Today s Agenda. Coding in General. ICD 9 & CPT Codes. ICD 9 CM Coding 12/20/2011

Transcription

1 Texas Speech Language Hearing Association Business Institute Program: Welcome to the World of Coding Presented by: Janet McCarty, Private Health Plans Advisor American Speech Language Hearing Association Today s Agenda Coding in General ICD 9 CM Diagnostic Codes CPT Procedure Codes New Codes in 2012 is Coming! Coding in General In order to support your professional judgment as to the cause of the patient s condition and required treatment, you must be able to support your coding decisions with: patient history; physician referral information; evaluation results; and other documentation. ICD 9 & CPT Codes ICD 9 (International Classification of Diseases) codes describe the diagnosis CPT (Current Procedural Terminology) codes describe procedures performed ICD 9 CM Coding ICD 9 CM Coding Diagnosis Determine a diagnosis based on test results and assign a diagnostic code. Assign the best, or most appropriate, diagnostic code. Be able to support the assigned code. Determine the highest level of specificity, which means using the 5 th digit. Keep in mind that , , and are subclassifications of 784.6, so when you use those codes, you are not excluding

2 Primary Vs. Secondary Codes 1. Primary Diagnosis Code: Assign a code for the speech language disorder as the principal diagnosis. (Also known as treatment diagnosis. ) 2. Secondary Diagnosis Code: Code the related medical condition. You may need to obtain this from the physician. (e.g., code autism diagnosis as the secondary diagnosis) Is the Speech Language Problem Related to a Medical Diagnosis? Check the patient s medical record for a related medical condition. 300s: 700s: Coding Pediatric Services: ICD 9 Diagnostic 300s vs. 700s speech language impairments are developmental in nature speech language impairments are organic or neurologically based Pediatric Verbal Apraxia Coding Example Speech disorder that is neurologically based Child has limited control of muscles Assign (Other symbolic dysfuntion; acalculia, li agnosia, agraphia, apraxia). Pediatric verbal apraxia is not a developmental delay, but rather an issue of health and normal physiological function Be sure to have supporting evidence (e.g., specific child verbal apraxia test) Provide Supporting Evidence for Code Recent scientific findings shed light on the cause of pediatric verbal apraxia. British neurogeneticists identified a gene mutation that appears responsible for verbal apraxia. (Nature, 413, ; 2001) Studies suggest basal ganglia, a brain region that controls movement, may be different for those with verbal apraxia. Coding Normal Results Many payers will not reimburse for evaluation results reported within normal limits When coding an uncertain diagnosis ( suspected suspected, rule out ) ), code thecondition as if it existed When testing produces a normal result, report the sign & symptom or chief complaint as the primary diagnosis 2

3 Signs/Symptoms Associated With Speech Language Pathology Difficulty speaking (speech disturbance) Difficulty understanding spoken language (aphasia) Cognitive deficits (symbolic dysfunctions, unspecified) Signs/Symptoms Associated With Audiology Difficulty hearing in noise (unspecified hearing loss) Acoustic trauma (acoustictrauma trauma, explosive, to ear) Delayed speech/language (dev. articulation disorder) or (delayed milestones; late talker/walker CPT Coding Procedures CPT Coding Procedures Procedure Performed Use CPT codes to describe the service or treatment. Choose the CPT procedure code that best describes the services. Don t unbundle codes. Example: Don t provide an additional CPT procedural code for oral motor activities if providing speech treatment under CPT or Those codes include oral motor activities as a component of the code. Examples of CPT Codes 92506: Evaluation of speech, language, voice, communication, and/or auditory processing 92507: Treatment of speech, language, voice, communication, and/or auditory processing; individual 92557: Comprehensive audiometry threshold evaluation and speech recognition (92553 and combined) CPT E&M Codes E&M = Evaluation & Management Codes Primarily OFFICE VISIT codes (for physicians) Most payers do not cover therapists for such office visits ii ASHA recommends you obtain written authorization from the payer before using these code. 3

4 CPT E&M Codes Just because you are paid for E&M codes does not mean that they are covered surprise retroactive denials 2 years later: $10,000! Hence, the need for written authorization CPT Coding: Using Modifiers 22 Unusual services: the service provided is greater than that usually required 52 Reduced services: procedure is partially reduced Correct Coding Initiative (CCI) Edits Medicare Pairs of codes that cannot be billed on the same day, or Code pairs that can be billed on the same day if the 59 CPT modifier is added, d and your documentation shows that the 2 procedures are distinct Learn more about CCI edits at CCI Edit Examples Q. Can these procedures be performed on the same date? Examples (group tx) (indiv) YES, with (SGD eval) YES, with (SGD tx) YES, with (FEES) (laryng func.) NO The 59 modifier is attached to the Column #2 code HCPCS Level II HCPCS Level II Maintained by Centers for Medicare & Medicaid Services (CMS) In cooperation with private health insurers & state Medicaid programs HCPCS includes some procedure codes because not included in CPT (Healthcare Common Procedure Coding System) 4

5 HCPCS Examples Examples L8500 Artificial larynx L8501 Tracheostomy speaking valve L8507 Tracheo esophageal esophageal voice prosthesis, patient inserted L8510 Voice amplifier Supplies A4622 Tracheostomy tube HCPCS Examples V Codes Includes many hearing aid types V5253 Hearing aid, digitally programmable, binaural, BTE Coding Examples Coding Examples Case: Patient seen for voice prosthesis evaluation and fitting. ICD 9 diagnostic code: from physician (aphonia) primary vs. secondary diagnosis CPT procedure code: (eval for use/fitting of voice prosthesis) Coding Example Case: Patient has normal hearing. Q. How do you code the diagnosis? A. Code the referring diagnosis. Example: /tinnitus; 389.9/unspecified hearing loss Coding Example Case: An SLP performs a speech language evaluation and treatment on the same date of service. Q: What would you code? A: Eval (92506) and treatment (92507) are now allowed on the same date of service with modifier 59 (distinct procedural service performed on same day). 5

