ICD‐10 and Other Notes

October 1st is coming soon and the big change is coming quickly.

After attending several webinars and researching online documents, here is some of the

most important information you can be aware of for ICD‐10.

Medicare and Medicaid and most major insurance companies have been running claims

with ICD‐10 testing for awhile. Most have been prepared due to the previous

transition deadline before. However, I still recommend, with any transition in the billing

world, make sure you financially prepare as much as possible in case there is a delay in

payments. I recommend at least 2 weeks worth of savings just in case, if not more of

course. I don't say this to scare anyone, just to prepare. I do believe the transition will go

smoothly.

ICD‐10 coding will begin with dates of services starting 10/1/15. If you have a claim that

contains the following dos: 9/28, 9/29, 9/30, 10/01, 10/02 then you will need to break up

your claim to read as follows: 9/28, 9/29, 9/30 then another separate claim that bills:

10/01, 10/02 to only display ICD‐10 codes. ICD‐9 and ICD‐10 diagnosis codes can not be on

the same claim sheet together.

When transitioning ICD‐10 from ICD‐9, make sure your new code with ICD‐10 can be carried

out to the 4th or 5th digit if possible. the more descriptive, the better. The basis behind

ICD‐10 is to describe to the most detail with the primary diagnosis code what the patient

has came to you to treat. The secondary diagnosis code should be in the most detail format

of what you found to be their diagnosis.

Medicaid stated in a webinar recently that "other specified" or "unspecified" can no longer

be used as a primary diagnosis for a patient. All ICD‐10 guidelines work this way. As ASHA described it: "Make sure the primary diagnosis code listed is the disease, symptom, injury and the secondary diagnosis code listed is what was found after the evaluation". Example, primary: F84.0 (Autistic disorder), secondary: F80.1 (Expressive language disorder)

Unfortunately many of the diagnosis codes used by therapists are unspecified. Billers

should discuss with therapists any appropriate codes to use to be as specific as possible

with these changes. Therapists need to also communicate with PCP/Drs to understand

specific diagnosis that have been given for patients (example, downs syndrome needs to be

coded one of the three different ways). Contact your local PCP/Dr offices and ask what

would be the easiest way to work with them communicating these specific codes.

Lack of coordination which many PTs and OTs use can not be used as a primary diagnosis

code anymore. Make sure any Down Syndrome diagnosis are listed as specific as possible to be used as a primary diagnosis.

I have been asked by several therapists to give a list of transition coding, however doing so

is not the easiest answer since the primary diagnosis must be specific to what the patient

has. However, entering any diagnosis code into the following website will allow you to look

up the general switch to ICD‐10. Make sure you do not use a unspecified or other code as

primary when switching ( http://www.icd9data.com/) and try to carry out the diagnosis

code to the 4th or 5th digit if possible. Here are some examples, but please note to

research before use:

ICD‐9 ICD‐10

315.9 F81.9 (CAN'T BE USED AS PRINCIPAL DIAG CODE) developmental delay

299.00 F84.0 autism

299.90 F84.9 Asperger

315.31 F80.1

315.32 F80.2

315.39 F80.89

315.8 F88

315.4 F82

343.9 G80.9 (UNSPECIFIED CODE)

345.00 (THIS CODE IS NOT TRANSITIONING SINCE IT NEEDS TO BE MORE SPECIFIC)

348.1 G93.1

389.10 H90.5 (UNSPECIFIC CODE)

389.9 H91.90 (UNSPECIFIC CODE)

530.81 K21.9

749.20 Q37.9 (UNSPECIFIC CODE)

758.0 Q90.9 (UNSPECIFIC CODE)

783.3 R63.3

784.59 R47.89, R47.81

784.69 R48.2

787.20 R13.10 (UNSPECIFIC CODE)

781.3 R27.9 (UNSPECIFIC CODE)

Other information:

ASHA stated in their webinar that PT and OT organizations are working on eventually

removing the timed minutes of their coding.

For speech evals, ASHA states that 92523 = 120 minutes

ASHA also gave some examples of ICD‐10 coding that could be used by speech therapists

(Please note these may not all be used for primary diagnosis codes) F80.81, I69.320, J38.2,

R13.11, R48.8, R49.0, R49.21, R41.841, R41.844 (most speech codes will be listed in F80

range)

Always remember to put the 59 or 52 modifier on the second cpt code when required.

ASHA stated that 92507 & 97532 are not allowed to be billed together. If you are a speech

therapist and have any questions about billing, you can email ASHA at

reimbursement@asha.org for more help.

The following are some great links for ICD‐10 information.

https://www.cms.gov/Outreach‐and‐Education/Outreach/NPC/National‐Provider‐Calls‐and‐Events‐Items/2015‐08‐27ICD10.htmlDLPage=1&DLEntries=10&DLSort=0&DLSortDir=descending

(Great recorded broadcast that can be downloaded and slide show presentation)

http://www.roadto10.org/action‐plan/phase‐2‐train/training‐resources/

Look to Medicaid's website as well to sign up for any webinars related to ICD‐10. Most of

the information in the presentations are repetitive, but Q&A afterwards can help you relate

and/or answer any questions you might have as well.

I will be giving a couple of presentations in September to go over ICD‐10 in Athens and

Atlanta. If you are interested in joining, please let me know.

And as always, feel free to pass this information along or send me any information to help

others. Thanks!