Optima’s solution is ICD-10 compliant, and has been since April 2014 (in preparation for the original ICD-10 mandate of October 2014). All affected areas of our application have been updated with accurate rules according to ICD-10 specifications.
We have implemented changes and allowed configuration options that ensure Rehab Optima users can participate in dual coding of ICD-9 and ICD-10 codes, in order to prepare for a successful transition to ICD-10. New search tools, including CMS GEM mapping, are available to assist users in choosing the correct ICD-10 code for a specific treatment.
Additionally, Optima has developed a training video to assist our customers in training their staff on ICD-10 usage for therapists. The video can be viewed solely for training purposes, or users can view the video and complete the post-test to obtain CEUs. We have applied for CEUs for both PT and OT and will update the website as the CEU approvals are received. Click here to take the test for CEU credit.
If you are an Optima user looking for more information on earning Continuing Education Units, please email OptimaCEU@OptimaHCS.com with questions.View Video Transcript
111 days. That’s the countdown from initial recording to October 1st, 2015, the ICD10 implementation date. Knowing the implementation date for ICD10 has changed often. Therapists in the industry are at different levels or phases in their preparation for, an understanding of ICD10. Our webinar focuses on assisting therapy professionals in successfully navigating and effectively transitioning to ICD10. Let’s mitigate challenges through education. Sit back, get ready, get set, and let’s get into the details.
Let’s review our training objectives. During our time together today, we will discuss essential facts that you must know about ICD10 in order to responsibly go about your business of serving your patient without any interruptions in care or reimbursement. We will define ICD10 and discuss its purposes because you need to know what ICD10 is and where it came from to be able to understand its impact on various healthcare settings. To help facilitate your understanding, I will provide an overview for you of the core differences between ICD9 and ICD10.
Let’s face it, as therapists we don’t like change. To get around that we will review several case scenarios that will walk you through ICD10 selection so that when you leave today’s webinar, you’ll feel you have practical takeaways that you can implement immediately in your daily work as well as share with others so they can do the same. There’s a great deal to know about coding. Today we are focused on the tools you need as a therapist to successfully work with ICD10. We will review ICD10 resources and I will also provide documentation tips as related to ICD10. Lastly, for those of you utilizing software for billing, documentation and electronic medical records, we will discuss what you should expect from your vendors relative to ICD10 functionality to facilitate a smooth transition from ICD9 to ICD10, as well as promote efficiency and quality.
A little bit of history to help with your understanding of ICD10. A diagnosis is a label that identifies a patient’s condition and complexities. It categorizes patients. It defines the care that should be provided to patients and identifies the main reason providers are caring for individuals. The term medical diagnosis often referred to as primary diagnosis refers to the label which the physician defines. It is usually used to define disease, disorder or condition at the level of the cell, organ or the system.
Treatment diagnosis on the other hand, refers to the label which the therapist defines to identify the impact of the disease, disorder or condition. It is more whole patient focused, as it’s related to the patient’s function or his or her movement patterns. We established the treatment diagnosis via differential diagnosis and it, or they if multiple, are used to support the plan of treatment and the course of skilled interventions that we as therapists determine are medically necessary for the patient. Diagnosis is a big picture. It involves all care providers.
ICD, International Classification of Diseases is used to standardize codes for medical conditions and procedures. It is currently in its ninth edition in the United States. ICD9 is more than 35 years old. ICD10 is the International Classification of Diseases 10th edition. It was first endorsed by the World Health Assembly around 1990. It provides code expansion for clinical diagnosis as well as procedure diagnosis.
As you continue to learn about ICD10, you will notice ICD10 CM, which stands for Clinical Modification. The United States has modified the initial World Health Organization model. You may also see ICD10 PCS which is the Procedure Coding System. It is the clinical version or the CM version that we therapists will be most involved with. It is used to provide diagnosis codes for outpatient services including but not limited to physical therapy, occupational therapy and speech language pathology services. ICD10 PCS is used to specify medical procedures. It is the Procedure Coding System.
So ICD10 has been implemented in other countries for quite some time now. The United States is one of the last countries to switch to ICD10. Why are we switching to ICD10 now? Because it’s the law. The Centers for Medicare and Medicaid Services or CMS was mandated by the government to implement ICD10 as part of a larger initiative to cut down on fraud and abuse, facilitate specificity that leaves no question about the care that is being provided to a patient and should be provided to a patient which can help guide decision making about future payment reform.
We know that laws change. For the past five years transition to ICD10 in the United States has been postponed. It was mandated to be implemented in the United States October 1st, 2013. However, because it takes time, resources and finances to transition to a new coding system, legislation changed that implementation to October 1st, 2014. Then the Protecting Access to Medicare Act, signed April 1st, 2014 pushed effective date back to no sooner than October 1st, 2015. And here we are today, as of the date of this recording, implementation will be October 1st, 2015.
By law, ICD10 is effective in the United States for all HIPAA covered entities. HIPAA is the Health Insurance Portability and Accountability Act. This excludes some workers compensation and auto insurances. Because of the many advantages of ICD10 over ICD9 coding CMS encourages all entities to transition. Of great emphasis is the purpose of continuity of patient care across the healthcare continuum.
Let’s review additional purposes of ICD10. Medical practices change over time. Data must keep up with the changes. ICD10, in comparison to ICD9 provides an avenue to reflect current practices. Payers are looking for ways to define best payment practices and then to reimburse for these practices perhaps through new and alternative methods to current payment systems. They need data specificity for analysis and decision making. The almost 70,000 ICD10 codes will provide that data. There’s layers and layers of specificity not currently available in the ICD9 coding system. ICD9 having approximately 15,000 codes, meager number in comparison to ICD10. The ICD10 specificity will facilitate patient care across provider settings which ultimately leads to public health reporting and tracking on patient outcomes, resources for care and costs of care. All data that can be used for decisions relative to quality of care and patient safety.
A benefit important to and for the patient is that data analysis of the specific ICD10 codes provides not only data about physician and therapist practices, but robust data about patient conditions and comorbidities, which helps define clinical treatment patterns and practices, that combined with additional analytics relates to outcomes. An additional purpose for ICD10, ICD9 was running out of capacity to accommodate new codes and procedures and in addition to the reasons already mentioned, ICD10 is needed.
Let’s take a look and compare ICD9 and ICD10. First, we’ll discuss some of the similarities. Both ICD9 and ICD10 include an alphabetical list of terms and corresponding codes. Both coding systems use main terms as well as sub terms to define detail. So for example, pain. Then there’s joint pain or abdominal pain or neck pain. And within each is more defined areas such as for joint pain, there is hip pain. I’ll make sure when we complete the clinical scenarios that I point that out to ensure you are coding to the highest specificities. Both ICD9 and ICD10 have tabular list of codes divided into chapters. It’s similar hierarchy to the alpha listing and the chapters are based on the body system or condition. And like ICD9, it is in this tabular list that the level of detail in the code is defined.
