1. IEP Health Related Services: Occupational and Physical Therapy Identifying ICD-10-CM Codes May, 2015

2. 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

3. 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

4. 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

5. 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

6. The child has a medical diagnosis of cerebral palsy. The IEP evaluation report indicates there is a medical need for Occupational Therapy or Physical Therapy and PCA services due to the lack of motor skills, motor impairment and spasticity in arm and legs. Occupational Therapist (OT) or Physical Therapist (PT) services will include working with the child two times a week for 20 minutes each time. PCA will assist with the Activities of Daily Living (ADL) - eating, mobility and toileting. Student Scenario 6

7. 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

8. The OT or PT is treating the signs, symptoms or condition of cerebral palsy. (Lack of motor skills, motor impairment and spasticity in arm and legs).  The OT or PT determines the correct ICD-10-CM code that best describes the treatment that is being provided  A PCA will assist the child with eating, mobility and toileting because the same signs, symptoms or condition that the OT or PT is treating prevents the child from performing these tasks without assistance Identify ICD-10 Code by Service Provided 8

9. If a health care provider gives a diagnosis without an ICD-10-CM code:  The OT or PT contacts the primary care provider or clinic to get the correct ICD-10-CM code OR  The OT or PT searches for the ICD-10-CM codes, in this scenario: Cerebral palsy ICD-10-CM Selection 9

10.  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 10

11. 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 11

12. To qualify for Special Education a child 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 12

13.  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

14. 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 14

15.  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 15

16. Optional Summary Sheet 16

17. Understanding the ICD-10-CM Code Structure

18. In the Student Scenario we just looked at, the child’s primary care provider diagnosed the child with cerebral palsy but did not give an ICD-10-CM code. The ICD-10-CM G80.9 has been used for other children with this same diagnosis, but is that correct for this child? G80.9 is an unspecified diagnosis code that does not clearly define the issues the specific child is experiencing. Working together the professional nurse and therapist could search for a code that describes this child’s signs, symptoms or conditions. Reporting Primary and Secondary ICD-10-CM Codes 18

19. ICD10Data.comICD10Data.com Motor Skills, Spasticity

20. For this scenario: After reviewing the ICD-10-Codes the nurse and therapist agree, that the ICD-10-Code G80.0 best describes the signs, symptoms or conditions of this child. Report the ICD-10-CM Code G80.0 for cerebral palsy as the primary diagnosis when billing for therapy and PCA services for this child. Documentation should clearly define the services. Reporting and Coding 20

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 21

22. 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 22

23. Jenny Roth, DHS IEP Services Coordinator (651) 431-2622; jenny.m.roth@state.mn.usjenny.m.roth@state.mn.us Ruth Ellen Luehr, MDE Special Education Interagency Education Specialist (651) 582-8403; ruthellen.luehr@state.mn.usruthellen.luehr@state.mn.us DHS – MDE Staff 23