1. DON’T PANIC….. PREPARE!!! Tabitha Harris, PT, DPT, OCS Steven Spinks, DPT, COMT

2. OBJECTIVES  Understand the history of ICD-10  Understand and describe the primary differences between ICD-9 and ICD-10  Understand how to report and bill ICD-10 codes appropriately (outpatient specific)  Ability to apply appropriate documentation principles to support ICD-10 codes  Identify when a 7 th character is required in ICD-10 coding  Define initial & subsequent encounter and sequela  Ability to apply correct ICD-10 coding concepts to PT, OT and SLP (outpatient specific)  Ability to identify, find and utilize appropriate resources for ICD- 10 coding

3. HISTORY of Coding  1948: ICD-6  1955: ICD-7  1965: ICD-8  1977: ICD-9  1990: ICD-10  What happened between 1990 and the present?

4. HISTORY of Coding  W.H.O. began working on 10 th edition of ICD coding system > 30 years ago (1983)  Endorsed by the World Health Assembly 1990  Ready for use 1994  Several countries quickly adopted the system – including Australia, France, Canada, Dubai…  United States?? A little late to the party, but we are getting there!

5. So Why Change Now?  ICD-9 is outdated  Technology changes  Lacks flexibility and accuracy  Unable to incorporate emerging diagnoses and procedures  U.S. one of few developed countries that has not transitioned:  complex healthcare system  highly influential special interest groups who control decision making  Repeated extension of transition deadlines

6. So Why Change Now?  2009 – Final rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) – Administrative Simplification with Modifications to the medical data code sets  ICD-10 would be the “standard” coding set as of October 1, 2013  2012 – September final rule moved implementation date back to October 1, 2014  2014 – “Protecting Access to Medicare Act of 2014” delayed implementation to “at least” October 1, 2015

7. So Why Change Now?  July 31, 2014 – US Department of Health & Human Services (HHS) issued ruling finalizing October 1, 2015 as new compliance date for “healthcare providers”

8. Who has to transition?  Rule applies to “Healthcare providers” covered by HIPAA. This includes:  Medicare  Medicaid  Third Party Insurance providers  Some Worker’s Comp providers  Some Auto insurance providers  Some Work Comp and auto insurance providers are not HIPAA covered entities  It is possible that some of these providers will not transition to ICD-10 and will continue to use ICD-9 diagnosis codes.

9. ICD-10-CM vs ICD-10-PCS  ICD-10-CM  Used for outpatient services (including therapy)  CM stands for clinical modification – US has “modified” ICD-10 as created by the W. H. O.  ICD-10-PCS  Used for inpatient claims only  PCS stands for procedure coding system  Hospitals and inpatient facilities should train/transition facility wide

10. Benefits of ICD-10 transition?  Increased specificity – approx. 70,000 ICD-10 codes!  Improved sensitivity when modifying grouping for reimbursement methodologies  Improved measurement of quality, efficacy and safety of care  Assists in design of payment systems and claims processing  Allows improved Public Health surveillance

11. Benefits of ICD-10 transition?  Allows greater detail in reporting on:  Laterality  Preventive health measures  Lifestyle related problems  Socioeconomic factors  Comorbidities – contributing factors

12. ICD-9 vs ICD-10: Major Differences ICD-9  3-5 characters  1 st character numeric or alpha  2-5 th characters always numeric  Decimal occurs after 3 rd character  No laterality of affected side  Just over 14,000 diagnosis codes  No place holders used ICD-10  3-7 characters  1 st character always alpha  2 nd character always numeric  3-7 th characters alpha or numeric  Decimal occurs after 3 rd character  Has laterality of affected side  Approximately 70,000 diagnosis codes  May use placeholder (X)

13. ICD-10 “Placeholder”  ICD-10 uses a placeholder character. 2 uses:  Allows future expansion of the code set  If a code has fewer than 6 characters and a 7 th character is required  Placeholder character is always “X”  The X is assigned to all characters fewer than 6 in order to meet coding requirement to 7 characters

14. ICD-10-CM “7 th ” Character  Used primarily when coding injury caused by trauma, or the “cause” of traumatic injury (CMS tabular Index Chapters 15, 19 and 20)  Choose one of three choices for 7 th character:  “A” = Initial Encounter  “D” = Subsequent Encounter  “S” = Sequela (Exception: Fractures have additional 7 th characters)