Both use similar lookup method crucial to correct selection. You should always search terms in the alphabetical index first, then verify code in the tabular list. If you weren’t in practice of doing that with ICD9, I strongly urge you to implement that practice with ICD10. Both share similar structure and conventions. For example, both have alpha characters and both have numeric characters. Examples of that would be V54.01 and R52. Both have characters after decimal, so 438.21 and S93.401A. Both have unspecified codes available to use which should only be used in the absence of more detailed documentation to support use of a more specific code. Lastly, both ICD9 and ICD10 require adherence to official coding guidelines under HIPAA.
So what about the differences between ICD9 and ICD10? An obvious difference between ICD9 and ICD10 is ICD10 has approximately 70,000 codes in comparison to ICD9’s approximate 14,000 codes. This substantial increase to 70,000 codes is due to updated medical terminology. With modern medicine comes expansion of procedures and the need to define with greater detail, you have to specify. In addition the side of body has been added to relevant codes. In other words, laterality is captured within the code itself. For example, right side hemorrhage or left side hemorrhage. Right side hip contracture or left side hip contracture or unspecified hip fracture.
There’s increased use of combination codes and this may occur more with codes that are more medical in nature versus more therapy in nature. However, an example would be E11.311, type two diabetes mellitus with unspecified diabetic retinopathy with Macular Oedema. In ICD10 categories are restructured. Injuries are grouped by anatomical site rather than type of injury. And G codes is a new section of the ICD10 manual. These additional codes assist in documenting complexities that may impact treatment such as mental health disorders, mental illness and more. V codes and E codes are also worked into ICD10 rather than the setup in ICD9 in the current system.
Increased specificity is the key behind ICD10. When reviewing most frequently used ICD9 codes by therapists, you’ll see more often than not, because of the greater specific in ICD10, well general equivalency mapping exists for codes, there usually isn’t a one-to-one code match from ICD9 to ICD10. Let’s take a closer look at the reasons why.
On the chart on this screen, you can see more detailed differences between ICD9 and ICD10. ICD9 being on the left side of the chart and ICD10 on the right. ICD9 codes are three to five characters in length whereas ICD10 codes can contain three to seven characters. In ICD10 the first character is always an alpha, whereas in ICD9 the first character can be alpha or numeric. In ICD10 the second character is numeric. In ICD9 the second through the fifth characters are numeric. In ICD10 characters three through seven can be numeric or alpha. In ICD10, the alpha after the decimal are not case sensitive. If you look at the chart you can see capital A, small A, capital S, small S in the example. Related to the specificity, the last four points are the core differences.
As mentioned earlier, laterality is embedded in the actual ICD10 code. Type of event is embedded in ICD10 coding. For example, we code for traumatic versus non traumatic, open fracture versus closed fracture, dominant side versus non dominant side. Effusions are considered in ICD10 whereas they weren’t with ICD9. Lastly, in ICD9, there are no seventh character codes. In ICD10 a seventh character can be used. The seventh character can be used for codes in certain chapters such as cause of an injury and musculoskeletal. The seventh character has a different meaning depending on the section where it’s used. We will make sure we review this with examples later on.
The seventh character can be used to describe an encounter. The coding resources will provide instruction in the tabular list when this is needed, and the options used to describe the encounter per code groups are noted. For outpatient therapies to describe an encounter if in a setting where this may apply in consideration of state practice guidelines we may see one of three different seventh character choices more often than others specifically the A, the D as in dog and the S as in Sam characters. A indicates initial encounter with the patient for treatment for the condition. D indicates subsequent encounter which is used after the patient has received active treatment for condition and now receiving routine care.
So in other words, aftercare following the initial treatment of the issue or the condition care during healing phase. For example a patient receiving OT after elbow fracture or after rotator cuff repair. S stands for sequela. This is used for treatment focused on complications after the condition and routine care was provided. For example, if the patient has scar tissue after a burn, the scar tissue was caused because of the burn after previous care. To address that now, we’ll be addressing the sequela of the medical condition.
Another thing to keep in mind, cases where a code requires a seventh digit. However the main code is less than seven digits. In these cases, placeholder X can be used. X is a fill in for empty characters when fewer than seven exist. We can’t emphasize enough that ICD10 is all about greater specificity with intent to enhance quality and promote efficacy of care.
Let’s take a look at ICD9 code categories. On this slide, you’ll note there are 17 or so chapters. They’re organized by condition and then injury is last. You’ll notice in the chapter listing to the right of the title, you’ll see the codes with the numeric range that are represented within each of those specific categories. As you’ll note on this slide, which is a snapshot of ICD10 code chapters, it’s a similar by chapter organization with conditions noted. And then injury and external causes are the last few chapters. You’ll notice though, that the code ranges are to the left of the chapter title. Note on the right of the chapter title, additional code ranges, and those I’ll start with the alpha character. You’ll see then in the last column, there’s additional visual cues, some first letter keys to point out groups in that chapter.
As therapists, we’d anticipate to use some chapters more than others. For example, in chapter six, diseases of the nervous system, we’d find medical conditions such as Parkinson’s disease, Alzheimer’s disease, MS, stroke, hemorrhages. Chapter 13, diseases of the musculoskeletal system and connective tissue, you’ll find diagnosis that support treatment plans focused on pain management, contracture management, conditions of joints related to osteoporosis or arthritis, osteomyelitis, dislocations, subluxations, etc. It’s in this chapter that you will notice the laterality more than other chapters and the specific area of the body that was added in ICD10 will stand out to you.
Chapter 18 symptoms, signs and abnormal clinical and laboratory findings is another chapter that therapists may visit more frequently than others. It includes speech, language, voice movement, some cognitive codes for signs and symptoms not well defined by other codes, as well as codes for other general signs and symptoms not well defined by other codes. It’s a replacement really, for those ICD9 codes we use now that start with 787, 784, 719, etc.
You will also see references to injury and external cause of morbidity codes in chapter 19 and 20. And depending upon your professional line of business, these may assist in defining codes or supporting codes selected from other chapters. So where do you access the ICD10 codes to be able to become more familiar with codes that support your services?
On our next slide here, we have some resources defined for you. I want to make sure we point out that several resources exist. And this is not a specific endorsement of any of these resources. We are just sharing with you the resources that we have experience with. If you do a simple internet search you can find a multitude of resources. You can pick and choose until you find the one that best works for you and your teams. There are some downloadable files that exist for ICD10 codes. You can find an alphabetical list and a tabular list on the CMS website at no cost. There’s also lists similar to that on the CDC website. If you or your teams in your working environments prefer coding manuals, you can purchase hard copy manuals. A general online search will yield numerous results. However, those at the AMA website, Optum website and HCPRO website are comprehensive, providing both the alphabetical index of codes as well as the tabular list of codes in one manual.
