Administrators, TPR Coordinator and Billing Agents IEP Health Related Services Identifying ICD-10-CM Codes May, 2015

US Department of Health and Human Services: Center for Medicaid and Medicare Services (CMS) Federal Regulations: 45 CFR CFR Health care providers, health plans and clearinghouses must use ICD-10-CM codes services on and after October 1, 2015 Healthcare Industry’s version of Data Driven Decision Making Why is ICD-10-CM reporting required? 2

MHCP Enrolled Providers – Individualized Education Program (IEP): Hot Topics ICD-10-CM Reporting for Schools (DHS-7092) (PDF),ICD-10-CM Reporting for Schools (DHS-7092) (PDF) Sign up to get notices of new Provider Updates, Provider News, etc. Find Information on the DHS Website 3

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? 4

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? 5

Who Determines the ICD-10-CM Codes? 6 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? 7

Understanding the ICD-10-CM Code Structure

Site for Locating ICD10Data.com

-Identify the correct ICD-10-CM Codes: Ask Am I treating the disease / disorder? or Am I treating a sign/symptom? -For treating disease/disorder, check the student record or contact the primary care provider. -For treating sign/symptom, select the ICD-10-CM that represents the problem being addressed in the services What do your IEP health related service professionals need to do?

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 valid, billable and specific to the child  Be medically necessary codes, not education codes What do your IEP health related service professionals need to do?

To qualify for Special Education a child must be eligible in one of these 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 12

 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 13

IEP Evaluation Report: Summarizes medical need States health related services are required during school day IEP 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 Records Align with ICD-10-CM 14

The child is wheelchair-bound and has been diagnosed with cerebral palsy and seizure disorder. The IEP Evaluation Report indicates there is a medical need for Nursing Services and PCA services. Nursing services include twice a day tube feeding, medication administration, medication management and chronic health condition management. PCA will assist with the Activities of Daily Living (ADL), mobility and toileting. Student Scenario 15

Nursing services include: administering medication providing medication management and chronic health condition management. The nurse delegates and trains the PCA to do tube feeding, toileting and assist with mobility.  The NURSE is treating the disease or disorder  The PCA is assisting and providing delegated nursing services that are needed because of the disease or disorder - Identify ICD-10-CM Code by Service Provided 16

1)Staff will need time to learn and practice how to do ICD-10-CM codes. 2)Set up a procedure for IEP health related services professionals to identify and document ICD-10-CM Codes in a student’s FILE, not in the IEP Plan. (See example or use computer documents.) 2)Workflow: Determine how the Biller gets the codes (along with other daily reports). What do Administrators, TPR Coordinators and Billing Agents need to do? 17

Optional Summary Sheet 18

 When a child has been diagnosed with a disease 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 What do Billing Agents need to do? 19

 Codes need to be valid and billable  Watch for code notations and rules  Check with your vendors: Batch submissions: No decimal points For MN-ITS, decimal points are removed. Watch for ICD-10-CM Code Notations 20

 Run a dual system –All claims (and through Sept. 30) claims will use ICD –For services provided on and after Oct. 1, ICD-10-CM codes must be used.  Refer to the HIPPA implementation guide (find the Washington Publishing Company – 5010 Guide)find the Washington Publishing Company  Make room for more than one code per claim  Batch submissions: No decimal points What do Vendors need to do? 21

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.comICD10Data.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 22

 Use ICD-9 Code for dates of service on or before September 30, 2015  Use ICD-10-CM Codes for dates of service on or after October 1, 2015 Window of opportunity: Districts need codes when you start billing for Oct. 1 services, late November. Reminder: 23

24 What is already in place? What infrastructure changes are needed? - Computer/software (district or vendor) - Work flow: Identify codes, get codes to TPR biller Who are your the early adopters? Start with the easy/doable codes. Change is hard. Staff need time and energy. Things for Administrators to Think About

Webinar recordings: MHCP Enrolled Providers – Individualized Education Program (IEP)MHCP Enrolled Providers – Individualized Education Program (IEP) Trainings DHS – MDE Staff Jenny Roth, DHS IEP Services Coordinator (651) ; Ruth Ellen Luehr, MDE Special Education Interagency Education Specialist (651) ; RESOURCES 25