Robert L. Falk, MD, is a staff radiologist with Radiology Specialists of Louisville in Louisville, Ky. Dr. Falk graduated Phi Beta Kappa from the University of Wisconsin in 1978 and continued his education at the Medical College of Wisconsin in Milwaukee where he graduated Alpha Omega Alpha from medical school in 1982. He subsequently completed a Diagnostic Radiology residency in 1986 and a Neuroradiology fellowship in 1987.
We recently asked for his feedback on the implementation of ICD-10. Here’s what he had to say:
It’s been more than four months since ICD-10. Has it been effective?
Has the transition to ICD-10 been more or less turbulent than you expected? Why?
It’s been less turbulent. The main reason is that our practice began preparing well in advance and we were able to engage the enthusiastic support of the physicians working with administration and billing to ensure a smooth transition.
Do you have any stories about your transition to ICD-10? (Billing issues, patient issues, etc.)
None that are specific to our transition. It was smooth. The most amazing stories relate to the number of codes, and no matter how bizarre the history, there seems to be a code for it. I heard a story about someone being injured when there water skis caught on fire, and yes, there is a code for that.
Can you list one advantage and one disadvantage of ICD-10 so far?
A definite advantage is better patient histories. The biggest disadvantage is the need to instruct the ordering physicians on the increased level of detail required, thus necessitating increased expense in tracking down needed information.
What insurance payers seem to be the most prepared for ICD-10?
We have not noticed any major differences in our payors. Our biggest two are Medicare and BlueCross/BlueShield.
If you could say anything to Medicare, what would you say?
Please eliminate the practice of requiring certain meaningless “magic words” and phrases in reports. It seems every year there is some new inane requirement. I remember several years ago if we didn’t specifically mention flow in the IVC on an abdominal ultrasound report we couldn’t bill for a complete abdomen. Then we went through the documentation of ER arrival time, scan time and report time for ER head CT’s. Now we need to say that “ultrasound was used to confirm vessel patency” if we use ultrasound guidance for line placement, even though that’s not why we use it. As often as these requirements pop up, they will sometimes disappear the next year. I nave no doubt that there is a committee that randomly comes up with this nonsense as a way to deny and delay payments until we as radiologists catch on, then they move on to something else. Please stop it.
Are there any procedures you can bill under ICD-10 that you couldn’t bill under ICD-9?
No, not that we’ve found.
How has your medical practice trained staff for ICD-10? Do you have any lessons you can share with our readers?
Be thorough, be prepared, start early and engage your doctors.
Does ICD-10 ultimately benefit the patient? Why or why not?
Yes. Better histories mean better readings. We do not engage in research, but I suspect the ability to mine data will also provide long-term benefits.
In the end, do you think ICD-10 will be an improvement for your practice? Why or why not?
Yes. Again, the main reason is better patient information that will help us in reading the studies, recommending follow up, and more accurate billing and coding will hopefully shorten the revenue cycle. That last point may be wishful thinking.
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