These manuals provide added benefit compared to the data and downloadable CMS files. For example, they provide visuals that help define expectations for ICD10 codes that will help with coding such as color coding or digit reminders. Such as fifth digit required, six digit week required there could be check marks or highlighting. As we look at the clinical scenarios in a few minutes, I will point those out for you. If you or your teams prefer online coding assistance, again, a general online search will yield various providers of such materials. Usually the same groups that offer the manuals for sale also offer the online versions for purchase. And many that do will offer different levels. For example, Optum offers a basic level and a professional level with the difference being ICD9/10 and CPT coding in the basic format, and they also offer advanced look-ups for LCD modifier, CCI edit in the professional level.
As therapists, we know that we use a smaller set of diagnosis codes in comparison to physicians and all other healthcare providers. The coding resources will assist you in creating internal tools such as a list of frequently used codes or cheat sheets of common codes based on clinical categories of patients. For example, ortho, neuro, pain management, etc.
So let’s consider some general coding guidelines and then we’ll get into some patient examples. When you are coding, you want to be as specific as possible. ICD9 allowed for some detail with fourth and fifth digit code requirements. However, I can’t say often enough, ICD10 is all about specificity. When selecting the diagnosis most often, it will not be a one-to-one match or conversion from ICD9 to ICD10. CMS has claim forms ready. And depending upon your type of business, in some cases, you can report up to nine diagnosis codes, and in others, up to 27. That doesn’t mean you should go crazy with coding. That just means that you can continue to focus and be specific to codes that support the type of treatment provided for individual patients. Prioritize the codes when recording. Indicate the primary reasons for treatment first, then any additional diagnosis supporting medical necessity or comorbidities impacting treatment after the primary. Report chronic conditions if they apply.
As therapists, we sometimes want to try to list every medical condition in our documentation. And that’s not necessarily the best approach. Focus on the patient’s condition and any comorbidities that may affect the outcome of your services. To help yourself with that, familiarize yourself with resources. As mentioned earlier, both ICD9 and 10 are presented in chapters. Learn the chapter organization, starting with those that you anticipate you will use the most. For example, as a speech pathologist working with adults, I may use chapters nine, diseases of the circulatory system and chapter 18, symptoms, signs and abnormal clinical and lab findings the most, depending upon the patient’s condition of course. It’s in these chapters where I’d find speech and language deficits following traumatic or non traumatic hemorrhages. Codes starting with I, and in chapter 18 codes starting with R for dysphagia. Whereas PT and OT may use other chapters more frequently, such as chapter six, diseases of the nervous system or chapter 13, diseases of the musculoskeletal system and connective tissues, different organizations will utilize different resources.
Some resources are free, posted on websites. Some are available for purchase both hard copy ICD10 manual and internet only access. No matter which you use, become familiar with the symbols, icons, check marks, numbers, color coding, dashes etc. That is what will ultimately help you be successful with ICD10 coding.
Another coding guideline is achieve and maintain consistency with documentation. When you select the diagnosis code that represents the primary reason for treatment, be sure your clinical documentation supports that selection. Same for evaluation codes justify why you were involved as the skilled professional. For example, if you select the ICD10 code for left hip fracture, non traumatic in nature, be sure to describe the circumstances related to that and indicate in your examination, the physical impairments and more importantly, the functional deficits as result of such. Correlate the information to the goals of the course and the plan of treatment. For example, a PT may specify left hip flexion range of motion is limited to a certain number of degrees as a result of fracture or left hip flexion strength is at a certain level resulting in reduced ability to ambulate without assistance.
Make sure the information that you’re documenting is consistent with the ICD10 code that is selected. If you are a speech pathologist and indicate aphasia following cerebral infraction, I69.320, be sure to indicate expressive versus receptive aphasia and describe the characteristics that paint the picture of the patient’s current functional communication abilities. Similarly, if you are an OT and your claim includes an ICD10 code for mixed incontinence, be sure your clinical documentation provides accurate history. You may also want to include review of irritants and details for stress and urge baseline behavior such as frequency, number of episodes, sensation, product management etc.
Lastly, a general coding guideline. Make sure you utilize both alphabetical index and tabular list when selecting the diagnosis code. No matter which resource you use to facilitate accuracy and code selection use both the alphabetical list and the tabular list when selecting your code. Some details about codes are located only in the tabular list. For example, sixth and seventh digit requirements if you don’t use that you run the risk of erroneous coding.
ICD10 Codes: Difficulty Walking
We’re going to move into clinical scenarios now, that will assist you in selection of ICD10 codes based upon patient conditions and complexities. Our first clinical scenario involves a 74 year old female who presents with difficulty walking and pain. Upon short review and patient interview, the physical therapist referred to ongoing as PT gathered the following information. Three weeks prior to evaluation by the PT, the patient fell on the ice while walking up her walkway at home. As a result, she sustained a nondisplaced right hip fracture. At eval, she reports pain with movement at six out of 10 in the right hip area. She wants to walk independently and return to living at home alone without any assistance or supervision. This patient is receiving physical therapy at the SNF as part of routine care for this hip fracture. She also has a history of cancer, hypertension and anemia. The primary reasons that physical therapists will be treating the patient are difficulty walking and pain and both are resulting from the fracture which was caused by a traumatic event, slipped on ice.
To determine which codes to include on the claim, the physical therapist starts a search in the alphabetical listing of ICD10 codes and chooses to look up difficulty walking first. As you can see, this is a PDF version of the alphabetical list. This particular version is downloadable and available on the CMS website. Notice at the top of the screen letters of the alphabet in blue representing hyperlinks to the specific section. The same function is available using the letters here on the left hand side of the screen. I want to use the most time efficient search possible, so I’m going to utilize the hyperlink for the letter D. Since difficulty walking is the first code, we’re going to look up. When I click on that, it brings me to page 313. And that’s helpful considering the document is over 1000 pages.
At this point, I could scroll through the words to locate difficulty for difficulty walking, or I can use the Ctrl F function to begin a more refined search typing difficulty in the search box. I click on next and notice it brings me to a group of codes for difficulty. I review those and don’t see difficulty walking so I can either scroll or click on next again. If I click on next again, notice it takes me to section G which is further than I wanted to go. Notice that I see walking difficulty not elsewhere classified R26.2 which might be my code, but at this point I’m not positive. If I go back to previous and then scroll, notice I find difficulty in walking at R26.2.
So as you can see, there are a couple of ways to complete the look up from the starting point. Once I identify R26.2, I want to make sure I look it up in the tabular list. Here is a tabular list of ICD10 codes, which is downloadable and accessed via the CMS website. Notice here the chapters with hyperlinks, as well as the indications of each code starting with the alpha character to the right of the chapter title. I have the same ability on the left hand side of the screen. So if I wanted to click on the specific title of the chapter, I could do that as well. So knowing that R26.2 is my starting point, if I scroll the list of chapters, I see symptoms, signs and abnormal clinical laboratory findings includes the codes containing letter R. I click on that and it brings me to chapter 18, and you’ll see a general overview for chapter contents, as well as some excludes information. If I scroll a little bit down, I see additional hyperlinks for codes. If I take a look at that I notice R25 to R29, which is symptoms and signs involving nervous and musculoskeletal systems.