15. ICD-10-CM “7 th ” Character – A  Initial Encounter  Used the FIRST time a patient is being seen for a condition  Emergency room visit  Evaluation by new physician or first time physician visit  Unusual for therapists to use this character  Direct access visit – seen by therapist prior to any other medical professional  In hospital – could be used if therapist evaluating in emergency dept. or under observation in hospital

16. ICD-10-CM “7 th ” Character – D  Subsequent encounter  Used for encounters after the patient has received treatment for a condition  While receiving routine care for condition  During healing/recovery phase  Most common character used in therapies

17. ICD-10-CM “7 th ” Character – S  Sequela  Used for conditions or complications that have arisen as a direct result of a condition  Ataxia as a result of CVA  Scar formation as a result of a burn  Must code both the injury and the sequela  S character identifies the injury responsible for the sequela (i.e. burn = injury, scar = sequela)

18. Implementation of ICD-10  Impact on CPT Codes?  CPT codes and HCPCS codes will not change  CPT codes will be used for billing the same as they were for ICD-9  It may be more difficult for payers to create lists of “reimbursable” codes  Claim form changes?  CMS has a revised version (paper form) of the 1500 claim form – allows up to 12 diagnosis codes on the form  Submitting on paper form – had to begin using revised form for DOS 4-01-14  Electronic version of 1500 form (837P) allows for 9 diagnosis codes  Electronic version of UB-04 (837I) allows for up to 27 diagnosis codes

19. Implementation of ICD-10  CMS requirements  Cannot accept claims with ICD-9 codes after September 30  Cannot accept claims with both ICD-9 and ICD-10 codes  ICD-10-CM (primarily outpatient facilities)  Date of service is the date service is provided, NOT the date of the claim  ICD-10-PCS (inpatient facilities)  Date of service defined as the date of discharge.  Patient admitted 9/05, DC 10/02: must use ICD-10 codes

20. Documentation for ICD-10  ICD-10 coding requires supporting documentation  Tell each patient’s complete “story”  Include details to support codes  Type of injury  Location of injury or symptoms (laterality)  Description of symptoms  Description of functional limitations  Comorbidities (other existing medical diagnoses)  External cause – including description of trauma, accident, what forces or machinery was involved.

21. Documentation for ICD-10: Example  Trauma Example: Patient is a [dominance, age, and gender] referred to [physical/occupational/speech] therapy for a [insert injury here, detailed as to laterality, anatomical location and characteristics] due to [exactly what happened]. Patient has [level of pain] and [joint stiffness? edema?] in her [affected joint/s].

22. Documentation for ICD-10: Example  Entrapment Neuropathy Example: Patient is a [dominance, age, and gender] referred to [physical/occupational/speech] therapy for [specific entrapment neuropathy, detailed as to laterality and nerve involved]. Patient complains of [pain, stiffness, atrophy, etc.] of the [specific body part].

23. Documentation for ICD-10: Example  TBI Example: Patient is a [dominance, age, and gender] referred to [physical/occupational/speech] following a [describe specific type of brain injury and details about length of loss of consciousness]. Patient presents with [-paresis or -plegia and type, laterality, and dominance] and [gait pattern? joint contracture? pain?].

24. Documentation for ICD-10: Example  Additional neurological information…

25. Documentation for ICD-10: Example  Non-traumatic musculoskeletal Example: Patient is a [dominance, age, and gender] referred to [physical/occupational/ speech] for complaints of [specific complaints—pain? stiffness? swelling?] of her [specific body part] following [type of activity or event that precipitated symptoms]. Patient was diagnosed with [specific diagnosis] and referred to [PT/OT/ST] to allow her to return to [e.g. pain free use of body part during a specific activity].

26. Coding Tools ICD-10 Coding Books Cross Walks And Cross Mapping Guides (GEMs) General Equivalency Mappings (CMS resources)

27. Coding Guidelines  General Guidelines – Follow 1-2-3 format  1. Code what you treat – always list treating diagnosis (es) first on claim form  2. Code medical diagnoses – comorbidities, other medical conditions  3. Code Injury and External causes of injury – last on claim form but important in telling patient story

28. Coding Guidelines  GEMs – Alphabetical and Tabular Index  1 st order of business: Download Indices:  Cms.gov > Medicare (top left) > ICD-10 (mid page under Coding) > 2015 ICD-10 CM and GEMs > 2015 Code Tables and Index (ZIP file)  Right click on “Index” PDF file, select copy, then paste onto desktop. Do the same for the “Tabular” PDF file.

