Unit 2 Diagnosis Coding in PT Practice Flashcards
Why is it important for physical therapists to understand how to select the correct codes?
You will be held accountable for the codes that you select. documentation needs to support the codes selected. you can be held liable for incorrect billing.
ICD-10 codes are used to describe Medical and Physical Therapy/Treatment Diagnoses. Explain each and give examples:
-Medical Diagnosis:
-Physical Therapy/Treatment Diagnosis:
-Medical Diagnosis: from the physician sending the referral. ICD-10 code is included on the referral. examples: femur fracture, femoral ORIF, ACL repair.
-Physical Therapy/Treatment Diagnosis: labels the physical therapy diagnoses for which the patient will be treated during their PT treatment. examples: muscle weakness, joint stiffness, knee pain, difficulty walking.
There are 69,000 ICD-10-CM codes (10th revision of International Classification of Diseases Clinical Modification) created by the World Health Organization used to ______.
Assign diagnosis or diagnoses to a patient’s condition (codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases).
ICD-10 CM codes provide the level of detail needed for morbidity classification and diagnostic specificity. ICD-10-CM allows for a high degree of specificity so third-party payers can better understand the nature of the patient’s disease, illness, disorder, or injury to make judgments about prognosis and plan of care.
List the benefits of ICD-10 CM codes.
-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 pt was doing when illness/injury occurred
______________________: the first 3 characters of any ICD-10-CM code
-category
1. letter: describes the chapter that diagnosis relates to
2. numerals
______________________ (spaces 3-6): the cause, anatomic site, severity, or other vital clinical details
-etiology
-more characters - more details
______________________ (the 7th character): episode of care
-extension
-primarily used to document episode of care for injuries and other conditions with external cause
How do you determine the first ICD-10-CM code on your Evaluation?
-should be the main reason that the patient is receiving therapy
-if there is a definitive diagnosis from a physician then that code should be used first
- ICD-10-CM Seventh Character:
The 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.
Explain these 7th Characters:
oA (initial):
oD (Subsequent):
oS (Sequela):
oA (initial): the entire period in which a pt is receiving active treatment for the condition. not typically used in PT unless direct access.
oD (Subsequent): after the active phase of treatment when the pt is receiving routine care for the condition during the period of healing or recovery phase of treatment. the majority of PT encounters.
oS (Sequela): complications or conditions that arises as a direct result of the condition. acute condition that occurs after the acute phase of the disease/illness/injury. can be caused indirectly by the treatment. example: scar formation
What chapter is the 7th character required for?
chapter 19 and chapter 15
Do all codes have 7 characters?
not all codes require a 7th character
What is the purpose of external cause codes?
-to provide contact to a particular diagnosis code
-found in chapter 20
-reported in the initial evaluation; not principle 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 pt 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, further describe the pt’s condition
