We recently hosted a webinar focused on helping PTS, OTs, and SLPs prepare for the ICD-10 switch. We got a lot of questions—so many, in fact, that we decided to organize the most common ones into an easy-to-reference blog post. Read on to find the answers to all your burning ICD-10 queries. Don’t see your question? Post it in the comments section below, and we’ll find you an answer.
Does ICD-10 affect CPT codes?
According to this CMS document, the answer is no: “The switch to ICD-10 does not affect CPT coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only.”
Where can I find additional training resources?
Beyond our WebPT blog posts and webinars, we recommend reviewing ICD-10 for PT for further information. Additionally, Rick Gawenda offers an array of valuable seminars, and Tom Ambury—of the PT Compliance Group—offers one-on-one scheduled trainings. Finally, as always, if you’re an APTA member, you have access to the association’s vast library of educational resources.
Where can I get information about ICD-10 testing?
To find out how your individual vendors and commercial payers plan to tackle testing, you’ll need to contact them directly. As far as Medicare testing goes, here’s the link to the CMS page with all the details.
How will ICD-10 affect the therapy cap and G-codes?
It won’t in any way. ICD-10 is wholly separate from all Medicare reporting regulations.
After October 1, what codes should I use for claims with dates of service prior to September 30?
As this CMS document explains, you should use ICD-9 codes for claims with dates of service falling on September 30 or earlier, regardless of when you submit the claim. For claims with dates of service that span the transition date, you'll need to submit split claims, because submitting claims with both ICD-9 and ICD-10 codes could lead to denials.
Is there a cheat sheet or crosswalk that contains ICD-10 equivalents of common PT diagnosis codes?
Because there are so many more ICD-10 codes than ICD-9 codes, it is impossible to develop a reliable one-to-one crosswalk. In fact, a single ICD-9 code may have dozens—sometimes even hundreds—of possible ICD-10 equivalents. Regarding a cheat sheet, your best bet is to create your own by identifying the ICD-9 codes you use most frequently in your practice and then determining their ICD-10 equivalents. To do so, follow the instructions in this blog post. If you're looking for a software solution to help ease the transition, WebPT has developed an ICD-10 tool that helps therapists select the most specific and accurate ICD-10 code based on their documentation and diagnosis.
I heard that workers’ comp and auto insurance payers will continue using ICD-9, even after the ICD-10 transition date. Is that true?
Because workers’ comp and auto insurers are not HIPAA-covered entities, the national ICD-10 mandate does not apply to them. Thus, they can legally continue to use ICD-9 if they choose to do so. However, some states may require universal use of ICD-10, and leaders in the healthcare space—including CMS—are strongly encouraging workers’ comp and auto insurance payers to voluntarily begin using ICD-10 codes once the transition occurs. So, you’ll need to contact the companies you work with directly to verify whether they plan to make the switch come October 1.
Can I use real patients for ICD-10 testing within WebPT?
When using WebPT's ICD-10 testing module, you should stick to fake patients only. You'll find a detailed explanation and video tutorial on how to use our ICD-10 testing feature by logging in to the app and clicking this link.
I have a cash-based practice. Why do I need to worry about ICD-10 codes?
Even though your practice is cash-based, your preparation for the ICD-10 transition should be very similar to that of any other private practice owner. Chances are that some of your patients work directly with their insurance companies to get reimbursed for the services you provide them, so it's still important for the codes on their invoices to be correct and as specific as possible.
Why do I need to know how to select an ICD-10 code? Won’t I just enter whatever code the referring physician sends?
You should bill using the ICD-10 code that matches the condition you, as the PT, are treating—and that code might not match the one sent by the referring physician. (Plus, direct access/self-referred patients won’t have physician prescriptions.) For that reason, we recommend that PTs double check all of the diagnoses they receive from referring physicians to verify that the code in the patient's record is the most accurate, specific code available. In some cases, the PT may need to consult with the physician to ensure this is the case—especially if the PT suspects that the ICD-10 code entered by the physician is not the best code available.
Will I ever have to submit more than one ICD-10 code?
In some situations, you may need to report multiple codes for a single condition. To determine when this is appropriate, check the Tabular List notes. These notes may read something like, “Use additional code” or “Code first,” which means you must code the underlying condition first. Keep in mind, though, that ICD-10 contains several combination codes—single codes that classify two or more conditions that often occur together. So, if a patient presents with two or more related conditions, check to see if there is a combination code that covers all of them before you code each condition separately. Furthermore, for injury codes, you may need to include secondary codes that describe the circumstances surrounding the injury. You can find these codes—known as external cause codes—in Chapter 20 of the Tabular List, and you can assign as many as you need to explain the patient’s condition. For more on these codes, check out this blog post.
What is the point of the ICD-10 transition?
You might not realize it, but ICD-9 is woefully inadequate when it comes to describing current medical practice, terminology, and diagnoses. After all, it’s 30 years old, and medicine has come a long way in the last few decades. In addition to being outdated, ICD-9 employs a code structure that limits the addition of new codes. And that, in turn, limits the accuracy and specificity of data regarding patients’ medical conditions. ICD-10 solves all of that. Plus, it leaves room for future developments in technology, treatment, and payment reform—and theoretically, it will streamline billing process and simplify fraud detection. Finally, keep in mind that the US is the only developed country that is still using ICD-9, which doesn’t make us look very good on the world stage of medical advancement and research. To stay on the cutting edge of modern medicine, we’ve got to speak the modern medical language.