IEP Health Related Services: Nursing Identifying ICD-10-CM Codes May, 2015

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

What Does this Mean for Schools? 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

Who Determines the ICD-10-CM Codes? Provider Diagnosis Signs/ Symptoms Primary Care (MD, PA, APRN (Advan Pract RN) x o Professional Nurses (LSN/PHN/RN, not LPN) Occupational Therapists Physical Therapists Speech-Language Pathologists; Audiology School Psychologist Mental Health Professionals

Who Determines the ICD-10-CM Codes For Other IEP health related services? 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.

Student Scenario 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.

Identifying the Correct ICD-10-CM Codes 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? 1) Am I treating the disease / disorder? This is likely a medical order/delegated medical function. The nurse may delegate the task to an LPN or a UAP (unlicensed assistive personnel) / para. (The professional nurse assigns the task to another professional nurse (ex.; LSN to RN, or RN to RN); this is an assignment, not delegation). 2) Am I treating a sign/symptom? Sign or symptom also means condition or problem. What problem is the child having (as a result of their medical condition)? What nursing services must be provided to address the problem? In professional nursing practice, this is the nursing diagnosis: Independent nursing functions: treating the implications of the health care problem, not the health care problem itself.

Identify ICD-10 Code by Service Provided 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

ICD-10-CM Selection If a health care provider gives a diagnosis without an ICD-10-CM code: The professional nurse contacts the primary care provider or clinic to get the correct ICD-10-CM code OR The professional nurse searches for the ICD-10-CM codes, in this scenario: Cerebral palsy Seizure disorder Professional nurse: Registered Nurse (RN), in school the Licensed School Nurse(LSN) or contracted Public Health Nurse (PHN). Not a Licensed Practical Nurse (LPN )

Reporting ICD-10-CM Codes 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

Watch for ICD-10-CM Code Notations 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 needs of the child Select medically necessary codes, not education codes

Special Education Disability Categories To qualify for Special Education a child must be eligible for 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

School Sources for Medical Diagnoses 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.

Special Education Needs Align with ICD-10-CM 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

Documenting ICD-10-CM Codes 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)

Optional Summary Sheet

Understanding the ICD-10-CM Code Structure

ICD10Data.com – Cerebral Palsy and Seizure Disorder Look for specific code

Reporting and Coding For this scenario: Report the ICD-10-CM code G80.9 for cerebral palsy as the primary diagnosis and the ICD-10-CM code F44.5 for the seizure disorder as the secondary diagnosis when billing for Nursing and PCA services for this child. Documentation should clearly define the services.

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

ICD-10-CM Implementation Timeline It may be necessary to work with both the ICD-9 code 315.9 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 315.9 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

DHS – MDE Staff Jenny Roth, DHS IEP Services Coordinator (651) 431-2622; jenny.m.roth@state.mn.us Ruth Ellen Luehr, MDE Special Education Interagency Education Specialist (651) 582-8403; ruthellen.luehr@state.mn.us