29. Coding Guidelines www.cms.gov

30. Coding Guidelines

31. Right click on the Adobe PDF version of the index, select copy, then paste onto your desktop. Repeat with the Adobe PDF version of the tabular.

32. Coding Guidelines – ABC Index  Search ABC Index first  Gives initial characters of your code  Dash (-) at the end of a code indicates more characters needed  Find complete code in Tabular Index (always verify in tabular)  Search ABC Index using one-word terms if possible  Go to first letter of the word you are searching before you begin the search  i.e. “Pain” – go to “P” then open search field “Sprain” – go to “S” then open search field

33. Coding Guidelines – ABC Index

35. Coding Guidelines – Tabular Index  Selection of complete codes - only done in tabular  Include laterality  No bilateral codes (use both left and right codes)  Avoid “unspecified” codes for laterality  Include 7 th character (when applicable)  Look at group heading to see if 7 th character needed  Required for traumatic injuries and external causes

36. Coding Guidelines – Tabular Index  Divided by “Chapters”  There is a table of contents at beginning of index  Each “chapter” has an additional table of contents

37. Coding Guidelines – Tabular Index  Common “therapy” chapters  E (Ch. 4): Endocrine, metabolic diseases  G (Ch. 6): Neurological conditions  M (Ch. 13): Musculoskeletal conditions  R (Ch. 18): Symptoms, signs, abnormal clinical findings (i.e. abnml gait, ataxia, abnml posture, dizziness, speech symptoms, etc…)  S/T (Ch. 19): Traumatic injuries (due to external causes – 7 th char.)  V-Y (Ch. 20): External causes, tell how injury occurred (7 th char.)

38. Coding Guidelines – Tabular Index  Chapter 4 (E) - Endocrine, nutritional and metabolic diseases (E00-E89)  Diabetes Mellitus – (E08-E13)  Obesity, overweight, hyperalimentation – (E65-E68)  Specificity of coding co-morbidities  Code only what you know  i.e. DM with or without complications: do not assume complications if they are undiagnosed or unclear.

39. Coding Guidelines – Tabular Index  Chapter 6 (G): Diseases of the Nervous System (G00- G99)  G10-G14: Systemic atrophies primarily affecting central nervous system (i.e. Huntington’s, ALS, post polio)  G20-G26: Extrapyramidal and movement disorders (i.e. Parkinson’s disease, Dystonia, Spasmodic Torticollis)  G30-G37: Other degenerative diseases, demyelinating diseases of CNS (i.e. Alzheimer’s, Dementia, Multiple Sclerosis)  G50-G59: Nerve, nerve root and plexus disorders (i.e. facial/cranial nerve disorders, Bell’s palsy, carpal tunnel syndrome, nerve lesions)  G80-G83: Cerebral palsy and other paralytic syndromes (i.e. CP, hemiplegia, monoplegia, paraplegia, quadriplegia)

40. Coding Guidelines – Tabular Index  Chapter 13 (M): Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)  M00-M19: arthropathies, inflammatory joint conditions, arthritis (inflammatory/ bacterial arthritis, joint infections, RA/JRA, gout, OA, etc…)  M40-M54: Dorsopathies, spondylopathies (i.e. kyphosis, scoliosis, spondylosis, ankylosing spondylitis, spinal stenosis, intervertebral disc disorders, etc…)  M60-M67: Disorders of muscles, synovium and tendon (i.e. Myositis, non-traumatic tears/ruptures of muscle, contractures, muscle wasting/atrophy, synovitis, etc…)

41. Coding Guidelines – Tabular Index  Chapter 13 (M): Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)  M70-M79: Other soft tissue disorders (“itis” conditions - i.e. bursitis, tendonitis, overuse disorders, adhesive capsulitis, IT Band syndrome, etc..)  M80-M85: Disorders of bone density and structure (i.e. osteoporosis with and without fractures, osteomalacia, etc…)  M96: Intraoperative and post-procedural complications and disorders of musculoskeletal system

