Administrators, TPR Coordinator and Billing Agents
IEP Health Related Services
Identifying ICD-10-CM Codes
May, 2015
Why is ICD-10-CM reporting required?
US Department of Health and Human Services:
Center for Medicaid and Medicare Services (CMS)
Federal Regulations: 45 CFR 162.1002
Health care providers, health plans and
clearinghouses must use ICD-10-CM codes
services on and after October 1, 2015
Healthcare Industry’s version of Data Driven Decision Making
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Find Information
on the DHS Website
MHCP Enrolled Providers – Individualized Education
Program (IEP):
Hot Topics
• ICD-10-CM Reporting for Schools (DHS-7092) (PDF),
• Sign up to get email notices of new Provider Updates,
Provider News, etc.
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What are the ICD-10-CM Codes Sets?
The ICD-10-CM code sets identify:
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Signs and symptoms
Abnormal findings
Complaints
Social circumstances
External causes of injury or diseases
Medical diagnoses
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What Does this Mean for Schools?
Schools must provide an ICD-10-CM code for
each billable IEP health related service.
These services include:
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Mental health (CTSS)
Nursing
Occupational therapy
Physical therapy
Speech-language pathology and audiology
PCA
Transportation
Assistive Technology
Interpreter Services
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Who Determines the ICD-10-CM Codes?
Diagnosis
Signs/
Symptoms
RN)
x
o
(LSN/PHN/RN, not LPN)
o
x
Occupational Therapists
o
x
Physical Therapists
o
x
Speech-Language Pathologists;
Audiology
x
x
School Psychologist
o
x
Mental Health Professionals
x
o
Provider
Primary Care (MD, PA, APRN (Advan Pract
Professional Nurses
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Who Determines the ICD-10-CM Codes
for other IEP health related services?
The IEP health related service professional who is
training, directing, supervising or ordering the service,
selects the ICD-10-CM code(s) for:
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PCA services
Special Transportation
Assistive Technology
Interpreter services
In most cases it is the same ICD-10-CM code used by the
professional.
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Understanding the ICD-10-CM Code
Structure
Site for Locating ICD10Data.com
What do your IEP health related service
professionals need to do? - 1
- Identify the correct ICD-10-CM Codes: Ask
Am I treating the disease / disorder? or
Am I treating a sign/symptom?
- For treating disease/disorder, check the student
record or contact the primary care provider.
- For treating sign/symptom, select the ICD-10-CM
that represents the problem being addressed in the
services
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What do your IEP health related service
professionals need to do? - 2
The ICD-10-CM code must:
 Clearly represent the child’s medical need as
identified in the child’s IEP / IFSP
 Logically relate to the IEP provider/service
 Relate to the activities / tasks provided
 Be valid, billable and specific to the child
 Be medically necessary codes, not education codes
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Special Education Disability Categories
To qualify for Special Education a child must be eligible in one
of these Educational Disability categories:
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Speech/Language Impaired
Developmental Cognitive disability – mild to moderate
Developmental Cognitive disability – severe to profound
Physically Impaired
Visually Impaired
Specific Learning disability
Emotional/Behavioral Disorders (EDB)
Deaf-Blind
Other Health Disabilities
Autism Spectrum Disorder
Developmental Delay
Traumatic Brain Injury Disabled
Severely Multiply Impaired
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School Sources for Medical Diagnoses
 A medical diagnoses is a criteria for eligibility for these
Special Education Disability Categories: Other Health
Disabilities, Physical Impairments and Traumatic Brain
Injury
 Speech/language pathologists and audiologists determine
the diagnoses for Speech/Language Impairments
 Mental Health Professionals provide DSM 5/ICD-10-CM
diagnoses when CTSS is included in the child’s IEP needs
and plan.
 Annually, medical orders are required for students needing
medication or certain treatments.
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Special Education Records Align with ICD-10-CM
IEP Evaluation Report:
• Summarizes medical need
• States health related services are required during
school day
IEP Assessment and Plan describe:
• Health problem, signs/ symptoms/ condition
• Plan of care/Treatment Plan; why and what services
are necessary, when, by whom, how often
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What do Administrators, TPR Coordinators
and Billing Agents need to do?
1) Staff will need time to learn and practice how to do
ICD-10-CM codes.
2) Set up a procedure for IEP health related services
professionals to identify and document ICD-10-CM
Codes in a student’s FILE, not in the IEP Plan.
(See example or use computer documents.)
2) Workflow: Determine how the Biller gets the codes
(along with other daily reports).
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Optional Summary Sheet
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What do Billing Agents need to do?
 When a child has been diagnosed with a disease
disorder from a primary care provider, report that
diagnosis code as the Primary diagnosis for all claims
for the child
 When providing health related services for a sign,
symptom, or condition resulting from the disease or
disorder, report that code as Secondary, Tertiary and so
on
 When no medical disease or disorder has been
identified, report the sign, symptom or condition code
that identifies the IEP health related service that is being
provided as the Primary diagnosis code
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Watch for ICD-10-CM Code Notations
 Codes need to be valid and billable
 Watch for code notations and rules
 Check with your vendors:
Batch submissions: No decimal points
For MN-ITS, decimal points are removed.
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What do Vendors need to do?
 Run a dual system
– All 2014-15 claims (and through Sept. 30) claims will
use ICD-9 315.9.
– For services provided on and after Oct. 1, ICD-10-CM
codes must be used.
 Refer to the HIPPA implementation guide
(find the Washington Publishing Company – 5010 Guide)
 Make room for more than one code per claim
 Batch submissions: No decimal points
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Online Resources for ICD-10-CM
Reporting and Coding
Visit the following websites for additional guidance:
Center for Medicare & Medicaid Services (CMS) – ICD-10:
Provides history, requirements, and coding sources
Centers for Disease Control and Prevention (CDC) – ICD-10:
Provides history, requirements, and coding sources
ICD10Data.com: Example of a commercial website that can be
used to find appropriate ICD-10-CM codes
MHCP Enrolled Providers – ICD-10, Minnesota DHS webpage:
Provides periodic updates about ICD-10-CM Implementation
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Reminder:
 Use ICD-9 Code 315.9 for dates of service
on or before September 30, 2015
 Use ICD-10-CM Codes for dates of service
on or after October 1, 2015
Window of opportunity: Districts need codes when you
start billing for Oct. 1 services, late November.
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Things for Administrators to Think About
What is already in place?
What infrastructure changes are needed?
- Computer/software (district or vendor)
- Work flow: Identify codes, get codes to TPR biller
Who are your the early adopters?
Start with the easy/doable codes.
Change is hard. Staff need time and energy.
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RESOURCES
Webinar recordings:
MHCP Enrolled Providers – Individualized
Education Program (IEP) Trainings
DHS – MDE Staff
Jenny Roth, DHS IEP Services Coordinator
(651) 431-2622; [email protected]
Ruth Ellen Luehr, MDE Special Education
Interagency Education Specialist
(651) 582-8403; [email protected]
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