Get Ready for ICD-10 The coding system for all medical conditions change in five months. Are you—and your billing system—ready? News in Brief
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News in Brief  |   May 01, 2015
Get Ready for ICD-10
Author Notes
  • Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org
    Neela Swanson is director of ASHA health care coding policy. nswanson@asha.org×
  • Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor. jmccarty@asha.org
    Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor. jmccarty@asha.org×
Article Information
Practice Management / News in Brief
News in Brief   |   May 01, 2015
Get Ready for ICD-10
The ASHA Leader, May 2015, Vol. 20, online only. doi:10.1044/leader.NIB6.20052015.np
The ASHA Leader, May 2015, Vol. 20, online only. doi:10.1044/leader.NIB6.20052015.np
It’s a change that’s been coming for years, and on Oct. 1 it will be a reality: the switch from the ninth to the 10th revision of the International Classification of Diseases, Clinical Modification. Repeated delays of the transition deadline—including a year-long postponement announced just six months before it was to have taken effect in 2014—have made it difficult for the health care industry and clinicians to prepare.
However, the new deadline of Oct. 1, 2015, is only five months away, and this time there is no reason to anticipate yet another delay. Any bill you submit to public or private insurers for services provided from that date forward must use the new codes. Preparing now for the transition and becoming familiar with the ICD-10 code set will help you avoid reimbursement problems. Here are some questions to help you check your knowledge and readiness.
Have you started preparing for the transition?
The change to ICD-10 is a significant undertaking for the health care industry. You should be well into planning billing, practice management and electronic health record software changes: ensuring that ICD-9 codes are correctly mapped to the corresponding ICD-10 codes, training clinicians and office staff, and communicating with payers.
Audiologists and speech-language pathologists in all settings, from major health care systems to solo practitioners, should be actively involved in the transition process. If you or your employer have not begun the transition, it’s not too late. Take a look at ASHA’s ICD-10 website for a preparation checklist and additional resources to help you develop your plan today. Also take a look at the sidebar below, “5 Warning Signs You’re Not Ready for ICD-10.”
Are you familiar with the ICD-10 code set?
The ICD-10 code set is much larger than the previous revision and the codes look very different. Many—but not all—of the ICD-9 audiology and speech-language pathology codes map directly to corresponding ICD-10 codes, and some have variations.
In audiology, for example, ICD-10 introduces different codes for unilateral versus bilateral conditions, considerably expanding the number of hearing-related diagnoses. ASHA has developed extensive resources specifically for audiologists and SLPs, including an online ICD-9 to ICD-10 mapping tool and spreadsheets, and ICD-10 code lists. ASHA staff developed the mapping resources using detailed analysis.
Identify the ICD-9 codes you use most frequently and use ASHA’s resources to map them to ICD-10. Audiologists and SLPs also can share these resources with employers and payers to ensure that their systems use the most accurate mappings. Remember, you are the audiology or speech-language pathology expert.
Have you practiced using ICD-10?
Here are some practice scenarios to get you started. Use ASHA’s resources to help you find the answers.
1. A newborn does not pass a hearing screening. What code should the audiologist use for the failed screen?
Assign code H91.90, unspecified hearing loss, unspecified ear. Use unspecified codes when information in the medical record is not enough to assign a more specific diagnosis.
2. An SLP performs a voice evaluation and laryngeal videostroboscopy for a patient with hoarseness and suspected vocal nodules; both are confirmed. What codes should be assigned?
R49.0, dysphonia, hoarseness, is the primary diagnosis; J38.2, nodules of vocal cords, is the secondary diagnosis. Under ICD-10, vocal nodules has its own code (evidence that ICD-10 indeed has greater specificity); under ICD-9, it was coded as 478.5, other diseases of the vocal cords.
3. A child with a diagnosis of autism is referred for a speech-language evaluation. Assessment measurements indicate that the child has a language deficit. How should the SLP code the diagnosis?
Assign R48.8, other symbolic dysfunctions, as the primary diagnosis, and F84.0, autistic disorder, as the secondary diagnosis.
R48.8 (symbolic dysfunction) is the appropropriate code rather than F80.2 (mixed receptive-expressive language disorder) because there is an underlying medical diagnosis contributing to the language problems. If no medical etiology has been identified, then F80.2 should be used. F80.2 is the ICD-10 “developmental” section, which is equivalent to the 315 series of codes in ICD-9.
Note: In ICD-10, the autism codes do not require an additional digit for current/active state or residual state.
4. What is the code for conductive hearing loss in both ears?
Assign code H90.0, conductive hearing loss, bilateral.
5. How should an SLP code developmental articulation problems when the child has no related medical condition?
For disorders with no related medical condition, use codes in the F80 section (specific developmental disorders of speech and language). In this situation, the appropriate code is F80.0, phonological disorder, functional speech articulation disorder.
6. A farmer heads out to tend to his livestock and a particularly irritable turkey chases him through the farmyard. The farmer sustains injuries to the backs of his legs, where the turkey pecked him. How should that be coded?
Yes, there is a code for that—W61.43, pecked by turkey! Codes like this one, called “external cause” codes, are fodder for jokes because of their very specific nature. They need to be specific, however, because they are intended to provide data for injury research. They can capture how an injury or condition occurred, whether it was accidental or intentional, where it occurred, and what the patient was doing when it happened.
The turkey example may be far-fetched for most clinicians, but audiologists and SLPs may find some external cause codes that are relevant. For example, codes listed under Y36.20 (war operations involving unspecified explosion and fragments) could be used in conjunction with cognitive impairments related to traumatic brain injury or hearing loss caused by a blast.
External cause codes are always used in addition to the primary diagnosis for the condition or disorder. In most cases, external cause codes are not required, unless they are state- or payer-mandated. However, the ICD-10-CM coding guidelines strongly encourage the use of external cause codes, when appropriate, to assist with data collection.
ASHA does not publish external cause codes because of the sheer size of the code set. Find a full list here.
So, are you ready?
You will be! ASHA has the resources to help you get there. Be proactive and work with your colleagues to share knowledge, experience and support.
How To Tell If You’re Not Ready for ICD-10

PhysiciansPractice.com suggests five warning signs that your practice or facility might not be ready for ICD-10 (adapted from the group’s website).

  1. You have not developed or budgeted for a preparation plan.

  2. You haven’t heard from your software vendor. Be concerned if your vendor can’t provide details on the ICD-10 transition.

  3. You have no cash on hand or available line of credit. Save some cash. Any number of glitches have the potential to slow your payments. Your cash flow could be disrupted while clearinghouses and software vendors fix any hiccups.

  4. You never saw an unspecified diagnosis code you didn’t like. If you use a lot of unspecified codes, pay attention. Start using specific ICD-9 diagnosis codes now to ease the transition to the more detailed and descriptive ICD-10 system. Greater specificity is a hallmark of ICD-10.

  5. You plan to review payer contracts after the ICD-10 dust settles. Now is a very good time to review and update contracts, incorporating ICD-10 codes when appropriate.

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May 2015
Volume 20, Issue 5