42. Coding Guidelines – Tabular Index  Chapter 18 (R): Symptoms, signs, abnormal clinical and laboratory findings (R00-R99)  R25-R29: Sx’s/signs involving nervous and musculoskeletal system (i.e. abnormality of gait, ataxia, difficulty walking, abnormal posture, dizziness, speech symptoms, etc…)  R40-R46: Sx’s/signs involving cognition, perception, emotional state, behavior (i.e. Coma scales, senility, dizziness, attention/concentration deficits, etc..)  R47-R49: Sx’s/signs involving speech and voice (i.e. dysarthria, apraxia, dysphasia, aphasia, etc…)  R50-R69: General symptoms and signs (i.e. headache, malaise/fatigue, delayed developmental milestones, etc…)

43. Coding Guidelines – Tabular Index  Chapter 19 (S/T): Injury, poisoning and certain other consequences of external causes (S00-T88)  Sprains, strains, dislocations, fractures, burns, ligament disruptions, etc…  Current, acute or traumatic injury codes (not chronic or recurrent)  Multiple injuries or fractures – code each separately  Fracture  Displaced vs non-displaced? Code displaced  Open vs closed? Code closed  7 th character required for injury codes

44. Coding Guidelines – Tabular Index  Chapter 20 (V00-Y99): External causes of morbidity  Tells how injury occurred  Codes from this Chapter will always be used secondary to a code from another chapter  Slips/trips, falls, transportation accidents, assault, exposure to animate/inanimate forces, complications of med/surg care, etc…  Helps insurance companies understand how injury occurred and why they need therapy  7 th character required

45. Coding Guidelines – Tabular Index  Searching Tabular Index  Open search field in index (Ctrl + F)  Enter the characters found in the ABC index to take you to appropriate diagnosis “group”  Once in the right area, you can do additional search  Ankle sprain (right CFL) – Example:  ABC > “S” > search “Sprain” > look for “ankle” > S93.40 –  Tabular search field > enter S93.40  Locate correct code (S93.411)

46. Coding Guidelines – Tabular Index

47.  Go to top of the section to see if 7 th character is required (Sprain is an injury – 7 th character should be expected)

48. Coding Guidelines – Tabular Index  Direct search in Tabular Index  Open appropriate “chapter” in tabular before beginning search  i.e. Ch. 6 (G) to search for neurological disorders (CP, hemiplegia…)  Use search field once in correct chapter (Ctrl + F)  Search key words rather than entire diagnosis  “Tab” through search results or further define search

49. Coding Guidelines – Tabular Index

50.  Injury codes: Can search directly in tabular  Ch. 19 (S00-T88): Injury, poisoning and other consequences…  Use search field once in correct chapter (Ctrl + F)  Search specific injury  Fracture of (bone), sprain of (ligament), dislocation of (joint), etc…  “Tab” through search results or further define search  7 th character required on traumatic injury codes

51. Coding Guidelines – Tabular Index  Injury code search example: Right ankle sprain ATFL  Search specific ligament (“sprain of talofibular”)  Code S93.491? (7 th character required for traumatic injury)

52. Coding Guidelines – Tabular Index  External Cause codes: search directly in tabular  Ch. 20 (V00-Y99): External Causes of Morbidity  Go to Table of Contents at the beginning of Ch. 20 in Tabular  In FIND field enter search term (i.e. fall, fire, knife, poison, accident) OR look through the options in the Table.  Try to narrow search field by finding most appropriate section (click on active heading link)

53. Coding Guidelines – Tabular Index  External Cause codes: search directly in tabular

54. Coding Guidelines – Tabular Index  Once in related section, further define your search  In FIND field, use 1-2 word search terms  i.e. knife, animal (fall from/over animal), motorcycle, car, truck, boat, etc…  Tab through selections to find appropriate one (or scroll)  Learning appropriate “key” search words will take some practice!

