iep health related services: nursing identifying icd-10-cm codes may, 2015
TRANSCRIPT
IEP Health Related Services: Nursing
Identifying ICD-10-CM Codes
May, 2015
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The ICD-10-CM code sets identify:
Signs and symptomsAbnormal findingsComplaintsSocial circumstancesExternal causes of injury or diseasesMedical diagnoses
What are the ICD-10-CM Codes Sets?
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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?
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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) o x
Occupational Therapists o x
Physical Therapists o x
Speech-Language Pathologists; Audiology
x x
School Psychologist o x
Mental Health Professionals x o
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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 CodesFor Other IEP health related services?
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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
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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
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Nursing services include: administering medication providing medication management and chronic health condition management.
The nurse delegates and trains the PCA to dotube 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 Code by Service Provided
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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 )
ICD-10-CM Selection
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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
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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
Watch for ICD-10-CM Code Notations
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
Special Education Disability Categories
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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
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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
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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
Optional Summary Sheet
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Understanding the ICD-10-CM Code Structure
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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.
Reporting and Coding
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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
Online Resources for ICD-10-CM Reporting and Coding
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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
ICD-10-CM Implementation Timeline
Jenny Roth, DHS IEP Services Coordinator(651) 431-2622; [email protected]
Ruth Ellen Luehr, MDE Special Education Interagency Education Specialist
(651) 582-8403; [email protected]
DHS – MDE Staff
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