Billing

ICD-10: READY … SET .. CODE!

ICD-10 Coding kicks in October 1, 2015! 

  • ICD-10 Coding for Inpatients based on discharge date or through date and outpatients based on the service date
  • List up to 4 codes only and in order of importance
  • NO claims with ICD-9 codes will be accepted after Oct 1st
  • Do NOT bill ICD-9 and ICD-10 codes on the same claim form

WHAT DOES THE SWITCH MEAN FOR ME?

  • ICD-10 allows for greater detail for laterality, primary encounters, external causes of injury, preventative health, as well as socioeconomic, family, and lifestyle related problems.
  • ICD-10 Code set provides greater specificity for patient diagnosis.  It is imperative that your documentation support the coding—-Be more specific to show medical necessity!!
  • ICD-10 supports—Need for PT services, patient complexity, duration of care, frequency of care, interventions selected.

 

 

WHAT DOES IT LOOK LIKE?

Each category consists of 3-7 characters:

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Use of the 7th Character:
  • Only necessary for certain chapters: musculoskeletal (except low back pain), obstetrics, injuries, external causes.
  • Different meaning depending on the section
  • When 7th character applies, codes missing the 7th character are invalid.
  • Initial encounter (A): surgery, emergency department care, or maybe athletic care (when you are first to address the injury as soon as it happens).  DOES NOT MEANfirst PT visit for the condition.
  • Subsequent encounter (D)MOST PT VISITS IN THIS CATEGORY!! After care and follow-up visits for treatment of injury or illness.
  • Sequela (S): complications or conditions that arise as a direct result of a condition—scar formation after a burn.
  • If you need a 7th character, but the original code does not have 6 characters, use “X” as a place holder.  For example,  S43.1XXD-Subluxation and dislocation of acromioclavicular joint-subsequent encounter.

WHERE DO I START?

For full access to all codes the index is available for purchase. There is also an option to download an electronic index from the website below.  The Centers for Medicare and Medicaid Services (CMS) provides electronic files for ICD-10-CM code. Although not recommended to use independently, CMS has developed a bidirectional crosswalk, referred to as the General Equivalence Mappings (GEMs), between ICD-9-CM and ICD-10-CM/PCS. There are GEMs for over 99 percent of all ICD-10-CM codes and for 100 percent of the ICD-10-PCS codes.

CMS ICD-10-CM and GEMS

Step 1: Look up term in alphabetic index

Step 2: Verify code in tabular list

Step 3: Add 7th character if appropriate

RESOURCES FROM THE SECTION ON WOMEN’S HEALTH

The members of the reimbursement committee of the Section on Women’s Health Section will be compiling a list of the some of the most frequently used codes for pelvic health rehabilitation.  Check our website for updates under Practice and Payment .

Contact us with questions by sending an e-mail to pc@womenshealthapta.org (Kelly Huestis, Payment Policy & Reimbursement Chair)

References

APTA-  ICD 10: Final Steps for Successful Implementation—presented by Matt Elrod, PT, DPT, MEd, NCS and Gayle Lee, JD

Nakisha
NaKisha Jackson, PT, DPT
NaKisha currently practices in an outpatient setting soley devoted to enhancing the pelvic health of men and women. She has 9 yrs of clinical experience and a strong orthopaedic background to compliment her skills in pelvic floor rehabilitation. What she enjoys most about physical therapy is the way it empowers people to take an active role in their health and make lifestyle changes that improve their overall quality of life.  When she is not working, she loves spending time with her husband, family/friends, and doing things that involve socializing and meeting new people!
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Lymphedema Coding Tips 101
PART 1: ICD-10 for the Pelvic Health Patient

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