55. EXAMPLE - Lymphedema  42 y.o. female, right hand dominant, 1 month s/p left breast mastectomy due to breast cancer, with lymph node removal. Patient c/o left arm swelling, pain left arm and forearm.  1.) What are we treating:  Post-mastectomy lymphedema syndrome  Pain of left upper arm  Pain of left forearm

56. EXAMPLE - Lymphedema  Post-mastectomy lymphedema syndrome:  Search “lymphedema” in ABC index (I97.2)

57. EXAMPLE - Lymphedema  Search I97.2 in tabular index to verify complete code

58. EXAMPLE - Lymphedema  Pain Left upper arm and forearm:  Search “pain” in ABC index (Go to “P” section first)  Then search “limb” (forearm M79.63- ; upper arm M79.62-)

59. EXAMPLE - Lymphedema  Search M79.63- and M79.62- in ABC index to find complete codes (M79.632; M79.622)

60. EXAMPLE - Lymphedema  2.) Co-morbidities, complicating factors:  Breast cancer – search “cancer” in ABC index (C50.91-)

61. EXAMPLE - Lymphedema  Search C50.91 in tabular index to find complete code  C50.912 – left breast, female, neoplasm

62. EXAMPLE - Lymphedema  3.) Injury/external causes:  Not applicable in this case  Injuries and external causes are only for acute, traumatic injuries  7 th characters only required on injury and external cause codes

63. EXAMPLE – Ankle sprain  17 yo high school student who suffered a grade 2 Right ankle sprain 2 days ago during a football game when an opposing player struck his leg. Patient presents straight to PT without seeing a physician (Direct Access). Findings include: pain and edema in R ankle, using crutches for ambulation with instability in the R ankle.  FIRST : Determine diagnosis categories you will need to search (treating diagnoses first):  Primary: Pain, Edema (use effusion), Instability  Secondary: Sprain, External Cause/Mechanism of Injury (Hit or strike another person). 42

64. EXAMPLE – Ankle sprain  SECOND: Search each category in ABC index (Remember, go to the first letter of a word before you begin the search).  Pain – ABC index > P > Search “Pain” > Enter (scroll down to “joint” under pain heading). Find “ankle” = M25.57- (- indicates another character needed).  Tabular Index > Ctrl/F > M25.57 > Enter.  Find Pain Right ankle = M25.571

65. EXAMPLE – Ankle sprain  Ankle Pain – ABC Index (search Pain, then do add’l search for “joint” once in pain section – or just scroll down…) Pain ankle joint M25.57-

66. EXAMPLE – Ankle sprain  Ankle Pain – Tabular Index (complete code for laterality)  R epeat the process for Effusion (M25.471), Instability (M25.371) Pain R ankle M25.571

67. EXAMPLE – Ankle sprain  Injury Code: Sprain of ATFL (Can search directly in tabular): Example of direct search in Tabular Index… Sprain R Ankle S93.491A

68. EXAMPLE – Ankle sprain  External Cause code: (search directly in tabular Ch. 20):  Hit or strike (accidentally) by another person – W50.0- - - W50.0XXA

69. EXAMPLE – Bursitis of Shoulder  61 yr old male who began experiencing left shoulder pain 3 weeks ago after repetitively lifting rocks to build a garden wall. Patient was seen by his physician and was diagnosed with shoulder bursitis. Pain is rated at 7/10 with activity, 3/10 resting.  FIRST: Determine diagnosis categories you will need to search (treating diagnoses first):  Primary (treating): Pain  Medical: Bursitis  External cause: None, was a repetitive motion injury

70. EXAMPLE – Bursitis of Shoulder Bursitis – Left shoulder pain: Index M25.51-

71. EXAMPLE – Bursitis of Shoulder Bursitis – Left shoulder pain: Tabular (Search M25.51) M25.512 Pain Left shoulder

72. EXAMPLE – Bursitis of Shoulder Bursitis: Index (scroll down to find the specific site…) M75.5-

73. EXAMPLE – Bursitis of Shoulder Bursitis: Tabular (Search M75.5) M75.52 Left shoulder bursitis

74. EXAMPLE – Traumatic Subdural Hemorrhage  64 y.o. right hand dominant male was driving a pick up truck when he was involved in an MVA where he was struck by an oncoming car. Patient sustained a subdural hematoma, and was unconscious for 45 minutes. He now presents with right spastic hemiplegia and ataxic gait pattern.  FIRST: Determine diagnosis categories you will need to search (treating diagnoses first):  Primary (treating): Ataxic gait  Medical: R spastic hemiplegia, Traumatic subdural hematoma (hemorrhage) with LOC 45 minutes  External cause: Pick up truck, hit by a car

75. EXAMPLE – Traumatic Subdural Hemorrhage  Second : Search ABC Index for treating and medical diagnoses  Third: Verify complete codes in Tabular  Fourth : Search injury and external cause codes directly in Tabular index