I click on that and it starts me with R25. I could continue to scroll here or I could use the Ctrl F feature. I type in difficulty and click on next and it brings me right to R26.2, difficulty walking not elsewhere classified. If I look around at other items, I notice, it is in the larger R26 category, abnormalities of gait and mobility. I also note the excluded information. So it excludes various codes for ataxia and other excludes various codes such as staggering gait, spastic gait, unsteadiness on feet, and other abnormalities of gait and mobility. I know from the history and from the assessment that the PT selected and completed that the other code descriptions do not fit this patient. So R26.2 is the code of choice for the difficulty walking that the patient has demonstrated.
As we mentioned earlier, this patient also exhibit six out of 10 pain in her right hip. So we want to make sure that we are coding for that as well. We want to start with our alphabetical list. So I go back to that. I go back to where I left off with the search for difficulty in walking, and I have two options, I can use my Ctrl F function, or I can use my alphabetical listing over on the left hand side of my screen to get me to section P for pain. If I do that, at first, it will bring me to the listing of all words starting with P, which could be time consuming.
So at this point, I can do a further defined search or keep scrolling. If I use Ctrl F, I replace the word difficulty with pain. And I go ahead and click on next. There are several references for pain. I’m going to click on next and I will demonstrate that for you, continue to scroll through and you know we want to find pain and joint. Notice here that we have a grouping which is M25.50. If I scroll down a little bit, I see ankle, elbow, finger, foot, hand, hip, knee, shoulder, etc. We are looking for the hip which is listed as M25.55- because that is what the patient has indicated. That dash is an indicator that a six digit is required. Again, those details are located in the tabular list of codes.
So we go back to the tabular list of codes using that same resource, the CMS downloadable file, and I’m still in chapter 18 from our difficulty and walking search, we know pain and hip is in the chapter with the M codes. At this point, I can either use the Ctrl F function and search for pain or use the chapter link on the left hand side of the page. If I use the Ctrl F function, it will take me to each reference of pain from where I am in this chapter, which is probably approximately 50 plus clicks. If I narrow down the search to pain in hip, it will bring me right to the M25.55 pain in hip. Notice then, the items indented underneath that, the M25.551, M25.552 and M25.559. Here is the laterality. I know the pain was in the patient’s right hip. So the right code will be M25.551. That will be the code we want to utilize to match up with the patient’s condition and complexity that was demonstrated.
So at this point, the PT has determined that R26.2 and pain in right hip M25.551 are the primary reasons for treatment. Let’s remember the patient fell on the ice and that is what caused the non displaced fracture of the right hip. So the cause is traumatic not pathological. To facilitate added specificity on the claim and to match the clinical documentation and history reported, I return to the alphabetical listing of codes and I want to do a search on fracture. Keep in mind during chart review the PT located X-ray results which indicated the fracture is non displaced, and at the upper end of the femur, specifically the neck. So if I complete my search, I enter fracture femur and click on next. The first reference I’m brought to is fracture, femur, lower end, which is under the larger category of fracture of femur, which is the S72.9-code, pointing out this is where the indented items and the sub indented items become important for the details of the code you’re looking for.
As I scroll down, I find the code for the upper end which is S72.00 with a dash. I scroll a little bit further to find neck. I find S72.00 with a dash and there are sub indents for displaced and non displaced. It appears that S72.04 with a dash not elsewhere classified would be appropriate, but I need to figure out what the six digit indicates.
To determine six digit I refer to the tabular list I left off where I was in pain in hip. I go back to the table of contents and knowing that my code starts with S as in Sam, I see that S codes are within chapter 19, which is injury, poisoning and certain other consequences of external causes. I click on that hyperlink and it brings me to chapter 19, which of course, similar to chapter 18, there are notes and specific information and there are hyperlinks to further define the details in the search in the chapter. At this point, I can search a hyperlink or if I wanted to, search specifically for S72.04. Notice when I do that, it brings me fracture of base of neck of femur. And I notice there are options that indicate the laterality as well as if this is a displaced or non displaced fracture. It appears here that non displaced fracture of base of neck of right femur, which is S72.044 is the most appropriate code for the case. Before I leave this area, I want to scroll up a little bit and point out right above the group, S72 fracture of femur, there are some instructions which specify that seventh characters are needed. And there are some options about which letter codes you can use to specify the encounter.
The PT is working with the patient as part of routine healing phase after the initial care was provided to the patient. If you look at the alpha characters that help find the seventh digit, you see letter D is for subsequent encounter for closed fracture with routine healing. The code that would be appropriate to add to the claim is S72.004D as in dog. To represent the subsequent encounter, almost finished for this patient. The cause of the fall may be addressed to add specificity to reporting. There are many reasons for false, and most are not captured with codes now, but they are with ICD10.
Thinking about the history provided the patient fell on the ice on the walkway at home. If you take a look at chapters for external here, external causes of morbidity addresses the cause of the fall. I select chapter 20. And there are several hyperlinks that go into detail about external causes. As I review the list, I see this subgroup titled slipping, tripping, stumbling and falls, which sounds like the right group to start with. I click on the hyperlink, I notice here are some groupings of information about the codes. I note the title W00, fall due to ice and snow. And I see the information that it does include, and information that is excluded. The fact that a seventh character is needed is also specified. And there are choices. Notice that the choices are different from the S code that we just looked at. I see the W00. Note the title of W01, fall on same level due to ice and snow, W00.1 is from stairs and steps. W00.2 is other. And W00.9 is unspecified.
We notice specified, falling on her walkway. There were no different levels or stairs nor steps included. W01 has a code for fall on the same level and it shows what it includes, but there are details about what it excludes. The other options under W01 give more information about falling against objects, such as an animal or a sharp object. None of that applies. So W00.0 would be most appropriate. For the seventh digit, we have to specify A, D or S. We know that this was a subsequent encounter, the patient is receiving PT after the routine care and after healing, there are only four digits the placeholder X now comes into play. Our code to reflect the cause of the injury is W00.0XXD as in dog. D representing routine aftercare pending the line of business or treatment environment you provide services in. For example, hospital versus SNF versus private practice, the PT may find the S and W codes already on the patient’s chart or may not. They may be required or they may not. The PT should consult with the physician and team relative to appropriate coding for claim submission.
Let’s return to our PowerPoint to summarize clinical scenario number one. The primary reasons that physical therapists will be treating the patient are difficulty walking and pain in the right hip. So the codes are R26.2 and M25.551. Those issues resulted from a fracture which was caused by a traumatic event of slipping on the ice. Those codes are represented by the injury, which is the S code and the cause of the fall which is the W code. The patient did have a history of cancer, hypertension and anemia. But the PT decided these would not have impact on the patient success with treatment and meeting goals. Therefore, the PT reported these in documentation. However, did not suggest for claim submission for physical therapy services.
