“Moving Over… Transition from a School to a Medical Position” Presenter: Linda K Pippert , MA, CCC-SLP, MBA Vice President, Clinical Operations AlphaVista Services Adjunct Faculty: Chapman University, Extended Ed CSU Fullerton, Adult Clinic Supervisor Nova Southeastern University, Field Associate for Southern California Course Objectives: Participants will be able to • Determine if a transition from a school-based position to a medical setting is a career move to consider. • Identify and name sources and topics related to continuing education that would prepare one for a transition to a medical placement. • Explore options for establishing a mentoring relationship with an SLP in the targeted setting. What’s involved in making a change? •Personal Aspects •Clinical Aspects •Professional Growth/Interest •Continuing Education •Training •Materials What will be the same…different? • You…will still be the SLP • You will be called the speechlanguage pathologist. • You…will still be making decisions about care. • You will be making decisions about communication, • You…will still have other interacting with family and professionals to work with healthcare workers. • You…will still be the “expert” on speech, language, cognitive and • You will be working with doctors, nurses, CNAs, RNAs, swallowing disorders. PTs, OTs • You…will still be the one who knows most about hearing and • You will be called upon to determine diet hearing disorders. levels…everyday Change: What is change to you? • Are you someone who shies away from change? • Are you someone who accepts change? (but would rather stay with the status quo) • Are you someone who chases after change? Key Factors to Consider… • How much prep will I need? • When will I access the continuing ed that I will need to prepare for a change in work settings? • How much am I willing to invest in change? • Do I have a mentor to assist me with this transition? • What is my lead time for making a career transition? Key Factors to Consider… • What kind of medical setting do you envision yourself in? • Have you had any prior experience in a medical setting? • Did you have a great externship in grad school and “don’t want to lose” those skills? • How far am I willing to travel for a medical position? • Am I will to change facilities mid-day? Key Factors to Consider… • How many hours a week do I want to work a medical position? • Will working with trachs and vents “gross” me out? • Will working with swallowing disorders be disturbing? • Do I have a strong support system should I make this change to a permanent position? Things to consider… • Personal Aspects • Clinical Aspects • Professional Growth/Interest • Continuing Education • Training • Materials Continuing Education Topics: •Dysphagia •Cognitive decline/Dementia •Neuro disorders: Parkinsons, CVA, TBI, Huntington’s Disease, ALS, MG Continuing Education Sources: • ASHA Healthcare Institute • ASHA • CSHA • Northern Speech Services • Speechpathology.com • Medical Speech Council of California: www.msccslpceus.org ASHA SIDs • Gerentology: Special Interest Group 15, Gerontology http://www.asha.org/SIG/15/ • Dysphagia: Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia) http://www.asha.org/SIG/13/ • Neurogenics: Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders. http://www.asha.org/SIG/02/ On-line Networks • Facebook (FB): Closed groups, but you can request to join. • Medical SLP Forum • https://www.facebook.com/groups/medicalslpforum/ • Adult Rehab Speech Therapy • https://www.facebook.com/groups/adultrehabspeechthera py/ • Brainline.org https://www.facebook.com/brainline Other ASHA Resources • http://www.asha.org/practice-portal/about/ • Clinical Topics: • Aphasia • Dementia “Search” on the ASHA Web Site: Access to articles and many PPTs from past ASHA Conventions! Billing and Coding: Diagnostic Codes • Diagnostic Codes: ICD-9s are still in use until October, 2015. • Here are some commonly used ICD-9s for medical facilities: • The “Medical Diagnosis” eg the diagnosis given by a medical doctor. • The “Treatment Diagnosis” eg the diagnosis given by the SLP • The “Medical Diagnosis” will be an illness, injury or disease, such as Parkinson’s Disease: ICD-9 332 CVA: ICD-9 436 ** 2014 ICD-9-CM Diagnosis Codes: Related to Speech and Hearing Disorders is available on the ASHA Web site. Billing and Coding: Diagnostic Codes • The “Treatment Diagnosis” will be the diagnosis which the SLP determines • • • • • 784.3 Aphasia 784.3 Voice Disturbance 784.40 Voice and resonance disorder, unspecified 784.41 Aphonia 784.42 Dysphonia, Hoarseness • 784.51 Dysarthria • 784.60 Symbolic dysfunction, unspecified • • • • • • 787.2 Dysphagia 787.20 Dysphagia, unspecified 787.21 Dysphagia, oral phase 787.22 Dysphagia, oropharyngeal phase 787.23 Dysphagia, pharyngeal phase 787.24 Dysphagia, pharyngoesophageal phases http://www.asha.org/practice/reimbursement/coding/SLPCodes.htm Billing and Coding: Diagnostic Codes • “Treatment Diagnosis” related to CVA • 438 Late effects CVA • 438.1 Late effects, CA Speech/Language Deficits • 438.11 Late effects CVA Aphasia • 438.12 Late effects CVA Dysphasia • 438.81 Late effects CVA Apraxia • 438.82 Late effects CVA Dysphagia http://www.asha.org/practice/reimbursement/coding/SLPCodes.htm Billing and Coding: Procedure Codes • The code to indicate what procedure that you have completed with the patient: • Evaluation Codes • 92521 Evaluation of Speech Fluency • 92522 Evaluation of Speech Sound Production: artic, phono, apraxia, dysarthria • 92523 Evaluation of Speech Sound Production with Evaluation of Language Comprehension and Expression • 92524 Behavioral and Qualitative Analysis of Voice and Resonance • 92610 Evaluation of Oral and Pharyngeal Swallowing Function • 92611 Motion Fluoroscopic Evaluation of Swallowing Function by cine or video recording • 96105 Assessment of Aphasia • 96125 Standardized Cognitive Performance Testing (eg RIPA-G, ABCD, etc) per hour. Billing and Coding: Procedure Codes • The code to indicate what procedure that you have completed with the patient: • Treatment Codes • 92507 Speech Therapy, Individual • 92508 Speech Therapy, Group • 92626 Dysphagia Treatment • 92532 Cognitive Treatment Working in a Skilled Nursing Facility • Part-A: Up to 100 days of “skilled care” (nursing and/or rehab) following a 3-day “qualifying stay” in an acute hospital • Part-B: Out-patient therapy, but may be provided at an acute hospital, rehab or Skilled Nursing Facility (SNF) • Working with Geriatrics: • Changes in the physical condition due to aging: skin, respiratory/circulatory systems, eye sight, hearing, bone condition. • Multiple diseases/conditions/illnesses • Affects of multiple medications Tests for use with the adult/geriatric population • • • • • • • • Communication Activities of Daily Living (CADL-2) ABCD RIPA-G WAB BDAE CLQT E/ROWPVT-4 Burns Brief Inventory of Communication and Cognition (Burns Inventory) My Favorite Materials… • Show and Tell… • Source for…books from Linguisystems • • • • • Aphasia Dysphagia Alzheimer’s and Dementia Executive Function Disorders Also from Linguisystems • Results for Adults • Just For Adults Photo Cards • VNA Books: Kathryn Kilpatrick English and Spanish (See Handout for books, workbooks, textbooks) Contact Information •Linda K Pippert, MA, CCC-SLP, MBA Pippert.linda@gmail.com 714-932-3931 References • (Handout has a complete list) • ASHA Web site: • Examples of Documentation of Skilled and Unskilled Care for Medicare Beneficiaries: Speech-Language Pathology Services • Medicare Coding Rules for SLP Services • Coding for Reimbursement FAQs: SLP • 2014 ICD-9-CM Diagnosis Coding: Related to Speech and Hearing Disroders • “Search” for the disorder that you are interested in learning more about: • Apraxia • Dysarthria • Dysphagia • Aphasia • Cognitive Decline • Dementia Courses on Speechpathology.com • O’Hara, Lorelei. Medicare Muscle: Creating Defensible Documentation • Swigert, Nancy. Documenting to Demonstrate Skilled Service and Focus on Function • Swigert, Nancy. Decoding the Coding Systems: When, How and Why to Code What • Swigert, NancyUnderstanding the Physiology of Impaired Pharyngeal Swallowing • Ludlow, Christy. The Effects of Transcutaneous Electrical Stimulation During Dysphagia Management: What it does and whether it alters recovery • Prakup, Barbara. What Should I Do? Ethical Considerations for SLPs who Work with Adults • (See handout for additional courses)