ICD-10 Are you Ready?

On August 28th CMS published the final results from the July 20 through 24, 2015, Medicare Fee-For-Service, end-to-end testing. Results demonstrated that CMS systems are ready to accept and process ICD-10 claims.  This testing included roughly 1,200 providers and billing companies, including ADVOCATE, submitting over 29,000 claims.

Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code. The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015; or accept claims that contain both ICD-9 and ICD-10 codes.

As reported earlier, Medicare will not deny radiology claims based solely on the specificity of the ICD-10 diagnosis code as long as the claim is submitted using a valid ICD-10 code from the right family. This change will alleviate the majority of claims at risk for denial due to ICD-10.

ADVOCATE offered a series of 3 free webinars on ICD-10 transition & preparation for radiology practices. Please CLICK HERE to access a free recording of the webinar. (after completing the registration form, the webinar starts playing immediately).

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Clinical history can be improved by documenting the specific anatomic location, severity/context, and any concurrent conditions that may impact the patient’s current condition. Below are a few key points to consider:

  • Develop process for the technologist to review the clinical history with the patient.
  • Implement patient questionnaires that the tech can review with the patient prior to the study
  • Make sure that the questionnaires/intake forms can capture the appropriate additional elements: specific location, context/severity, concurrent conditions
  • Make sure that the tech notes/intake forms are scanned to PACS and readily available to the radiologist at the time of dictation

60% of the highest volume diagnosis codes in radiology are derived from the clinical history-signs, symptoms, and conditions that prompt the imaging study. Of that 60% over half are diagnoses pertaining to pain: chest pain, limb pain, headache, back pain, or simply “pain”. Additional details that “tell the story” of the pain will result in coding to the highest specificity, which will ultimately reduce the risk for denials. Below are a few more key points to consider:

  • Document specific site of pain
  • Document context of pain (sudden, stabbing, dull, etc.)
  • Document severity of pain (pain scale, when appropriate)
  • Document duration of pain
  • Document any injury or related possible cause of pain
  • Document any related signs or symptoms
  • Document any associated disease/condition

As always, ADVOCATE will keep you up to date on this and all issues impacting radiology as they become available.

Best regards,
Kirk Reinitz, CPA
President/CEO