Slide 17 through 27 are snapshots that reflect the code selection steps we just completed and are included in the presentation as a reminder to you after today’s webinar of how to code using ICD10 selection, and those steps were based upon the information about our patient that was provided. Prior to moving to our second scenario, I want to show you the visual from a few other resources just to emphasize the points we made earlier about choosing the ICD10 coding resource that will work best for your teams. And keep in mind that while the codes are the same, some resources have more visuals than others.
If you take a look at this snapshot here, this is an alphabetical list for ICD10 from a source posted on the CDC website. The core difference between this resource and the one from the CMS website is that this uses two columns on a page instead of just one with the listing of codes. This isn’t a major problem in terms of time of lookup for a larger category like pain. However, it most likely includes some further refined search as well. So things like Ctrl F or other techniques from within the material you’re using will be important for time efficiency. Note too, the further indents underneath the main categories. If the therapist is searching pain and using our scenario of joint pain, which is on the next page, you see it listed as M25.5. So there is a similar starting point but it doesn’t end up with a dash. Always do your lookup with the alphabetical list and finish with the tabular list so you know if additional characters are required.
Let’s look at another resource. Another variation across resources, this snapshot is from one that is available for purchase. In it, there are three columns versus just one or two listed on a page. Notice in the joint area of M25.50 the joints are indented much like the other two that we looked at, there is a dash present. There is also a check mark, which indicates that additional characters are required for those codes.
Let’s look at another resource. This is a snapshot from a manual that is available for purchase. This is the tabular index. Notice the yellow highlights or unspecified areas such as unspecified joint, unspecified shoulder, unspecified elbow, and also take a look at the green text to help highlight this specific joint, the shoulder, the elbow, the wrist, the pain, as well as the green text to highlight the laterality of right versus left. Also notice the digit indicator to the left of the ICD10 code which is an orange, brown colored check mark with a six in the box. That’s a reminder that these codes have six digit requirements. As a team, decide on the resource you want to use. Become familiar with it, then train the team members to ensure your accuracy in ICD10 coding for claim submission.
Let’s move now to our second clinical scenario. Our second clinical scenario is the same patient as in the first scenario we just reviewed. However, when the patient fell on the ice, she also sustained a shoulder fracture. In addition to the physical therapist treating the patient at the SNF, she received an evaluation by the Occupational Therapist, OT, as we continue this discussion. The OT has determined that treatment is medically necessary to address the shoulder pain in addition to the muscle weakness that has resulted since the event occurred in the shoulder area. It is limiting the patient’s ability to independently perform self care tasks and IADLs. This patient wants to return home, live alone and independently live her life.
As a reminder, she is being treated at a SNF’s last rehab unit receiving therapy as part of routine care for this shoulder fracture. She also has a history of cancer, hypertension and anemia. To determine appropriate ICD10 codes for this patient’s condition and complexities, similar to PT, we will use the CMS downloadable alphabetical lists. The primary reasons the OT will be treating the patient during this episode of care are pain in right shoulder and muscle atrophy and weakness. Both are a direct result of the shoulder fracture caused by slipping on the ice. So traumatic versus pathological in nature.
As you can see, this is a PDF version of the alphabetical list of ICD10 codes accessed via the CMS website that we used a little bit earlier. We are going to start by using the Ctrl F function. We ended in the pain section that we were in earlier for PT. So we don’t have to use a research function to find the joint pain area. I know that I’m already in that area and I had been using fracture femur as my lookup, so I can search pain joint as my lookup and click on next. It’s going to land on the first reference that has pain and joint listed. I’m going to scroll up a little bit knowing that pain and joint, M25.50 is just above in the listing where my first reference was in the search. I see multiple options, ankle, elbow, finger, foot, hand, hip, knee, shoulder. And I see that shoulder pain is listed as M25.51-. I know that I need to determine what that dash or six digit is. So I return to my tabular list.
I return to the CMS tabular list downloadable file. I’m going to go back to the table of contents and I know that the M codes are in chapter 13, which is musculoskeletal system and connective tissue. I will use my hyperlinks to refine my search. Within that I will search for pain and shoulder. I click on next, and I’m brought to the group M25.5 of pain and joint. And I find M25.51 for pain and shoulder. I see the laterality which is pain in right shoulder, pain and left shoulder or pain in unspecified shoulder. I see M25.511, M25.512 and M25.519. Pain of course, is in the right shoulder. So in this case, M25.511 is the code that will be used for this patient. We also know that the patient had some muscle atrophy and weakness, which will be addressed by the OT.
So back in the alphabetical listing, I need to look for atrophy. Since I know I’m in the pain section, I can use the right hand columns to search alphabetically for the A hyperlink to find atrophy. Notice when I do that, I want atrophy that is not elsewhere classified and it doesn’t look like this is a match for me. I’m going to go ahead and click on next again and I see several different references for atrophy that are listed. I want to make sure to scroll down to see which of these might be appropriate. Notice there are several atrophy listings for things like ear, eyeball, facial, gastric, etc. I’m looking for muscle atrophy. And I see muscle/muscular, diffuse, general, idiopathic, primary M62.50. Scrolling further, I note that there is a joint section and further information with that grouping, I find the group for shoulder region, M62.51-. We know that dash means there are some additional coding. We know the additional codes are found in the tabular list of codes. So I switch over to that list.
I’m already in the chapter for M. So I’m going to search M62. It shows me M62, which is other disorders of muscle. And it goes into more specific information within this group of issues with muscles. That is a wide search. And since I know I’m looking for just the last digit clarified, I do a further refined search for M62.51. Now I’m in the muscle wasting and atrophy not elsewhere classified group and I have a few excludes. I review and none apply. My first reference here is muscle wasting and atrophy not elsewhere classified shoulder. We know that right shoulder is the issue. So M62.511 appears to be the best code to address this part of the treatment. The medical information as well as the cause may need to be addressed as well. I go back to my alphabetical listing and I’m going to go ahead and complete a search relating to the fracture. I could go ahead and complete my search using the Ctrl F function and keep pressing next.
Notice on my fourth click, I come up with fracture and I have several different options like bone, clavicle, femur and humerus. I know though that PT use the S codes. When I first scan these codes, it doesn’t look like the correct grouping of codes I want. For time efficiency and searching, let’s go to the S grouping and then further complete this search. We know that we’re looking for an S42 code, so I complete my search that way. I notice then, that the first item I land on in my search is clavicle. I scroll down to find some additional options. I’m looking for S42. But something related to the shoulder or the humerus, I scroll down in my options not knowing exactly which code I want. So I keep scrolling until I find humorous, S42.30. Notice all the items that are indented. These help give further specificity when searching the alphabetical listing. I know that S42.30- is my starting point, I need to clarify what that dash is. I need to clarify that by searching with the tabular list and at this point, I can search by code which will help me get to my groupings more efficiently.