76. EXAMPLE – Traumatic Subdural Hemorrhage  Ataxic gait: ABC Index  Verify the code in Tabular Index Ataxic Gait R26.0

77. EXAMPLE – Traumatic Subdural Hemorrhage  Right Spastic Hemiplegia: ABC Index  Find complete code in Tabular Index Spastic hemiplegia G81.1-

78. EXAMPLE – Traumatic Subdural Hemorrhage  Right Spastic Hemiplegia: Tabular  Complete code for laterality, type, dominance Spastic hemiplegia Right dominant G81.11

79. EXAMPLE – Traumatic Subdural Hemorrhage  Traumatic subdural hemorrhage: ABC Index?  Search directly in Tabular – Chapter 19 (injuries) Traumatic Subdural Hemorrhage with LOC 31-59 min S06.5X2?

80. EXAMPLE – Traumatic Subdural Hemorrhage  Traumatic subdural hemorrhage: 7 th character?  Look at top of chapter (S06) to determine Traumatic Subdural Hemorrhage with LOC 31-59 min S06.5X2S (Sequela)

81. EXAMPLE – Traumatic Subdural Hemorrhage  External cause – (MVA – pick up truck hit by car)  Search directly in Tabular – Chapter 20 Click the Link to the most appropriate section

82. EXAMPLE – Down Syndrome  6 y.o. male referred to Speech Therapy with Down Syndrome (Trisomy 21) due to stuttering/unintelligible speech and mixed receptive-expressive language disorder with receptive language stronger than expressive language.  FIRST: Determine diagnosis categories you will need to search (treating diagnoses first):  Primary (treating): Mixed receptive-expressive language disorder and childhood onset fluency disorder  Medical: Down Syndrome  External cause/Injury: None

83. EXAMPLE – Down Syndrome  Second : Search ABC Index for treating and medical diagnoses  Third: Verify complete codes in Tabular  No injury or external cause codes

84. EXAMPLE – Down Syndrome  Mixed receptive-expressive language disorder – ABC Index (search “aphasia”)  Verify/complete code in Tabular Index Developmental Aphasia Receptive- Expressive F80.2 ?

85. EXAMPLE – Down Syndrome  Mixed receptive-expressive language disorder - Verify/complete code in Tabular Index F80.2

86. EXAMPLE – Down Syndrome  Childhood Fluency Disorder – ABC (disorder, fluency)  Verify/complete code in Tabular Index Fluency disorder F80.81

87. EXAMPLE – Down Syndrome  Childhood Fluency Disorder – Verify in Tabular Index Childhood onset Fluency disorder F80.81

88. EXAMPLE – Down Syndrome  Down Syndrome – ABC Index  Verify/complete code in Tabular Index Down Syndrome Q90.9

89. EXAMPLE – Down Syndrome  Down Syndrome – Verify code in Tabular Index Down Syndrome Trisomy 21 NOS Q90.9

90. Abnormality of Gait ICD-9 to ICD-10 Diagnosis Abnormality of gait ICD-9 781.2 ICD-10 R26.0 Ataxic Gait R26.1 Paralytic Gait R26.81 Unsteadiness on feet R26.89 Other Abnormalities of Gait and Mobility R26.9 Unspecified Abnormalities of Gait and Mobility

91. Carpal Tunnel Syndrome ICD-9 to ICD-10 Diagnosis Carpal Tunnel Syndrome Other Lesion Median nerve ICD-9 354.0 354.1 ICD-10 G56.01 CTS R upper limb G56.02 CTS L upper limb G56.11 Other lesions of median n. R upper limb G56.12 Other lesions of median n. L upper limb

92. Cerebral Palsy ICD-9 to ICD-10 Diagnosis Diplegic Infantile CP Hemiplegic Infantile CP Quadriplegic Infantile CP Monoplegic Infantile CP Athetoid Cerebral Palsy ICD-9 343.0 343.1 343.2 343.3 333.71 ICD-10 G80.1 Spastic Diplegic CP G80.2 Spastic Hemiplegic CP G80.0 Spastic Quadri- plegic CP G80.8 Other CP G80.3 Athetoid Cerebral Palsy

93. Dizziness & Vertigo ICD-9 to ICD-10 Diagnosis Dizziness and Giddiness Benign Paroxysmal Vertigo ICD-9 780.4 386.11 ICD-10 R42 Dizziness and giddiness H81.11 BPV Right Ear H81.12 BPV Left Ear H81.13 BPV Bilateral

