October 23, 2012

Tips for the ICD-10 Transition: Educate Referring Physicians Above All Else

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Like all other healthcare providers, radiology providers must plan for ICD-10 system implementation by building organizational awareness and developing a communication plan. To help achieve that goal, the Centers for Medicare & Medicaid Services (CMS) have provided a “formal roadmap.”

 

One of the key points in this plan relates to “roles and responsibilities,” and CMS directs providers to “assign and clearly define communication roles and responsibilities to everyone involved in the transition.”  Most importantly, it’s essential that all internal staff and external business partners understand their roles and responsibilities.

In the case of radiology, external business partners include referring physicians, and they are responsible for providing detailed clinical indications (signs and symptoms) on the orders they submit. Take, for example, the “rule-out” rule. A nurse may call the radiology office to order a “DXA scan for osteoporosis.” The radiology office staff should be trained to say: Does she have known osteoporosis, or is it to rule out (i.e., a screening exam) osteoporosis?

Instead of simply taking this order on face value, the radiology office staff should be trained to say: Does she have known osteoporosis, or is it to rule out osteoporosis (i.e., perform a screening exam)? Another order may say “pain in abdomen” but the exact location of the pain is not included, which should be provided by, or gathered from, the referring physician.

If details are not forthcoming, and often they are not, it’s up to the radiologist and his or her office staff to communicate with referring physicians and educate them about how clinical details drive the ICD-10 codes—and payment—assigned. When specificity is missing from the order, it’s missing from the codes assigned, and a true picture of the procedure performed will not be had.

Use This as a Roadmap

 

Although communicating with referring physicians is certainly a priority for radiology providers, they also should consider CMS’s general guidelines for establishing a communication plan. Key points include the following.

  • Project purpose:

Provide ICD-10 background information and clearly describe the current state of ICD-10 progress in your organization, identify goals for the plan, and explain the purpose and expected outcomes of the transition.

  • Partners:

Identify all parties involved in your ICD-10 transition. For internal staff, you will need to establish a process to communicate governance issues to leaders and assess staff training needs. Coordinate with external groups such as vendors, clearinghouses, and state agencies about implementation updates and changes required in your systems and business processes.

  • Messages:

Be clear and consistent about what you say, focusing on specific steps and actions that need to happen for the ICD-10 transition.

  • Issues:

Outline your organization's protocol for identifying potential implementation issues and provide a plan for correcting them.

  • Roles and responsibilities:

Assign and clearly define communication roles and responsibilities to everyone involved in the transition.

 

  • Timelines:

Identify project milestones, secondary tasks, and deadlines. Be certain all project teams know what they will need to do. Develop back-up plans for each milestone to help you handle potential problems.

  • Communication methods:

Think about how to best communicate within your organization. Emails, in-person meetings, and conference calls may all be effective, but some might work better for different staff and divisions.

While the size of your organization will determine how much planning and documentation will be necessary for the ICD-10 transition, it is always important to keep the lines of communication open. This will help to foster trust among staff members and show that your organization is taking steps to implement ICD-10.

Information Source:

 

Numerous resources about ICD-10 implementation can be found at

http://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10.

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Donna Richmond, BA, RCC, CPC

Donna's more than 20 years’ experience in billing, coding and compliance include positions as Coding Services Manager for a computer-assisted coding company, directing 30+ coders and assisting clients with coding questions; and billing, coding and compliance responsibilities for a practice management / billing company. Donna is a past member of the Radiology Business Management Association (RBMA) Programs committee and Chairman of the Coding sub-committee. She was the Radiology Coding Certification Board’s RBMA Liaison for 2 years and previously served on the Education Committee. In addition to Donna’s coding hotline responsibilities for Panacea, she performs a variety of Radiology and Cardiology audits, contributes to several publications and webcasts.