The first reference I come to is fracture of shaft of humerus and S42.30 is unspecified fracture of shaft of humerus. But even with that there is some specificity. There is 01 for right, 02 for left and 09 for unspecified. S42.301 is for right side and that seems to be the most appropriate. Remembering that my S code needs a seventh digit, I scroll up and confirm this. Review options. The seventh digit in this case represents that it is from the aftercare, it is not the initial care. This patient is in the routine healing phase after the acute care phase, the suggestion is add D as the seventh character. So S42.301D subsequent encounter for fracture with routine healing.
The OT can consult with the PT regarding the cause of the fall as the same code would apply for both PT and OT. The patient fell on the ice. We know that in chapter 20 of the ICD10 manual, external causes are where those type of items are identified. The W00.XXD would be most appropriate in this case, because the patient fell on ice going up the walkway at home. The Xs are needed as a fill in because a seventh character is needed for this particular code. Again, the W00.XXD would be representing the subsequent encounter or the routine aftercare. Pending the line of business or treatment environment you provide services in, for example, hospital versus SNF versus private practice, the OT may find the S and W codes already on the patient’s chart or may not. They may be required or they may not. Much like PT, the OT should consult with the physician and team to facilitate proper coding for claim submission.
So to summarize this case, a 74 year old female is being treated by OT for pain in shoulder and muscle atrophy or weakness as a result of the right shoulder fracture. The codes that would be appropriate to add to the claim would be pain in right shoulder, M25.511, muscle atrophy and wasting M62.511, injury, S72.044D. Cause of the fall, W00.0XXD. Remember, this patient did have a history of cancer, hypertension and anemia. But the OT did not feel these would have impact on the patient’s success with treatment and meeting goals. Therefore, the OT reported these in documentation, however, did not suggest for claim submission to support medical necessity of OT services. Slides 35 through 41 are snapshots that reflect the code selection steps we just completed using the CMS ICD10 resources.
Let’s move to our third clinical scenario. In our third example, the speech language pathologist evaluates a patient with swallowing impairments resulting from a stroke. The patient is 84 years old and has been a resident of a Nursing Center for approximately 10 years due to her prior medical history of osteoporosis, schizophrenia, cataracts. With chart review and patient interview, the speech pathologist gathers the following information, two weeks prior to today’s evaluation the patient presented with signs and symptoms of dysphagia slurred speech and complained of right side weakness. The patient was sent to the emergency room and subsequently admitted to the hospital. Tests were completed, including a modified barium swallow and therapy was initiated at the hospital.
The speech pathologist determines in her evaluation today, that the primary reason for establishing a plan of treatment with this patient is due to signs and symptoms of as well as documented evidence from the modified barium swallow, oral pharyngeal dysphagia. We are also going to use the CMS downloadable file to look up the codes the speech pathologists should be using. Again, we want to code to the highest level of specificity.
I use the PDF version of the alphabetical list of ICD10 codes, accessed via the CMS website. I select the D section since I want difficulty in swallowing, I type in difficulty into the Ctrl F search bar. I see difficulty, difficulty in, and I find difficulty swallowing and it tells me to see dysphagia, which is very helpful. We could have started with that. However, I wanted to point out the difficulty in section for those that may start with that type of search.
Sticking with that for a moment, I select next. It sends me to difficulty walking. So I press previous and scroll down and keep looking at bolded headlines for dysphagia. That could take a while. So instead, I changed my search and I’m brought to the category for the code for dysphagia. Notice the larger group is R13.10 and then there are further indented items such as following. And there are further indented items. Below that you see functional, hysterical nervous, neurogenic, oropharyngeal phase, R13.12, pharyngeal phase R13.13. For this patient, several of these could apply. But I know from the history that the reason the patient has dysphagia is a result of a stroke because this patient suffered a stroke and the new onset of dysphagia is a result of the stroke or sequelae of the stroke or following cerebral infraction, I69.391.
If I wanted to start my lookup that way, I would use I69.391 and search the index of codes to find in my table of contents, the chapter for I codes. I click on the hyperlink and I see more information for cerebrovascular diseases. We know we need to double check the code in the tabular index as well. So let’s switch to that CMS document. Note chapter nine, diseases of the circulatory system. We select that, we view the excludes list and at this point, we can either select the hyperlink for the group I60 through I69 for cerebrovascular diseases, or we can search using the Ctrl F function. If we search using just dysphagia we’ll need to go through each reference to the word in the chapter. Therefore I searched by I69.399. This takes us to other sequelae of cerebral infraction reviewing the items below, we see that a six digit is required.
As I review the list, I see I69.391, dysphagia following cerebral infraction. Also right under that there’s a note, use additional code to identify the type of dysphagia if known, R13.1-. In addition to using the I69.391 we also have to use the R code to find out what the dash represents. I change my search to R13.1. Clicking next will give me the searches for that reference. So I continue to select next until I find the R grouping of codes. I have R13, aphasia and dysphagia. I find R13.1 for dysphagia. And there’s a note that says code first, if applicable. Dysphagia cerebrovascular disease I69 with final characters -91.
We know through the history and the assessment from the speech pathologists that R13.12 will be the code because it is consistent with the clinical documentation. It’s worth mentioning again, in other resources while the resources we are using today guide you in the code selection, in other resources, you might see information presented in a different way such as the code first note in red text or yellow highlight as means to emphasize the point. You might also see other information to help with choosing which code to use such as check marks with numbers to indicate fourth or fifth digit requirements.
ICD 10 Codes: Difficulty Swallowing
As a summary, for our third scenario, our 84 year old female with swallowing impairments lives in the SNF and has suffered a stroke. She has a history of osteoporosis, schizophrenia and cataracts. Based on this information, the appropriate codes for this scenario described then are I69.391, and R13.12. Remember, this patient did have a history of osteoporosis, schizophrenia and cataracts. But the SLP did not feel these would have impact on the patient success with treatment and meeting goals. Therefore the SLPT reported these in documentation, however, did not suggest for claim submission. Much like PT and OT, the speech pathologist must work with facility personnel and follow supervisor instruction relative to procedures that ensure proper code selection and order on claims for reimbursement. Procedures may vary across the settings you work in, for example, SNF outpatient, HH, private practice, know the expectations.
I’m sure you’re all getting the idea behind ICD10, greater specificity. You need to have the details which support conditions and complexities, facilitate consistency within the medical record and across the continuum of care. Slides 45 through 48 are snapshots of the steps we just walked through for the speech scenario. Let’s walk through a few other examples to ensure you leave today’s training with very few questions.
