2021 ICD-10-CM Diagnosis Codes Related to Speech - ASHA
uploadedfiles › icd-
ASHA DOCUMENTS
ates the relationship between the ASHA Code of Ethics, the Scope of Practice, Standard III-G: The applicant must demonstrate knowledge of contemporary professional issues
Spring - Inside This Issue
presentatives received a reply from NCCI on January 31, 2019: Speech language pathologists shall not report HCPCS/CPT codes 97110, 97112 , 97150, 97530, 97127, or
Medicare G Codes Gawenda Seminars - Ruforum
medicare- PDF
Ethical Decision-Making: A Public Health - Lavi Institute
https://www asha org/uploadedFiles/2019-SLP-HC-Survey-Summary- scores, etc , that would be in violation of the ASHA Code of Ethics ” Audiology CPT Codes
[PDF] asia airport codes list
[PDF] asia university ranking 2020 india
[PDF] assas calendrier examens oraux
[PDF] assembler programming tutorial pdf
[PDF] assembly instructions for ikea platform bed
[PDF] assembly language tutorial for beginners pdf
[PDF] assembly language tutorial pdf download
[PDF] assessing english language proficiency in u.s. k 12 schools
[PDF] assessment for english language learners
[PDF] assigning values to variables in java
[PDF] association habitat et humanisme ile de france paris
[PDF] assume that there are two alleles r and r
[PDF] assumed mean method pdf
[PDF] atelier langage petite section maternelle
CAPCSD Medicare Webinar
October 17, 2018
CAPCSD Medicare Webinar Disclaimer
CAPCSD is providing information on Medicare in a university clinic environment for informational purposes and may not reflect the most current developments. These informational materials are not intended, and should not be taken, as legal advice on any particular set of facts or circumstances. You should contact your attorney for advice on specific legal programs.If you have any specific questions about any legal matter you should consult your attorney. You should seek legal advice in a timely manner before entering into any new business relationships or changing your business model.
Medicare Implementation in
a University Clinic: Training &Teamwork
Danielle R. Varnedoe, MA, CCC-SLP
Heidi Verticchio, MS, CCC-SLP
Lisa Scott, PhD, CCC
-SLPDisclosures
Danielle VarnedoeHeidi VerticchioLisa Scott
FinancialFinancialFinancial
Employed by University of
South CarolinaEmployed by Illinois State UniversityEmployed by Florida State UniversityReceiving a stipend from
CAPCSD for this webinar
Receiving a stipend from
CAPCSD for this webinar
Non-FinancialNon-FinancialNon-Financial
None to reportNone to reportSecretary of CAPCSD
CAA site visitor
Learning Objectives
Discuss the compliance requirements for University settings in the implementation of providing services to Medicare beneficiaries Identify considerations for University settings for each of the compliance requirements Implement coding principles for correct claims submissionWho is involved in the training team?
Clinic Administrators
Understanding of the rules and regulations
Clinical Educators
Responsible for the correct coding and documentation of services Responsible for training of graduate student clinicians in clinical coding and documentation of servicesFront office staff
Authorizes and submits claims
Collects co-payments
Medicare Compliance Requirements
Supervision Requirements
Reasonable and Necessary Services
Documentation
Claims Submission
Resource: Medicare Benefit Policy Manual, Chapter 15Supervision Requirements
Personal supervision (REQUIRED)
In the room with the patient and clinician (1:1 supervision) Medicare uses the term Active Participation: Guiding and personally engaged the servicesDirect supervision
On the premises and immediately available if neededGeneral supervision
Available to the clinician; but not necessarily on the premises Resource: ASHA, Medicare Coverage of Students and CFs for SLPConsiderations on Implementation of
Supervision Requirements
Fostering independence with 1:1 personal supervision Licensed, provider is the responsible individual for proper coding and documentation. It is unlikely that an entire caseload would consists of Medicare beneficiaries Can alter the number/percentage of patients who are Medicare beneficiaries We must provide students with a wide ranger of experiences to cover the breadth and depth of the fieldReasonable and Necessary Services
As defined by the Medicare Benefit Policy Manual Chapter 15 "The services shall be of such a level of complexity and sophistication or the condition of the patient shall be such that the services required can be safely and effectively performed only by the therapist." " Services that do NOT require the performance of a therapist are not skilled and are not considered reasonable or necessary, even if they are performed by a qualified professional." "The key issue is whether the skills of a therapist are needed to treat the patient, or whether the services can be carried out by nonskilled personnel."Rehabilitation vs. Maintenance
Therapy
Medicare does recognize a distinction between rehabilitation and maintenance therapy Type of intervention needs to be supported in the documentationRehabilitation
Skilled services to address recovery or improvement in functionMaintenance
