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October 2015

ICD-10 & Clinical History
ICD-10 & Workers' Comp
ICD-10 Clinical Concepts
New Rotator Cuff Research

How to Improve Clinical History in the Age of ICD-10

A recent article from the president and CEO of Advocate Billing LLC entitled "ICD-10 ARE YOU READY?" suggests that clinical history can be improved by documenting specific points, including precise anatomic location, severity / context, and any concurrent conditions that may impact the patient's current condition. They recommend taking the following steps:

  • Create a set process that the technologist can use to review clinical history with the patient.
  • Develop a patient questionnaire that the technologist can review with the patient prior to the study.
  • Ensure that your questionnaire and / or intake form captures necessary information, such as specific location, severity / context, and concurrent conditions.
  • Scan tech notes, as well as questionnaires and intake forms, into PACS so they are readily available to the radiologist at the time of dictation.

According to the article, of the highest volume diagnosis codes used in radiology, 60% are derived from the clinical history-signs, symptoms, and conditions that prompt the imaging study. Of that 60%, more than half are diagnoses related to pain, including chest pain, limb pain, headache, back pain, or simply 'pain'. Additional details pertaining to 'pain' will result in coding to greater specificity, which may reduce the risk for denials under ICD-10. Advocate Billing recommends documenting the following:

  • Specific site of pain
  • Context of pain (sudden, stabbing, dull, et cetera)
  • Severity of pain (use pain scale when appropriate)
  • Duration of pain
  • Any injury or related possible cause of pain
  • Any related signs or symptoms
  • Any associated disease / condition

To read the full article, as well as find other helpful resources from Advocate Billing, visit RADADVOCATE.COM.

ICD-10 & Workers Comp: Many States Will Not Convert

HEALTHCAREFINANCENEWS.COM has reported that many states will not convert to ICD-10 for workers' compensation claims. According to the Workgroup for Electronic Data Interchange (WEDI), an advisor to the Department of Health and Human Services, worker's comp practitioners are not required to switch to the new ICD-10 codes.

WEDI reports that roughly half of the states - 21 in total - are ready to switch to ICD-10 for workers' comp claims, while half are not. Here's a breakdown:

  • 21 States Adopting ICD-10 for Worker's Comp:
    Alabama, California, Florida, Georgia, Hawaii, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, South Dakota, Texas and Washington
  • 3 States Adopting ICD-10 for Hospital Inpatient Billing ONLY:
    Indiana, Maine and South Carolina
  • 26 States NOT Adopting ICD-10 for Worker's Comp (Unless There's Pending ICD-10 Regulation):
    Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Hawaii, Iowa, Kansas, Kentucky, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Virginia, Wisconsin and Wyoming

The article states, "Those still using ICD-9 on Oct. 1 will be using a different coding system than the providers and vendors with whom they collaborate, which will lead to confusion, according to Risk & Insurance."

To read the full article, visit HEALTHCAREFINANCENEWS.COM.

For more information regarding your state, download WEDI'S ICD-10 STATE WORKERS' COMPENSATION READINESS LIST.

CMS Publishes ICD-10 Clinical Concepts for Orthopedics

CMS (Centers for Medicare & Medicaid Services) has created a whole page of PROVIDER RESOURCES to ease and aid the transition to ICD-10. One of the main features is a new Clinical Concepts Series. For orthopaedics specifically, CMS has created ICD-10 CLINICAL CONCEPTS FOR ORTHOPAEDICS, a 36-page document containing:

  • Common Codes for:
    Cervical Spine Disorders and Displacement, Neck and Back Pain, Osteoarthritis of the Knee, Radiculopathy (Primary), Rheumatoid Arthritis, Selected Shoulder Conditions, Spinal Stenosis of the Lumbar Region, Selected Sprains (Rotator Cuff, Cruciate Ligament and Ankle), and Thoracic, Thoracolumbar and Lumbosacral Intervertebral Disc Disorders
  • Clinical Documentation Tips for:
    Fractures, Arthritis and Injuries
  • Clinical Scenarios for:
    Fracture Follow-up Visit, Shoulder ROM Office Visit, Tear of Medial Meniscus with Anterior Cruciate Ligament Injury, Right Shoulder Pain and Possible Rotator Cuff Tear, Cervical Disc Disease, Struck by Car and Fracture
CMS ICD-10 Clinical Concepts for Orthopedics

To read the full CMS ICD-10 Clinical Concepts for Orthopaedics, CLICK HERE.

New Shoulder Research Including NationalRad Radiologists Published in The American Journal of Sports Medicine

In August, The American Journal of Sports Medicine published new research entitled PSEUDOPARALYSIS FROM A MASSIVE ROTATOR CUFF TEAR IS RELIABLY REVERSED WITH AN ARTHROSCOPIC ROTATOR CUFF REPAIR IN PATIENTS WITHOUT PREOPERATIVE GLENOHUMERAL ARTHRITIS by a global team of authors, including two of our MSK radiologists and partners:

  • Patrick J. Denard, MD, Southern Oregon Orthopedics, Medford, Oregon, USA
  • Alexandre Lädermann, MD, Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
  • Paul C. Brady, MD, Tennessee Orthopaedic Clinics, Knoxville, Tennessee, USA
  • Pablo Narbona, MD, Department of Shoulder Surgery, Sanatorio Allende, Córdoba, Argentina
  • Christopher R. Adams, MD, Arthrex Inc, Naples, Florida, USA
  • Paolo Arrigoni, MD, Policlinico San Donato, Università degli Studi di Milano, Milan, Italy
  • Dave Huberty, MD, Oregon Orthopedic and Sports Medicine Clinic LLP, West Linn, Oregon, USA
  • Stephen S. Burkhart, MD, The San Antonio Orthopaedic Group, San Antonio, Texas, USA
Rotator Cuff Study

The investigation was performed at Southern Oregon Orthopedics, Medford, Oregon, USA, and the study concluded: "ARCR can lead to reversal of preoperative pseudoparalysis in patients with minimal preoperative glenohumeral arthritis. ARCR is a viable first line of treatment for patients with pseudoparalysis in the absence of advanced glenohumeral arthritis."

To read the abstract and access the full article, CLICK HERE.

If you or any of your orthopaedic staff would like to discuss this study and its findings, please contact us at INFO@NATIONALRAD.COM.

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