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 1^st
• 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:

Use of the 7^th Character:

• Only necessary for certain chapters: musculoskeletal (except low back pain), obstetrics, injuries, external causes.
• Different meaning depending on the section
• When 7^th character applies, codes missing the 7^th 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 7^th 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

CMS: 2014 ICD-10-CM and GEMs

Step 1: Look up term in alphabetic index

Step 2: Verify code in tabular list

Step 3: Add 7^th 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