not even close to being prepared for the conversion to the International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM), diagnostic coding system which must be implemented by Oct. 1, 2013.

"You're going to find, especially in radiology, that diagnoses like chest pain just aren't going to cut it anymore," Flint added. "If you look at the top 20 radiology codes for ICD-9—such as chest pain, hypertension, diabetes, abdominal pain, shortness of breath—they're very unspecific codes."

In fact, the transition from ICD-9 to ICD-10 will expand the number of codes from 14,000 to 70,000—a substantial increase in the specificity and documentation elements needed for proper coding. "The onus will be not only on primary care providers to submit specific diagnoses to radiologists, but also radiologists in turn will have to pick the correct corresponding codes as well," Flint said. "The impact will be pretty serious."

The big worry, said Richmond, is that payers who change over to ICD-10 will not pay for diagnoses that are non-specific. "When I first started coding, in radiology we didn't even use diagnosis codes, so getting out of that unspecified mindset is going to be a huge change for radiology," she said. "With ICD-10, we are going to have to learn to embrace that specificity and either get on board or lose money."

Laying the Groundwork for Transition

What is the best way to prepare for the ICD-10 conversion? If they haven't already, Richmond said, radiology groups should be setting up transition committees that are "looking at everything ICD touches," from the schedulers and registration desks, to patients, technologists, physicians and coders. From there it can be determined what kinds of changes need to be implemented.

Practices can also start testing to see how the ICD-10 transition could affect workflow.

"Give one or two coders 10 or 15 reports and have them code with ICD-9 and then recode with ICD-10 and look at the time difference," she advised. "That should give you the idea of the slowdown you'll face in 2013 when you have to start using those codes."

Such testing could also help practices determine whether they'll need to add staff or outsource when the time comes—something they can plan for in advance. In addition, if practices face a significant slowdown once they transition to ICD-10, payments may also slow, creating potential cash-flow issues. "Practices may need to start setting up lines of credit so that they'll be ready when that slowdown hits," Richmond said.

Some of the most important training is for physicians, Flint said. "The overwhelming feeling among physicians is that 'I'm a doctor and I know how to code.' But the documentation elements are just so different."

Flint also warned practices to not to get caught in the trap of thinking that this is "just an IT issue" that vendors will handle. "You have to be all inclusive," he said. "This is an issue that impacts the entire practice." He pointed out that areas as varied as superbills, pre-authorization of procedures and services, and outside referrals are all going to require changes in order to implement ICD-10.

One tool highly recommended by experts is General Equivalence Mappings, which can help users manage and analyze the code translation to ICD-10. (See Web Extras).

CMS offers a free online version of the tool while some consulting companies, including Flint's, also have versions available.

Dr. Thorwarth added: "It is time for every radiology practice to commit to an organized and systematic process to make the transition to ICD-10. Your practice and your ability to continue to provide quality care to your patients depend on it."