Now that ICD-10 is officially in full effect, radiology practices have had to fully integrate with the implementation of ICD-10. To make the conversion both swift and successful (and to avoid losing money), practices will need to implement new strategies and education. Setting up, performing, testing, and training on the new system will take some time – hopefully you’ve got the hang of most of it since the October 2015 switch. But what kind of impact is ICD-10 going to have on radiology billing? Good question.
The biggest impact ICD-10 will have on radiology billing is that radiologists are going to have a much clearer picture of what’s actually going on with the patient. ICD-10 codes give a lot more information than ICD-9 codes did, so when the physician gives the order and reason for the exam, a radiologist will have a better understanding. At the same time, though, this means that to properly bill a patient, radiology is going to have to acquire much more history information, so that precertification, dictation, and billing go smoothly.
ICD-10 is also going to require that radiologists be more specific in their documentation of an exam. Also, the coding of the dictation will be different depending on whether the procedure is outpatient or inpatient. ICD-10-PCS codes are only used for inpatient exams and procedures. This can create report codes that aren’t equivocal, as the same exam could be performed on the same patient twice, but once as inpatient and once as outpatient. In this case, the report codes would be different.
As always with billing, failing to include the correct codes with complete reporting can not only delay reimbursement, but also lead to possible lost revenue. Because of this, radiologists need to have better communication with the referring physician.
Referring physicians are the ones who write the order and give the reason behind the exam, and radiologists are dependent on them to provide that pertinent information. This means that in order to bill properly, radiologists need to keep a good relationship with the referring physicians, and make sure that they provide the information needed for proper reimbursement. Referring offices that are not supplying necessary information or which aren’t ready for the new codes and reporting requirements may greatly impair a radiologist’s ability to bill.
Making sure referring physicians and radiologists are ready for ICD-10 is a huge step towards making sure that the radiology billing is as painless (and as profitable) as possible. You may need to take extra steps in education and introduction of ICD-10 to ensure efficiency. The point of the ICD-10 is to provide better data in a variety of areas, but if you, or your referrers aren’t well-versed in it, it’s only going to cause confusion and lost revenue.
The experts at Health Information Services, urge you to educate yourself and learn the new coding system.