FAQ – ICD-10

PT & OT Case Scenarios

Speech Therapy Case Scenarios

A patient is referred to speech therapy diagnosed with bilateral vocal cord nodules last week with complaints of hoarseness, vocal fatigue pain in throat that impact her ability to communicate effectively. What ICD-10 would I use on the claim form?

7th Character Questions & Answers

I heard the Centers for Medicare and Medicaid Services (CMS) provided an answer about rehabilitation therapy and what 7th character they would use when a 7th character is required. Is that true? Can you provide an example of when a therapist would use the letter “S” as the 7th character when a 7th character is required? Can you provide an example of when a therapist would use the letter “D” as the 7th character when a 7th character is required? Can you provide an example of when a therapist would use the letter “A” as the 7th character when a 7th character is required? If the reason the patient is referred to therapy is due to a traumatic injury such as a fracture, sprain, strain, burn, TBI, concussion, dislocation, etc., the visit I do my initial evaluation, will the 7th character always be the letter “A”? When an ICD-10 code does require a 7th character, which 7th characters will be used by physical therapists, occupational therapists, and speech language pathologists? Can you provide which 7th characters outpatient therapists will primarily use and the definition of each one? When does an ICD-10 code require a 7th character?

Claim Form Questions & Answers

If I have a cash-based practice, will I need to provide ICD-10 codes to my patient’s? How many ICD-10 codes can be reported on the UB-04 claim form used by non-private practices? How many ICD-10 codes can be reported on the 1500 claim form used by private practices? If new signs and symptoms develop after the initial evaluation, say visit 3 or 4, should we add those ICD-10 codes to the claim form? As signs and symptoms a patient had at the start of therapy resolve, should we delete those ICD-10 codes from the claim form? What ICD-10 code should be primary, the medical diagnosis or therapy diagnosis? Must every claim we submit have a medical diagnosis that was provided by the physician? In the ICD-10-CM book, which diagnosis codes are medical and which are a therapy or treatment diagnosis? Under outpatient therapy, must the therapist diagnosis code(s) match the physician diagnosis code(s) that was provided on the order or referral? Who determines what ICD-10 code(s) will be placed on the claim form? With the implementation of ICD-10 on October 1, 2015, how many ICD-10 codes will we need to place on the claim form?

Documentation Questions & Answers

How does my documentation impact the ICD-10 codes that I report on the claim form? Does the implementation of ICD-10 change how I must document compared to ICD-9? Do I need to list the actual ICD-10 codes in my evaluation and subsequent documentation?

ICD-10 Terminology Questions & Answers

In ICD-10-CM book, I often see the abbreviation “NEC” under an ICD-10 code in the Index List or under an ICD-10 code in the Tabular List. What does “NEC” mean? In ICD-10-CM book, I often see the abbreviation “NOS” under an ICD-10 code in the Index List or under an ICD-10 code in the Tabular List. What does “NOS” mean? In the tabular section of the ICD-10-CM book, I often see Excludes 2 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 2”. What does Excludes 2 mean and can you give an example? In the tabular section of the ICD-10-CM book, I often see Excludes 1 under an ICD-10 code with additional ICD-10 codes following the words “Excludes 1”. What does Excludes 1 mean and can you give an example?

General Questions & Answers

How will ICD-10 impact or change how we report PQRS measures on our Medicare Part B outpatient’s? How will ICD-10 impact or change how we report functional limitation reporting on our Medicare Part B outpatient’s? How will ICD-10 impact or change how we use CPT codes? For Medicare patient’s, do we have to do an updated plan of care and have it signed by the physician or non-physician practitioner for Medicare patient’s who are continuing with outpatient therapy services on or after October 1, 2015? On October 1, 2015, do we need to do an evaluation or re-evaluation on all of our current patient’s? What is the character “X” used for in the ICD-10-CM codes? Is the first character in ICD-10-CM alpha or numeric? What are the main differences between ICD-10-CM and ICD-9-CM? What is the difference between ICD-10-CM and ICD-10-PCS? What are benefits of switching to ICD-10-CM for outpatient therapy services? What are benefits of switching to ICD-10-CM or ICD-10-PCS? After the implementation of ICD-10, is it possible that we could use ICD-10 codes with some insurance carriers and ICD-9 codes with other insurance carriers? Will all insurances mandate we report ICD-10 codes instead of ICD-9 codes? What is the implementation date for ICD-10?