While the adoption of ICD-10 on October 1 will dramatically expand the number of billing codes frequently used in radiology claims, the new diagnosis coding system will affect some imaging subspecialties much more than others, according to research published July 23 in the Journal of the American College of Radiology.
A team led by Dr. Margaret Fleming from Emory University School of Medicine mapped the impact of converting diagnosis codes from ICD-9 to ICD-10 for nearly 600,000 radiology claims. Based on the results, the researchers projected a nearly sixfold increase in the number of billing codes that account for most claims. However, while musculoskeletal imaging will experience a nearly 30-fold explosion in the most commonly used diagnosis codes, other areas such as breast imaging will only have modest growth, they estimated.
"For this reason, practices are advised to prioritize their ICD-10 educational and operational conversion initiatives to areas that will experience the largest impact from this transition," the authors wrote.
Full steam ahead
The U.S. is years behind many other developed countries in implementing version 10 of the International Classification of Diseases, and efforts at rolling out the latest coding system in recent years have been stymied by last-minute reprieves. However, it appears that ICD-10 will finally be implemented this year, senior author Dr. Richard Duszak Jr. told AuntMinnie.com.
Dr. Richard Duszak Jr."For a health system like ours, which has been planning laboriously, that means we're going full steam ahead," he said.
Emory's radiology department performs approximately 1 million exams across all of its sites and has about 130 clinical faculty members. As a result, the challenge was deciding how to prioritize the facility's operational and educational resources, Duszak said. Seeking to take an evidence-based approach, the research team performed ICD-9 to ICD-10 code mapping to identify areas on which to focus (JACR, July 23, 2015).
Using the 3M Code Translation Tool (3M Health Information Systems), the researchers mapped ICD-9 diagnosis codes for 588,523 radiology claims in 2014 from five hospitals and affiliated outpatient sites to matching ICD-10 codes. They then calculated the impact of converting to the new codes for the entire radiology system and for each individual subspecialty division.
Out of the total 14,025 ICD-9 codes available, only 3,407 were used as the primary diagnosis for any of the claims. In addition, 348 ICD-9 codes -- just 2.5% of the 14,025 available codes -- accounted for 90% of all radiology claims. Under ICD-10, the number of codes involved with the same 90% of all radiology claims would reach 2,048, a 5.9-fold increase. The researchers also found significant variation in the effect of ICD-10 by subspecialty.
| Impact of ICD-10 conversion by radiology division | |||||
| Division | ICD-9 codes for 90% of claims | ICD-10 codes for 90% of claims | Increase | ||
| Musculoskeletal | 146 | 4,199 | 28.8x | ||
| Emergency | 137 | 1,036 | 7.6x | ||
| Community practice | 254 | 1,471 | 5.8x | ||
| Interventional | 205 | 810 | 4.0x | ||
| Neuroradiology | 230 | 756 | 3.3x | ||
| Abdominal | 212 | 607 | 2.9x | ||
| Cardiothoracic | 76 | 200 | 2.6x | ||
| Nuclear medicine | 147 | 389 | 2.6x | ||
| Breast | 11 | 12 | 1.1x | ||
"For our musculoskeletal division, the number of codes in the new universe will explode almost 30-fold," Duszak said. "And because our emergency and community divisions do a lot of musculoskeletal imaging, they'll see that impact, albeit to a reduced degree, as well. So we're really going all out in education in those divisions."
Although it's unknown exactly how much ICD-10 coding will affect radiology practices until the conversion takes place, the new study's models show that radiology practices can best prepare for the transition by using an evidence-based approach, Duszak said.
"Our exact conversion impact factors may not apply to every practice, but based on the numbers (over 500,000 exams in this study), we think they're generalizable to most practices," he said.
Focus on operations, education
To prioritize planning for ICD-10, radiology practices need to work on both operational and educational issues. Practices need to ensure that reporting and billing software can handle the new longer alphanumeric codes in ICD-10, while administrative, technical, and physician staff members need to understand how to document better and how that documentation will translate to new codes.
"Successful health systems will focus on both [operational and educational initiatives], targeting their highest areas of need first," Duszak said.
The benefits of these preparations can also extend beyond the radiology department.
"If a radiology group is prepared and an emergency physician group is not, then the infrastructure the radiology group creates will buy a lot of goodwill with a hospital administration and that referring group once the October 1 day of reckoning comes," Duszak said. "For radiology groups that have good working relationships with their orthopedic and emergency physician referrers -- the groups that will be impacted the most by the [musculoskeletal]-heavy impact of ICD-10 -- there will be lots of opportunities to leverage that to create synergies to improve everyone's information gathering for correct coding purposes."