Skilled services to maintain functional status or prevent/slow further loss of skillResources:
Medicare Benefit Policy Manual, Chapter 15
ASHA, Medicare Guidance for University Clinics
Considerations on Implementation of
Services that are Reasonable and
Necessary
Determination of medical necessity
Understanding the difference between skilled and unskilled servicesResources:
ASHA, Guideline on admission and discharge criteria in SLP ASHA, Documentation of Skilled vs. UnSkilled Care for Medicare Beneficiaries ASHA, Examples of Documentation of skilled vs. unskilled servicesDocumentation (AUD)
Reason for the test
Examples of this documentations: the physician's order, the audiology report, the medical recordDocumenting skilled services
Indicate what was ordered
Reason services should be covered
Services completed by qualified audiologist
Resources:
ASHA, Documentation FAQs for AUD
ASHA, Practice Portal on Documentation of AUD servicesDocumentation (SLP)
Medicare has documentation for each of these types of service visitsEvaluation
Plan of Care/Plan of Treatment
Certification/Recertification
Daily visit notes
Progress notes
Discharge notes
Resources:
ASHA, Overview of Documentation for SLP
ASHA, Practice Portal on Documentation in Health CarePlan of Care
Must be established before treatment begins
It's established when it is created (dictated/written)Must contain
Patient's diagnosis
Long term treatment goals
Type of therapy services
Amount of therapy services
Duration of therapy services
Frequency of therapy services
Must be certified by a physician within 30 calendar days of first treatment dayCertification/Recertification
Initial certification must be done within 30 calendar days of the initial treatment dayCertification indicates
the patient is under the care of the physicianIndicates concurrence with plan of care contents
Recertification occurs when
Significant modification to plan of care
Every 90 calendar days after first treatment day
Considerations on Implementation of
Documentation Requirements
If it is not documented, it did not happen.
Create a time-line/flowsheet to assist clinical educators with documentation requirements The licensed provider is responsible for coding and documentation Teaching students the proper documentation requirementsClaims Submission
CPT codes
ICD-10 codes
G-codes and Severity Modifiers
CPT (Current Procedural Terminology)
Owned by the American Medical Association
These codes indicate what we do with our patients
Procedure based codes which are reported regardless of appointment length MostCPT codes for both AUD and SLP do not have a time component associated with them.Resources:
ASHA, CPT codes for AUD
ASHA, CPT codes for SLP
ASHA, Timed and Untimed CPT codes
Timed code documentation
Documentation must be provided to match the timed code justification To bill for the additional time, the time with the patient must exceed the halfway point of the time identified in the code An additional hour charge must be greater or equal to 31 minutes An additional 30-minute charge must be greater or equal to 16 minutes An additional 15-minute charge must be greater or equal to 8 minutesNCCI edits
National Correct Coding Initiative
Identifies specific CPT codes that can be reported/billed on the same day Includes how these codes must be reported (modified) for proper billing/reimbursementResources:
ASHA, NCCI edits for Audiology
ASHA, NCCI edits for SLP
Modifiers
-22 Unusual Services Service was greater than usually required for the listed procedureA report may be necessary to document this
-52 Reduced Services Service is partially reduced or eliminated at the providers discretion Identifying the basic service with a reduction in service -59 Distinct Procedural Service Distinct, independent services provided on the same day Example: 92507 and 92508 on the same day (individual and group therapy)See NCCI/OCE Edit for coding procedures
Modifiers
-96 Habilitative Services Help patients learn skills and functioning for daily living that they have not yet developed , and then keep and/or improve those new learned skills Help patient keep, learn, or improve skills and functioning for daily living -97 Rehabilitative Services Help patients keep, get back or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabledResources:
ASHA, Medicare Coding Rules for AUD
ASHA, Medicare Coding Rules for SLP
CPT codes for SLP
CPT codes for AUD
CPT codes for AUD (cont.)
ICD-10 (International Classification of
Diseases and Disorders, 10
th revisionThese codes indicate the reason for our services
Used to describe this disease or disorder
Required as a component of HIPAA
They should relateto the CPT codes
ICD is the reason the patient is coming and the CPT is what we do with the patient Resource: ASHA, ICD-10 Diagnosis codes and information for AUD and SLPICD-10 coding principles
"Code to highest degree of specificity" Those that provide the greatest degree of completenessUse the full number of characters available
Unspecified and Other
Unspecified means there isn't enough information in the record to assign a more specific ICD-10 codeOther means that sufficient documentation exists in the record to assign a diagnosis, but no ICD-10 code exists for the specific condition