In our fourth clinical scenario, the speech language pathologists evaluates a patient with new onset of apraxia and aphasia. These communication impairments are subsequent to intracerebral hemorrhage, which most likely resulted from longtime high blood pressure and was exasperated by use of blood thinners. The speech pathologist is assessing the patient three weeks after the event at SNF where the patient has been admitted for rehab.
Chart review, patient interview and assessment indicates uncomplicated hospital course. Symptoms consistent with Broca’s type aphasia, oral and verbal apraxia and these communication impairments are currently the primary reason for this episode of treatment. Similar to the previous scenarios, the code search will begin with the alphabetical list of diagnosis and conditions first, in this case, the speech pathologist decided to use an ICD10 manual that she purchased to complete her code search. In the snapshot you’ll see three different columns with codes slightly different look the CMS resource we used earlier.
The speech pathologist looks up aphasia first and notices there are several different items underneath that. There’s acquired, auditory, developmental, and then following. There is cerebrovascular disease and some items further indented underneath that. We know that the patient’s issues are following intracerebral hemorrhage. So I69.120 appears to be the best option. Something else to point out, in this scenario and the last, these codes are replacing the 438 version codes that we use now with ICD9. In this case, the 438.11 and 438.81 are the ICD9 codes being replaced by the ICD10 code options seen here. The SLP then moves to tabular index in the same manual and selects chapter nine, diseases of the circulatory system.
You’ll notice in the snapshot, the group I69.1 sequelae of non traumatic intracerebral hemorrhage indicate fifth digit requirement as you see with the five and the check mark to the left of I69.1. There’s a few options here, I69.10, I69.11, I69.12. .12, speech and language deficits following non traumatic intracerebral hemorrhage is where we start. And note that a six digit is also required. Reviewing the list further, the speech pathologist determines I69.120 would be the appropriate code to represent the aphasia that the patient is demonstrating after non traumatic intracerebral hemorrhage.
Recall, the evaluation also indicated the patient exhibited apraxia. Within that section of the manual, when the speech pathologist is completing further search, we find a group labeled other sequelae of non traumatic intracerebral hemorrhage that is within the I69.19 group, and it too has a six digit requirement noted. Reviewing the list further then, we see options for apraxia, dysphagia, facial weakness, ataxia. And it’s the I69.190 apraxia, following non traumatic intracerebral hemorrhage that is most appropriate to use. Since the history of high blood pressure will most likely not affect the outcome of treatment, further coding may not be warranted. However, as a reminder, the speech pathologist must work with facility personnel, much like OT and PT, and follow supervisor instruction relative to procedures to ensure proper code selection and code orders submitted on claims.
Note here also in this snapshot, some of the other coding cues such as yellow highlighting, green text, the check mark and the red text. Similar to the last case we just looked at, in this resource, which is a little different than the CMS resource there is a note in red text to use the R code for dysphagia, the I69.191. As a summary for this patient with aphasia and apraxia for intracerebral hemorrhage, the appropriate codes were I69.120, and I69.190. One for aphasia and one for apraxia, both following non traumatic intracerebral hemorrhage.
Let’s proceed to a few other examples to ensure your successful navigation through ICD10. Our next clinical scenario focuses on PT and speech as both disciplines are providing skilled services to this patient. This patient is being seen as an outpatient. The primary reason that physical therapists will be treating the patient is difficulty walking. As per patient and caregiver reports and examination results the patient presents with ataxic gait as well as shuffling and festinating gait pattern with stops and starts. The behaviors are an exasperation of symptoms non traumatic in nature.
Similar to an earlier PT example involving difficulty walking, we know we will be searching codes in the R26 group. And of course we start with the alphabetical listing search and difficulty walking is within the group of abnormalities of gait and mobility. The snapshot of this slide is from the CMS downloadable alphabetical listing. You see in the snapshot difficulty in walking, R26.2. The patient did exhibit ataxic gait and shuffling. So the PT decided to check the alphabetical listing for ataxia as well. Notice when the PT does that, when first looking at ataxia in the alpha list, it appears R27.0 might be the code to select. However, in scrolling down the list, you’ll note the word gait with the code R26.0 in the same group list.
Again, the indenting within the broader category is important. So within ataxia, we see the indented code for gait. Our next step is to check the tabular listing. In chapter 18, symptoms, signs and abnormal clinical and lab findings not elsewhere classified we find R26, abnormalities of gait and mobility. Note the excludes that is pointed out under the R26 excludes ataxia not otherwise specified. The R27.0 along with excludes hereditary ataxia G11-. Local motor ataxia A52.11 and immobility syndrome M62.3.
Continuing to review the list of code options, we determined that R26.0 ataxic gait as well as R26.89, other abnormalities of gait and mobility are the codes that best represent the primary reasons for this physical therapy treatment. The reason being R26.89, other abnormalities of gait and mobility represent the shuffling, festinating and stop and start abnormal behavior which the PT documented in the clinical documentation. The PT decided not to use R27.0 ataxia unspecified as it is in the group labeled other lack of coordination and coordination is not the issue. The behaviors are non traumatic in nature.
The primary reason the speech pathologist has established a plan of treatment with the patient is to address the signs and symptoms related to dysarthria. If we take a look in this CMS alphabetical list and complete a search for dysarthria, we note R47.1 to the right of the title, dysarthria. We see other options following and review the options in the list. None of the options apply to this patient based upon the history and medical information provided. This is an exacerbation of symptoms, not a new neurological event nor a traumatic event. So none of those code options apply like cerebral infarct, cerebrovascular disease, intracerebral hemorrhage, etc. We stay with R47.1.
Let’s review the tabular list now. We know that R codes are located in chapter 18, symptoms, signs and abnormal clinical and lab findings not elsewhere classified. We see the group R47, speech disturbances not elsewhere classified as well as the excludes notes. Per the history provided, none of those apply. Let’s take a look at the R47.1, dysarthria and anarthria. There’s an exclusion note following cerebrovascular disease, which does not apply to this patient. We determine R47.1 is the best option that reflects the primary reason for treatment based upon the characteristics exhibited by the patient during assessment. We notice, when we look at R47.8, the other speech disturbances. The patient does not demonstrate stuttering. However, the patient does demonstrate behaviors consistent with hypokinetic dysarthria such as fading volume in precise consonants, inappropriate silences and short rushes of speech.
Certainly if other cognitive communicative impairments existed with this patient and or swallowing impairments, additional coding for such would be appropriate and the speech pathologist would follow similar procedures for lookup. And those would start with the alphabetical listing first, followed by the tabular list for additional details. From chapter six disease of the nervous system within the grouping, extrapyramidal and movement disorders, G20 would most likely be in the medical record representing the patient’s medical condition, Parkinson’s disease, if in fact the physician confirmed that. I’m sure you have the idea.
With the greater specificity with ICD10, there usually is not a one-to-one code match from ICD9 to ICD10. While there are similar lookup procedures, however, there is far more detail right versus left, displaced versus non displaced, traumatic versus non traumatic in ICD10. Let’s emphasize all that with one more scenario focused on occupational therapy.
