District 10 Hot Topics Presentation 10-15-2014

“Moving Over…
Transition from a School
to a Medical Position”
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
• 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
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.
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:
•Cognitive decline/Dementia
•Neuro disorders:
Parkinsons, CVA, TBI, Huntington’s Disease, ALS, MG
Continuing Education Sources:
• ASHA Healthcare Institute
• Northern Speech Services
• Speechpathology.com
• Medical Speech Council of California:
• Gerentology: Special Interest Group 15, Gerontology
• Dysphagia:
Special Interest Group 13, Swallowing and
Swallowing Disorders (Dysphagia)
• Neurogenics:
Special Interest Group 2, Neurophysiology and
Neurogenic Speech and Language Disorders.
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
• 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
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
Billing and Coding: Procedure Codes
• The code to indicate what procedure that you have completed with the
• 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
• 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
• Multiple diseases/conditions/illnesses
• Affects of multiple medications
Tests for use with the adult/geriatric population
Communication Activities of Daily Living (CADL-2)
Burns Brief Inventory of Communication and Cognition (Burns Inventory)
My Favorite Materials…
• Show and Tell…
• Source for…books from Linguisystems
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
[email protected]
• (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
• Swigert, Nancy. Decoding the Coding Systems: When, How and Why to
Code What
• Swigert, NancyUnderstanding the Physiology of Impaired Pharyngeal
• Ludlow, Christy. The Effects of Transcutaneous Electrical Stimulation
During Dysphagia Management: What it does and whether it alters
• Prakup, Barbara. What Should I Do? Ethical Considerations for SLPs who
Work with Adults
• (See handout for additional courses)
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