Who Does ICD- 10 Impact?
Every facility is organized differently and
there is not one right or wrong way to
do things. Sometimes you just have to
work within the system that you have.
The following areas of concern may
not be relevant to each organization,
but should be food for thought from a
process perspective so that even if they
are not under your area of control you
will contemplate their impact on your
department and data process.
The scheduling staff will play an
even more important role in ensuring
detailed clinical information is provided
by the referring physician to the radiology department. This is critical today,
but any problems you have today will be
amplified when ICD- 10 is implemented.
Your next line of defense is the registration staff. Bad data should not reach the
technologists for scheduled outpatient
services. Inpatient and ER services are
a different animal all to themselves.
If the technologists are frequently
receiving incorrect or incomplete orders
then you have a process problem that
must be addressed. The radiologist must
dictate a detailed report to support the
diagnosis codes that are assigned for
both the professional and facility billing.
Finally, the referring physician may be
the outside influence, but their data is
what starts the whole process and must
be complete and accurate to ensure the
patient is treated accurately and appropriately.
For radiology services the biggest
area impacted by the implementation
of ICD- 10 is trauma. For example, in
ICD- 10 the fracture codes are more
specific than they are in ICD- 9. The
radiologist must document whether a
fracture is: open or closed, displaced or
non-displaced, and whether the fracture
is communicated, spiral, oblique, green-
stick, torus, etc.
In ICD- 10, most injuries require a
designation that classifies them as initial
or subsequent encounters. The following situations qualify as initial encounters: This is the patient’s first exam for
the injury; or the patient is being seen
in the ER (even if the injury occurred
earlier); or the patient is undergoing
surgery (eg, ORIF). Subsequent encounters include exams performed while the
patient is receiving routine treatment
during the healing and recovery phase.
For example, exams prior to or following a cast change or removal, or exams
prior to or following removal of a fixation device are considered subsequent
encounters. If the patient is designated as
an ER patient, it is appropriate to assign
the initial encounter code. For other
cases, there must be a clear way to determine whether the encounter is initial or
subsequent. This may require radiologist
documentation or it may be something
that you can determine based on the site
of service. It is very important that you
evaluate the potential scenarios where
this information is not crystal clear and
ensure that you have a good system in
place to ensure accurate identification
and subsequent code assignment. The
subsequent encounter codes for fractures
indicate whether the fracture shows: routine healing, delayed healing, nonunion,
or malunion. The documentation must
clearly indicate this information. As a
spot check, how many of your reports
contain this information today?
Another example of change is for
abdominal pain. ICD- 10 contains separate codes for abdominal pain, tenderness, and rebound tenderness. There are
also separate codes for each abdominal
region. So epigastric rebound tenderness
would be assigned code R10.826.
How Do We Get Ready?
Every facility should have an ICD- 10
implementation team already in place.
If you don’t, stop right now and get one
together! Get connected with the team,
if you have not already, so you can find
out where radiology fits into the plan
and you can ensure they are taking your
systems into account. There are a lot of
systems within radiology and the majority of them contain diagnosis information that may eventually get turned into
codes. Think about your order entry
systems, order forms, scheduling systems, registration, RIS, and others. How
are they going to be impacted by the
implementation? What is the plan for
updating/modifications? What are the
timeframes? How does that impact your
The majority of the implementation
planning will be outside of your control, but you should get involved where
you can. You should identify the items
that are unique to radiology and make
your own plan to ensure they don’t get
overlooked. Keep in mind that the biggest changes will occur in the system as
opposed to people. A lot of programming needs to occur behind the scenes,
so this is why it is so important that you
ensure that your systems are included in
Think for a minute about your facility’s Electronic Health Record (EHR).
Does your RIS interact with that EHR? If
so, what data is shared and how is it used?
There are real ICD- 10 implications based
on the answers to these questions.
Build Your Plan
The first thing you need to do is select
a champion. This should be an individual responsible for the oversight of the
implementation in your area and who
can perform awareness training for the
staff. Awareness training doesn’t require
a lot of detail, but it does require an
overview of what ICD- 10 is and isn’t
and how it impacts radiology. Secondly, you should conduct an overall
You should identify the items that are unique to radiology
and make your own plan to ensure they don’t