94. Joint Replacements ICD-9 to ICD-10 Diagnosis Right Shoulder Jt. Left Shoulder Jt. R THA L THA Bilateral THA R TKA L TKA Bilateral TKA ICD-9 V43.61 V43.64 V43.65 ICD-10 Z96.611 Presence R artificial shldr jt. Z96.612 Presence L artificial shldr jt. Z96.641 Presence R artificial hip jt. Z96.642 Presence L artificial hip jt. Z85.643 Presence BIL artificial hip jt. Z96.651 Presence R artificial knee jt Z96.652 Presence L artificial knee jt Z96.653 Presence BIL artificial knee jt.

95. Muscular Dystrophy (MD) ICD-9 to ICD-10 Diagnosis Congenital Hereditary Muscular Dystrophy Hereditary Progressive Muscular Dystrophy Myotonic Muscular Dystrophy ICD-9 359.0 359.1 359.21 ICD-10 G71.2 Congenital Myopathies G71.0 Muscular Dystrophy (incl. Becker, Congenital, Duchenne) G71.11 Myotonic Muscular Dystrophy

96. Nervous System Diseases ICD-9 to ICD-10 Diagnosis Multiple Sclerosis Parkinson’s Secondary Parkinsonism. Bell’s Palsy ICD-9 342 332.0 332.1 351.0 ICD-10 G35 G20 G21.11 Neuroleptic induced Parkinsonism G21.19 Other drug-induced Parkinsonism G51.0

97. Women’s & Men’s Health ICD-9 to ICD-10 Diagnosis Female Stress Incontinence Male Stress Incontinence Urge Incontinence Mixed urge/stress incont. Incontinence without sensory awareness Damage to Pelvic Joints & Ligaments w/delivery Damage to Pelvic Joints & Ligaments postpartum ICD-9 625.6 788.32 788.31 788.33 788.34 665.61 665.64 ICD-10 N39.3 Stress Incontinence female N39.3 Stress Incontinence male N39.41 Urge Incontinence N39.46 Mixed Incontinence N39.42 Incontinence Without Sensory Awareness O71.6 Obstetric damage to Pelvic Joints & Ligaments O71.6 Obstetric Damage to Pelvic Joints & Ligaments

98. Additional Resources  ICD-10 Coding Books  ICD-10-CM 2015, The Complete Official Draft Code Set, American Medical Association, 2014  ICD-10-CM Mappings 2015, Linking ICD-9 CM to All Valid ICD-10-CM Alternatives, American Medical Association, 2014 (https://commerce.ama-assn.org/store/catalog /categoryDetail.jsp?category_id=cat1150004&nav Action=jump)

99. Additional Resources  American Hospital Association (AHA): Provides coding advice – as of 1/01/14 began focusing on ICD-10 questions only, no longer addressing ICD-9 questions. Questions can be submitted or tracked at their site: www.codingclinicadvisor.com www.codingclinicadvisor.com  CMS Ombudsman: William Rogers (director of CMS’ Physicians Regulatory Issues Team). Email questions to: ICD10 _ omsbudsman@CMS.HHS.gov ICD10 _ omsbudsman@CMS.HHS.gov  CMS Road to 10: Multiple resources, educational and instructional tools to assist with transition to ICD-10: www.roadto10.orgwww.roadto10.org  Gawenda Seminars: rick@gawendaseminars.comrick@gawendaseminars.com  CMS site has multiple resources. Go to www.cms.gov click on ICD-10 under “coding”, then choose “provider resources.” You will find multiple provider educational tools including a clinical documentation videowww.cms.gov

100. References  Rick Gawenda, PT: www.gawendaseminars.comwww.gawendaseminars.com  CMS: www.cms.govwww.cms.gov  AAPC: http://www.aapc.com/ICD-10/codes/http://www.aapc.com/ICD-10/codes/  CMS Road to 10: www.roadto10.orgwww.roadto10.org  CMS and AHA webinar (national provider calls): Resources can be found at www.cms.gov/npcwww.cms.gov/npc

101. Contact Us  If you need to contact us with questions or comments, please email us at: Tabitha Harris, PT, DPT, OCS tharris@benchmarkpt.com Steven Spinks, DPT, COMT sspinks@benchmarkpt.com HAPPY CODING!