Diagnosis Coding in Physical Therapy Practice - Week 6 Flashcards
Why is it important for physical therapists to understand how to select the correct codes?
- to bill for service, need to include a diagnosis that includes the medical necessity of your care
- you are accountable for the codes you select
- can be held reliable for incorrect billing
Physical Therapy/Treatment Diagnosis:
- physical impairments you found during evaluation that require need of PT
- muscle weakness, knee pain, difficult walking
Medical Diagnosis:
- medical reason they are being referred to PT
- femur fracture, ACL repair
benefits of ICD-10 CM code
- Laterality: Right or Left
- Traumatic or Non-traumatic Injury
- Dominant Side or Non-Dominant Side
- Unilateral Condition or Bilateral Condition
- Cause of the Traumatic Injury
- Place of Occurrence
- Activity the Patient was Doing
- When Illness/Injury Occurred
the first 3 characters of any ICD-10-CM code
Category
spaces 4-6
the cause, anatomic site, severity, or other vital clinical details
the 7th character
Episode of Care
FIRST ICD-10-CM CODE
- main reason they are getting therapy
- more for coexisting conditions
- if no medical diagnosis you can use codes for signs, symptoms, and ill-defined conditions
- the more codes the better you can describe situation
TREATMENT DIAGNOSIS: REASON FOR PT
- ICD-10 codes are a PT’s first step toward demonstrating medical necessity: What is the patient’s diagnosis, and is that diagnosis appropriate to be evaluated and treated by a PT?
- Primary treatment diagnosis identified by the PT: a diagnosis that best fits the reason thatt he patient will be receiving physical therapy services (may be different than the referring diagnosis)
- Secondary codes: used to provide more detail in terms of the medical necessity for the interventions included as part of the POC; can be descriptive of complexity; comorbidities
- Causation i.e., don’t just code for knee pain-what caused the knee pain (underlying condition)
7th character focuses on
the patient’s condition and the patient’s treatment phase; not the health care provider being seen or how many times the patient has been seen. This means “initial” or “subsequent” encounter is based on the patient’s course of treatment and not whether it is his or her first visit vs follow-up treatment with a provider.
7th character:
A (initial):
the entire period in which a patient is receiving active treatment for the condition
- any treatment for that injury
- PT only use if see patient in direct acess
7th character:
D (Subsequent):
after the active phase of treatment when the patient is receiving routine care for
the condition during the period of healing or recovery phase of treatment
- most PT encounters will use this one
7th character:
S (Sequela):
complications or conditions that arises as a direct result of the condition
ex. scar formation after burn
What chapter is the 7th character required for?
- Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes)
- Chapter 15 (Pregnancy, Childbirth and the Puerperium)
- Instructions specifying 7th character use
Do all codes have 7 characters?
no
What is the purpose of external cause codes?
• Provide context to a particular diagnosis code to how injury happened
• Reported on initial evaluation; not principle or main diagnosis
–> is secondary code for main diagnosis
What are the different types of external cause codes?
External Cause Code
• How did the injury or condition happen?
Place of Occurrence Code
• Where did it happen?
Activity Code
• What was the patient doing when it happened?
Intent
• Was it intentional (assault, self-harm) or unintentional (accidental)?
Individual’s Status
• the status of the person at the time the event occurred; civilian, military, volunteer
Is it mandatory to report external cause codes?
no
Do external cause codes apply to all categories of diagnosis codes?
-
Where do you document External Cause codes?
-
Aftercare visit codes
(Z codes) cover situations in which the initial treatment of a disease has been performed or the injury or disease has been removed, and the patient requires continued care during the healing or recovery phase or for the long-term consequences of the disease.
When should “Aftercare Codes” be used?
- no other way to express
- if you can’t find a 7th code
