IEP Health Related Service: Speech/Language Pathology and Audiology Identifying ICD-10-CM Codes May, 2015

The ICD-10-CM code sets identify:  Signs and symptoms  Abnormal findings  Complaints  Social circumstances  External causes of injury or diseases  Medical diagnoses What are the ICD-10-CM Codes Sets? 2

Schools must provide an ICD-10-CM code for each billable IEP health related service. These services include:  Mental health (CTSS)  Nursing  Occupational therapy  Physical therapy  Speech-language pathology and audiology  PCA  Transportation  Assistive Technology  Interpreter Services What Does this Mean for Schools? 3

Who Determines the ICD-10-CM Codes? 4 Provider Diagnosis Signs/ Symptoms Primary Care (MD, PA, APRN (Advan Pract RN) xo Professional Nurses (LSN/PHN/RN, not LPN) ox Occupational Therapistsox Physical Therapistsox Speech-Language Pathologists; Audiology xx School Psychologistox Mental Health Professionalsxo

The IEP health related service professional who is training, directing, supervising or ordering the service, selects the ICD-10-CM code(s) for:  PCA services  Special Transportation  Assistive Technology  Interpreter services In most cases it is the same ICD-10-CM code used by the professional. Who Determines the ICD-10-CM Codes For Other IEP Health Related Services? 5

The IEP evaluation report indicates the child has a articulation disorder and is unable to use speech sounds appropriate for the child’s age. The child will need medically necessary Speech Language services (SLP) The SLP searched and found that ICD-10-CM code F80.0 best describes the speech disorder this child is experiencing. No other health related services are identified. Student Scenario 6

Stop and think: Am I treating the disease / disorder? or Am I treating a sign/symptom? What code best describes the need for service and the service that is being provided? Identifying the Correct ICD-10-CM Codes 7

The SLP is treating the speech disorder by meeting with the child three times a week to teach the child the production of sounds within words, sentence, and conversation speech. Identifying the ICD-10 Code by Service Provided 8

 When a child has been diagnosed with a disease or disorder from a primary care provider, report that diagnosis code as the Primary diagnosis for all claims for the child  When providing health related services for a sign, symptom, or condition resulting from the disease or disorder, report that code as Secondary, Tertiary and so on  When no medical disease or disorder has been identified, report the sign, symptom or condition code that identifies the IEP health related service that is being provided as the Primary diagnosis code Reporting ICD-10-CM Codes 9

Whether you use an online resource or purchase a ICD-10- CM guide, it is important to read and understand the guidelines and exceptions for selecting ICD-10-CM codes.  Select codes that are valid and billable  Watch for code notations and rules The ICD-10-CM code must:  Clearly represent the child’s medical need as identified in the child’s IEP / IFSP  Logically relate to the IEP provider/service  Relate to the activities / tasks provided  Be specific to the child’s needs  Select medically necessary codes, not education codes Watch for ICD-10-CM Code Notations 10

To qualify for Special Education, a child must be eligible for services in one of the following Educational Disability categories:  Speech/Language Impaired  Developmental Cognitive disability – mild to moderate  Developmental Cognitive disability – severe to profound  Physically Impaired  Visually Impaired  Specific Learning disability  Emotional/Behavioral Disorders (EDB)  Deaf-Blind  Other Health Disabilities  Autism Spectrum Disorder  Developmental Delay  Traumatic Brain Injury Disabled  Severely Multiply Impaired Special Education Disability Categories 11

 A medical diagnoses is a criteria for eligibility for these Special Education Disability Categories: Other Health Disabilities, Physical Impairments and Traumatic Brain Injury.  Speech/language pathologists and audiologists determine the diagnoses for Speech/Language Impairments.  Mental Health Professionals provide DSM 5/ICD-10-CM diagnoses when CTSS is included in the child’s IEP needs and plan.  Annually, medical orders are required for students needing medication or certain treatments. School Sources for Medical Diagnoses 12

IEP Evaluation Report:  Summarizes medical need  States health related services are required during school day IEP Record: Assessment and Plan describe:  Health problem, signs/ symptoms/ condition  Plan of care/Treatment Plan; why and what services are necessary, when, by whom, how often Special Education Needs Align with ICD-10-CM 13

 Record the ICD-10-CM codes in the child’s IEP file, not on the IEP Plan  Follow your school district procedures to document ICD-10-CM codes for billing purposes (some schools will have electronic documentation procedures) One example is a Summary Sheet for all ICD-10-CM codes for a child’s IEP health related services (next slide) Documenting ICD-10-CM Codes 14

Optional Summary Sheet 15

Understanding the ICD-10-CM Code Structure

ICD10Data.comICD10Data.com – Articulation Disorder

The SLP determined that the ICD-10-CM code F80.0 best describes the medical reason why this child needs the services that will be provided to this child. No other services are being provided to the child, and no other ICD-10-CM codes are on file for this child. Report the ICD-10-CM F80.0 as the primary diagnosis code when billing for the SLP services. Reporting and Coding 18

It may be necessary to work with both the ICD-9 code and the new ICD-10-CM codes until all claims for dates of service on or before September 30, 2015 have been submitted.  Use ICD-9 code for dates of service on or before September 30, 2015  Use ICD-10-CM Codes for dates of service provided on or after October 1, 2015 ICD-10-CM Implementation Timeline 19

Visit the following websites for additional guidance: Center for Medicare & Medicaid Services (CMS) – ICD-10Center for Medicare & Medicaid Services (CMS) – ICD-10: Provides history, requirements, and coding sources Centers for Disease Control and Prevention (CDC) – ICD-10Centers for Disease Control and Prevention (CDC) – ICD-10: Provides history, requirements, and coding sources ICD10Data.com ICD10Data.com Example of a commercial website that can be used to find appropriate ICD-10-CM codes MHCP Enrolled Providers – ICD-10MHCP Enrolled Providers – ICD-10,Minnesota DHS webpage: Provides periodic updates about ICD-10-CM Implementation Online Resources for ICD-10-CM Reporting and Coding 20

Jenny Roth, DHS IEP Services Coordinator (651) ; Ruth Ellen Luehr, MDE Special Education Interagency Education Specialist (651) ; DHS – MDE Staff 21