Transition to ICD-10
DON’T PANIC….. PREPARE!!!
Tabitha Harris, PT, DPT, OCS
Steven Spinks, DPT, COMT
OBJECTIVES

Understand the history of ICD-10

Identify when a 7th character is
required in ICD-10 coding

Understand and describe the
primary differences between
ICD-9 and ICD-10

Define initial & subsequent
encounter and sequela

Understand how to report and
bill ICD-10 codes appropriately
(outpatient specific)

Ability to apply correct ICD-10
coding concepts to PT, OT and
SLP (outpatient specific)

Ability to apply appropriate
documentation principles to
support ICD-10 codes

Ability to identify, find and utilize
appropriate resources for ICD10 coding
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?
HISTORY of Coding

W.H.O. began working on 10th 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!
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ICD-9 is outdated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
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
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”
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.
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
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
Benefits of ICD-10 transition?
 Allows
greater detail in reporting on:
 Laterality
 Preventive
 Lifestyle
health measures
related problems
 Socioeconomic
 Comorbidities
factors
– contributing factors
ICD-9 vs ICD-10: Major Differences
ICD-9
ICD-10

3-5 characters

3-7 characters

1st character numeric or alpha

1st character always alpha

2-5th characters always numeric

2nd character always numeric

3-7th characters alpha or numeric

Decimal occurs after 3rd character

Has laterality of affected side

Approximately 70,000 diagnosis
codes

May use placeholder (X)

Decimal occurs after 3rd
character

No laterality of affected side

Just over 14,000 diagnosis codes

No place holders used
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 7th 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
ICD-10-CM
th
“7 ”
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 7th character:
 “A”
= Initial Encounter
 “D”
= Subsequent Encounter
 “S”
= Sequela
(Exception: Fractures have additional 7th characters)
ICD-10-CM
th
“7 ”
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
ICD-10-CM
 Subsequent
th
“7 ”
Character – D
encounter
 Used
for encounters after the patient has
received treatment for a condition
 While
receiving routine care for condition
 During
 Most
healing/recovery phase
common character used in therapies
ICD-10-CM
th
“7 ”
Character – S
 Sequela
 Used
for conditions or complications that
have arisen as a direct result of a condition
 Ataxia
 Scar
 Must
S
as a result of CVA
formation as a result of a burn
code both the injury and the sequela
character identifies the injury responsible for
the sequela (i.e. burn = injury, scar = sequela)
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

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
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
 External
(other existing medical diagnoses)
cause – including description of trauma, accident,
what forces or machinery was involved.
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].
[detailed as to laterality, anatomical location and characteristics]
What are great examples of this?
NOT: (too vague)
Open, displaced compound
Torn ligament
fracture of the right humerus
Non-displaced, closed fracture of
Fractured wrist
the left radius
Complete rupture of the ACL of
RCT
her left knee
[exactly what happened]
What are great examples of this?
NOT: (too vague)
Patient fell while climbing stairs
MVA
into her house
Patient was a passenger in an
Fall
sedan hit by another sedan
Patient fell off a boat and was
Poor balance
struck by a boat propeller
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].
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?].
Documentation for ICD-10: Example

Additional neurological information…
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].
Coding Tools
ICD-10
Coding
Books
Cross
Walks
And
Cross
Mapping
Guides
(GEMs)
General
Equivalency
Mappings
(CMS
resources)
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
Coding Guidelines
 GEMs
– Alphabetical and Tabular Index
 1st 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.
Coding Guidelines
www.cms.gov
Coding Guidelines
Coding Guidelines
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.
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
Coding Guidelines – ABC Index
Coding Guidelines – ABC Index
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 7th character (when applicable)
 Look
at group heading to see if 7th character needed
 Required
for traumatic injuries and external causes
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
Coding Guidelines – Tabular Index
 Common
E
“therapy” chapters
(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 – 7th
char.)
 V-Y
(Ch. 20): External causes, tell how injury occurred (7th
char.)
Coding Guidelines – Tabular Index

Chapter 4 (E) - Endocrine, nutritional and metabolic
diseases (E00-E89)
 Diabetes
 Obesity,

Mellitus – (E08-E13)
overweight, hyperalimentation – (E65-E68)
Specificity of coding co-morbidities
 Code
 i.e.
only what you know
DM with or without complications: do not assume
complications if they are undiagnosed or unclear.
Coding Guidelines – Tabular Index

Chapter 6 (G): Diseases of the Nervous System (G00G99)

