RMC’s AHIMA Approved ICD-10 Trainers meet multiple times per week fielding questions from clients and staff. Below is an actual question that was submitted, along with our team’s response. *
CODING QUESTION: We recently received a denial on a speech therapy account because the payer (BC of NJ) said we should be using the ICD10 crosswalk code for V57.3 which is Z51.89 in order to get our claim paid. After extensive review of the Coding Guidelines and also querying 3M Nosology, we can find nothing that supports the use of Z51.89 for ST, PT or OT accounts. We should be coding the diagnosis that is requiring the services. The original account had the codes F80.9 and F84.0. What are your thoughts? We have been having more and more problems with payers (EOCCO/BC) requesting that certain codes must be used in certain sequences in order to get the claim paid and oftentimes it goes against coding guidelines.
RMC RESPONSE: Trainers suggest following official coding guidelines for coding. Crosswalks are not recommended for coding in ICD-10. For example, in this case, the Z51.89 Encounter for other specified aftercare does not apply.
ICD9 -V57.3- Care involving speech language therapy
ICD10- Z51.89- Encounter for other specified aftercare
Trainers recommend coding the reason for the therapy (as the condition the patient is presenting) as the first -listed diagnosis. There is no code for admit for PT, OT or ST in ICD-10 as there was in ICD-9. Guidelines instruct coders to use the reason for encounter first, followed by any additional diagnoses.
Reference: OCG I.2.K- Admissions/ Encounters for Rehabilitation
When the purpose for the admission/encounter is rehabilitation, sequence first the code for the condition for which the service is being performed. For example, for an admission/encounter for rehabilitation for right-sided dominant hemiplegia following a cerebrovascular infarction, report code I69.351, Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side, as the first-listed or principal diagnosis. If the condition for which the rehabilitation service is no longer present, report the appropriate aftercare code as the first-listed or principal diagnosis. For example, if a patient with severe degenerative osteoarthritis of the hip, underwent hip replacement and the current encounter/admission is for rehabilitation, report code Z47.1, Aftercare following joint replacement surgery, as the first-listed or principal diagnosis.
Reference: OCG- 1.21.7
Aftercare visit codes cover situations when the initial treatment of a disease has been performed and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, acute disease. The diagnosis code is to be used in these cases.
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* Every effort has been made to answer these questions to the best of RMC’s abilities, at the time the original question was submitted. Answers should not be considered official coding advice, and we always encourage conversation and dialogue regarding our responses. As best practice policy, always be sure to refer to your Official Coding Guidelines, Coding Clinic, CPT Assistant, etc.