6 New 2012 CPT Codes: OAE 2012 New CPT Codes (New): Evoked otoacoustic emissions, screening The new OAE screening code is used: whenan automatedpass/fail screeningisis performed, via a fixed number of limited frequencies at single intensity level, when administered by support personnel, AUD, or physician CPT Codes: Revisions (Revised): Distortion product evoked otoacoustic emissions; limited eval (to confirm the presence or absence of hearing disorder, 3 6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report (Revised): comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report 2012 CPT Codes: SLP (Revised): Evaluation for prescription of non speech generating augmentative and alternative communication device, face to face with the patient; first hour (New): Each additional 30 minutes 2012 CPT Codes: Revisions (Revised): Developmental screening, with interpretation and report, per standardized instrument form (rather than developmental testing; limited) (Revised): Developmental testing (includes assessment of motor, language, social, iladaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report Codes now reflect accurate terms and current practice is now a stand alone code, where it once was extended 2012 CPT Codes: Modifier Preventive Services (New): When the primary purpose of the service is the delivery of an evidence based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used. Rationale: In response to the Patient Protection and Affordable Care Act (ACA) which requires all health care plans to begin covering immunizations and preventive services without any cost sharing, modifier 33 has been added to identify a service as a preventive service. 6

7 Preventive Services Modifier 33 The ACA provides specifically for the preventive health needs of children, requiring private insurers to cover without cost sharing the preventive services recommended by the Health Resources and Services Administration s Bright Futures Project, which provides evidence informed recommendations to improve the health and well being of infants, children, and adolescents. The preventive services to be covered for children and adolescents include the immunization and screening services described in the previous two categories, behavioral and developmental assessments, iron and fluoride supplements, and screening for autism, vision impairment, lipid disorders, tuberculosis, and certain genetic diseases X Cognitive Codes Developed by U.S. Dept. of Defense and Veterans Affairs These codes capture a spectrum of cognitive disorders associated with conditions, such as TBI. Source: Kaiser Family Foundation X Attention/concentration deficit Cognitive communication deficit Visuospatial deficit Psychomotor deficit Frontal lobe and executive function deficit Other signs and symptoms involving cognition 799.5X Exclusions Amnesia (780.93) Amnestic syndrome (294.0) Attention Deficit Disorder ( ) Late Effects of Cerebrovascular Disease (438) Memory Loss (780.93) Mild Cognitive Impairment (331.83) [Found under cerebral degeneration ] Specific Problems in Developmental Delay ( ) Transient Global amnesia (437.7) Visuospatial neglect (781.8) How Can SLPs Use the 799.5X codes? ASHA is working with the National Center for Health Statistics (ICD 9 committee) to provide guidance on how SLPs can use the 799.5X codes. The committee will be working with the American Hospital Association (AHA) Advisory Board. Guidance will be published in the AHA Coding Clinic. The AHA serves as the U.S. clearinghouse for issues related to the use of ICD 9 codes. ICD 10 is Coming! October 1,

8 ICD 10 is Coming! When? October 1, Diagnosis coding in health care settings will change from ICD 9 to ICD 10. Why? Because the ICD 9 CM is running out of codes. The ICD 9 CM is 30 years old, has outdated and obsolete terminology, and produces limited data. allows for more codes and greater specificity and thus better data tracking of incidence and prevalence of disease. How many more new codes? 17,000 ICD 9 141,000 ICD 10 ICD 10 codes look very different. Speech example: Hypernasality ICD 9 ICD R49.21 Hearing Example: ICD 9 ICD Presbycusis H91.1 Presbycusis H Presbycusis; unspecified H91.11: right ear H91.12: left ear H91.13: bilateral Coding Example Snow White biting the poisoned apple yeah, there s a code for that, according to Find A Code LLC, it may be a case of T78.04, anaphylactic shock due to fruits and vegetables. (Source: Anna Wilde Matthews, Wall Street Journal, Sept. 13, 2011.) Preparation Checklist 1. Look at your current usage of ICD 9 ICD 10 will replace that. ICD 10 will be used for all clinical documentation, billing, electronic records, etc. 2. Contact clearinghouses, billing services, practice management vendors. Ask about Version Payer contracts: Replace covered ICD 9 codes and update to ICD 10 codes. 8

9 Preparation Checklist 4. Develop an implementation plan: a. Determine when staff training will take place Should start 6 8 months prior to implementation date of Oct. 1, 2013, so that would be February March of b. Develop a new superbill c. Be proactive! Things to Think About Budget time and costs related to implement: Offer staff training Update software Reprint superbills Analysis of You have millions of transactions flowing in the health care system and this is an opportunity to mess them all up. Jeremy Delinsky chief technology officer for athenahealth Inc. (Anna Wilde Matthews, Wall Street Journal, Sept. 13, 2011.) Resources Resources ASHA is working on to help members prepare 1. Developed a website to provide members information on ICD / 2. Preparing a list of codes relevant for speech and hearing conditions 3. Developing tools to assist with finding equivalent codes General Resources Coding ASHA's New Coding, Reimbursement, & Advocacy Modules provide anoverview of important coding, reimbursement, and advocacy concepts Summary Mark on your calendar: Effective Oct. 1, 2013 Begin gathering information and making a transition plan Budget time and costs for transition Stay informed through ASHA resources 9

10 Questions Coding questions?? 10