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)
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…)
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
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…)
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

7th character required for injury codes
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

7th character required
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)
Coding Guidelines – Tabular Index
Coding Guidelines – Tabular Index
 Go to top of the section to see if 7th character is required
(Sprain is an injury – 7th character should be expected)
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
 “Tab”
key words rather than entire diagnosis
through search results or further define search
Coding Guidelines – Tabular Index
Coding Guidelines – Tabular Index

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”
 7th
through search results or further define search
character required on traumatic injury codes
Coding Guidelines – Tabular Index

Injury code search example: Right ankle sprain ATFL

Search specific ligament (“sprain of talofibular”)

Code S93.491? (7th character required for traumatic injury)
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)
Coding Guidelines – Tabular Index

External Cause codes: search directly in tabular
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!
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
EXAMPLE - Lymphedema

Post-mastectomy lymphedema syndrome:
 Search
“lymphedema” in ABC index (I97.2)
EXAMPLE - Lymphedema

Search I97.2 in tabular index to verify complete code
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-)
EXAMPLE - Lymphedema

Search M79.63- and M79.62- in ABC index to find complete
codes (M79.632; M79.622)
EXAMPLE - Lymphedema

2.) Co-morbidities, complicating factors:
 Breast
cancer – search “cancer” in ABC index (C50.91-)
EXAMPLE - Lymphedema

Search C50.91 in tabular index to find complete code

C50.912 – left breast, female, neoplasm
EXAMPLE - Lymphedema

3.) Injury/external causes:
 Not
applicable in this case
 Injuries
and external causes are only for acute,
traumatic injuries
 7th
characters only required on injury and external
cause codes
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
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
 Find
Index > Ctrl/F > M25.57 > Enter.
Pain Right ankle = M25.571
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-
EXAMPLE – Ankle sprain

Ankle Pain – Tabular Index (complete code for laterality)
Repeat the process for Effusion (M25.471), Instability (M25.371)
Pain R ankle
M25.571
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
EXAMPLE – Ankle sprain

External Cause code: (search directly in tabular Ch. 20):
 Hit
or strike (accidentally) by another person – W50.0- - -
W50.0XXA
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
EXAMPLE – Bursitis of Shoulder
Bursitis – Left shoulder pain: Index
M25.51-
EXAMPLE – Bursitis of Shoulder
Bursitis – Left shoulder pain: Tabular
(Search M25.51)
M25.512
Pain Left shoulder
EXAMPLE – Bursitis of Shoulder
Bursitis: Index
(scroll down to find the specific site…)
M75.5-
EXAMPLE – Bursitis of Shoulder
Bursitis: Tabular
(Search M75.5)
M75.52
Left shoulder bursitis
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
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
EXAMPLE – Traumatic Subdural Hemorrhage
 Ataxic
gait: ABC Index
 Verify
the code in Tabular Index
Ataxic Gait
R26.0
EXAMPLE – Traumatic Subdural Hemorrhage
 Right
Spastic Hemiplegia: ABC Index
 Find
complete code in Tabular Index
Spastic hemiplegia
G81.1-
EXAMPLE – Traumatic Subdural Hemorrhage
 Right
Spastic Hemiplegia: Tabular
 Complete
code for laterality, type, dominance
Spastic hemiplegia
Right dominant
G81.11
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?
EXAMPLE – Traumatic Subdural Hemorrhage

Traumatic subdural hemorrhage: 7th character?
 Look at top of chapter (S06) to determine
Traumatic
Subdural
Hemorrhage
with LOC
31-59 min
S06.5X2S
(Sequela)
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
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
EXAMPLE – Down Syndrome
 Second:
Search ABC Index for treating
and medical diagnoses
 Third:
 No
Verify complete codes in Tabular
injury or external cause codes
EXAMPLE – Down Syndrome

Mixed receptive-expressive language disorder – ABC
Index (search “aphasia”)
 Verify/complete
code in Tabular Index
Developmental
Aphasia ReceptiveExpressive
F80.2 ?
EXAMPLE – Down Syndrome

Mixed receptive-expressive language disorder Verify/complete code in Tabular Index
F80.2
EXAMPLE – Down Syndrome

Childhood Fluency Disorder – ABC (disorder, fluency)
 Verify/complete
code in Tabular Index
Fluency disorder
F80.81
EXAMPLE – Down Syndrome

Childhood Fluency Disorder – Verify in Tabular Index
Childhood onset
Fluency disorder
F80.81
EXAMPLE – Down Syndrome