This OT is seeing a patient with the primary reason being bladder incontinence. The patient indicates this is new onset, causing her great frustration and embarrassment. She’s stopped participating in community activities because of it. She does have a history of low vision. As in our other examples, we began our code selection in the ICD10 alphabetical list and we are going to do that same thing here using the CMS downloadable files. In this case, the OT used Ctrl F function searched by incontinence and the first in the alphabetical list to come up was incontinence R32.
Considering the history from the patient, the OT knew that more specificity was likely the case. The OT scans the options here and notes the stress, the urge and the mixed. The OT notes the mixed option under the urinary group. For stress and urge with the code of N as in Nancy, 39.46. Well, there is no indicator present that indicates additional coding is needed. The OT is well trained to know that a more detailed diagnosis search in the tabular list is needed. The OT moves to chapter 14, diseases of the genital urinary system. The OT located N39.4. Other specified urinary incontinence taking a look at the first options noted and reviewing the excludes that are noted, it looks like none appear appropriate.
So the OT continues the search. In reviewing the continued list, N39.46 mixed incontinence appears to be the appropriate code based upon the history and assessment completed with the patient. Of course, if any other symptoms of incontinence were present, the OT would code for those as well, such as post void dribbling, continuous leakage, etc, as there are specific ICD10 codes for those. Remember, the primary reason the OT has established a plan of treatment is to address the new onset of incontinence. However, during physical examination with the patient, the OT determines that the patient’s history of low vision will impact the patient’s ability to independently manage the incontinence and decides it is appropriate to add to the claim.
The OT also added that comorbidity to the plan of treatment in the clinical documentation so it was well described. The OT went to the alphabetical list and noted that low vision is in the H54.2 category and she wants to make sure she is coding low vision for both eyes. In the tabular list which is chapter seven, diseases of the eye, H54 is located. Blindness and low vision is the grouping and we note there in the yellow highlighting notes and exclusion factors and a code search queue and lower on down the list you see H54.2, low vision for both eyes and the note, visual impairment categories one or two in both eyes. Within that section of the instructions, there is also a table which provides classification for severity of visual impairment recommended by the WHO study. Note that on the slide here, the OT reviews the categories and because the patient’s visual acuity testing results are consistent with the levels, the OT determines H54.2 is the code to represent this complexity.
Certainly with the patients we work with, each presents differently. Some present with few conditions and others very complex, numerous conditions. As therapists proper coding for claim submission is part of our responsibility to facilitate cohesive, thorough, coordinated patient care as well as to ensure patients receive the services they are entitled to without coding being a reason for denial.
Today’s webinar is intended to provide you with the critical info that will assist you in better understanding ICD10 code selection. If you haven’t already, get yourself the coding resources and to begin to duplicate the steps we completed today in our examples, as well as implement with other staff and team members. Where can you find other ICD10 resources? You can find other information on the CMS website and I strongly suggest you start with this. Because it is the most factual and updated information.
When you first log on to the site, there’s a countdown clock for the ICD10 compliance date. It’s a user-friendly site with loads of information. Very well organized and well marked. There is current information and archived information. If you aren’t already used to it, I would strongly suggest you visit that site as well as register to receive ICD10 email updates from CMS. It’s a great resource for keeping teams on track. You’ll also see links to the 2015 ICD10 CM, Clinical Modification work and gems, which are the general equivalency mapping. Reminder from the conversation earlier, as therapists we’ll use the CM lists Clinical Modification lists. Those files are huge. You might want to check your professional associations for smaller versions specific to therapy.
For example, if you visit the actual website, you’ll find an easy-to-use equivalency mapping for common SLP ICD9 and ICD10 codes. The American Medical Association also has ICD10 information on their website. It’s many places really. You want to focus on credible, updated resources, which is the reason for the suggestion CMS and AMA. The Centers for Disease Control and Prevention is another location with ICD9 and ICD10 information. There’s white papers posted, FAQs, how to prepare articles, crosswalking, cheat sheets and on the AMA site, ICD10 code manuals for purchase on their website. Various organizations sell the manual and some will offer online purchase as well.
Again, we are not endorsing nor recommending any specific resources. Just making you aware of different options available and those that we have experience with. Be sure, absolutely critical to partner with your vendors. A large piece of ICD10 can be automated. So those of you not using software for billing, documentation and operations, this is yet another area of regulation that should make you consider partnering with vendor or vendors. And for those of you that do use software, be sure you know how your vendor is preparing you for the transition.
At Optima Healthcare Solutions we feel the content on this slide represents areas where your expectations of your software vendor should focus because go-live of ICD10 is October 1st. And as you can see, there is great detail involved in ICD10 coding. You should expect your vendors to provide you with a reasonable timeframe to practice with ICD10 before actual go-live of October 1st. You should also expect functionality that promotes your ability to do several things. First and foremost, enter ICD10 codes for some patients but not others. This option allows you to decide when to start practice data entry. You can design your own time frame for scheduling staff training, implementing in waves if desired. Some practice starting July 1st, others perhaps July 15th, or even August 1st, etc.
Make sure that you have a solid transition plan in place. The vendor should provide the ability to distinguish timing for claim submission and allow both ICD9 and ICD10 codes on a patient episode. Remember, ICD10 does not necessarily apply to all payers. For example, workers comp, make sure your software vendor can accommodate that. You want options for quick data entry and because staff should be knowledgeable in comparing ICD9 selection to ICD10 selection, your vendor should provide you with mapping options during data entry.
Strong search options are important too. Expect efficiency, expect keyword searches, expect code searches. You want as few clicks as possible. There’s approximately 70,000 codes. So you want to make sure we are guiding the therapist in the best manner possible. Your entire system will be affected by ICD10 coding, from clinical documentation to LCD rules, clinical and operational reports, claim submission to interoperability, know your vendor’s plan for implementation. CMS has indicated that the claims that are for services on or before September 30th, 2015 can be submitted with ICD9 codes. And as for claims October 1st and after, only ICD10 codes will be accepted. Know your transition plan.
I want to point out here too, that there’s always information being distributed by CMS about ICD10. For example, in a recent update, CMS published facts about ICD10. They are noted here on the slide and focus on options for providers. If providers cannot submit ICD10 claims electronically by October 1st, CMS strongly urges to prepare and train now and emphasize that initial cost to implement are substantially lower than projected.
On the next slide, you’ll see several reference materials that were used to assist in putting this webinar together. Several of the links and locations lead you to additional resources. Information included in this presentation has been provided by Rita Cole, clinical director at Optima Healthcare Solutions. If you have any questions or would like to provide feedback, please contact firstname.lastname@example.org. Please remember to provide your contact info in the event discussion or follow up is needed. Thank you for attending today’s webinar. I hope you find this to be a helpful resource as you continue to prepare for ICD10 implementation and compliance.