Down Syndrome – ABC Index
 Verify/complete
code in Tabular Index
Down Syndrome
Q90.9
EXAMPLE – Down Syndrome

Down Syndrome – Verify code in Tabular Index
Down Syndrome
Trisomy 21 NOS
Q90.9
Abnormality of Gait
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Abnormality of gait
781.2
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
Carpal Tunnel Syndrome
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Carpal Tunnel Syndrome
354.0
G56.01 CTS R upper limb
Carpal Tunnel Syndrome
354.0
G56.02 CTS L upper limb
Other Lesion Median
nerve
354.1
G56.11 Other lesions of
median n. R upper limb
354.1
G56.12 Other lesions of
median n. L upper limb
Other Lesion Median
nerve
Cerebral Palsy
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Diplegic Infantile CP
343.0
G80.1 Spastic Diplegic
CP
Hemiplegic Infantile CP
343.1
G80.2 Spastic
Hemiplegic CP
Quadriplegic Infantile
CP
343.2
G80.0 Spastic Quadriplegic CP
Monoplegic Infantile CP
343.3
G80.8 Other CP
Athetoid Cerebral Palsy
333.71
G80.3 Athetoid
Cerebral Palsy
Dizziness & Vertigo
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Dizziness and Giddiness
780.4
R42
Dizziness and
giddiness
Benign Paroxysmal
Vertigo
386.11
Benign Paroxysmal
Vertigo
386.11
H81.12 BPV Left Ear
Benign Paroxysmal
Vertigo
386.11
H81.13 BPV Bilateral
H81.11 BPV Right Ear
Joint Replacements
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Right Shoulder Jt.
V43.61
Z96.611 Presence R artificial shldr jt.
Left Shoulder Jt.
V43.61
Z96.612 Presence L artificial shldr jt.
R THA
V43.64
Z96.641 Presence R artificial hip jt.
L THA
V43.64
Z96.642 Presence L artificial hip jt.
Bilateral THA
V43.64
Z85.643 Presence BIL artificial hip jt.
R TKA
V43.65
Z96.651 Presence R artificial knee jt
L TKA
V43.65
Z96.652 Presence L artificial knee jt
Bilateral TKA
V43.65
Z96.653 Presence BIL artificial knee
jt.
Muscular Dystrophy (MD)
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Congenital Hereditary
Muscular Dystrophy
359.0
G71.2 Congenital Myopathies
Hereditary Progressive
Muscular Dystrophy
359.1
G71.0 Muscular Dystrophy (incl.
Becker, Congenital, Duchenne)
Myotonic Muscular
Dystrophy
359.21
G71.11 Myotonic Muscular
Dystrophy
Nervous System Diseases
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Multiple Sclerosis
342
G35
Parkinson’s
332.0
G20
Secondary Parkinsonism
332.1
G21.11 Neuroleptic induced
Parkinsonism
Secondary Parkinsonism
332.1
.
Bell’s Palsy
G21.19 Other drug-induced
Parkinsonism
351.0
G51.0
Women’s & Men’s Health
ICD-9 to ICD-10
Diagnosis
ICD-9
ICD-10
Female Stress Incontinence
625.6
N39.3 Stress Incontinence female
Male Stress Incontinence
788.32
N39.3 Stress Incontinence male
Urge Incontinence
788.31
N39.41 Urge Incontinence
Mixed urge/stress incont.
788.33
N39.46 Mixed Incontinence
788.34
Damage to Pelvic Joints &
Ligaments w/delivery
N39.42 Incontinence Without
Sensory Awareness
665.61
Damage to Pelvic Joints &
Ligaments postpartum
O71.6 Obstetric damage to Pelvic
Joints & Ligaments
665.64
O71.6 Obstetric Damage to Pelvic
Joints & Ligaments
Incontinence without
sensory awareness
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)
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

CMS Ombudsman: William Rogers (director of CMS’ Physicians
Regulatory Issues Team). Email questions to:
ICD10_omsbudsman@CMS.HHS.gov

CMS Road to 10: Multiple resources, educational and instructional tools
to assist with transition to ICD-10: www.roadto10.org

Gawenda Seminars: rick@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
video
References

Rick Gawenda, PT: www.gawendaseminars.com

CMS: www.cms.gov

AAPC: http://www.aapc.com/ICD-10/codes/

CMS Road to 10: www.roadto10.org

CMS and AHA webinar (national provider calls):
Resources can be found at www.cms.gov/npc
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!