Eli's Rehab Report

Careful: Crosswalks can be your best friend — or worst nightmare.

ICD-10 codes are coming soon, and they’re a lot more detailed than ICD-9. Use the following examples to get a feel for the higher granularity you’re looking at for common rehab diagnoses.

1. Flaccid Hemiplegia

An OT documents a visit for a right-handed client with flaccid hemiplegia impacting the right side. “In ICD-9, the therapist could code the treatment diagnosis of 342.01 (Flaccid hemiplegia and hemiparesis affecting the dominant side),” says Jeremy Furniss, MS OTR/L, coding and payment specialist for the American Occupational Therapy Association (AOTA). “The ICD-10, however, looks at dominant and non-dominant as well as laterality, so the ICD-10 code is G81.01 (Flaccid hemiplegia affecting right dominant side). 

“The documentation would not have to change, but the level of detail in the coding does have to change,” Furniss says. “The therapists’ documentation will have to support the use of more granulated codes provided in ICD-10; however, evaluation documentation by OTs should already include this level of detail.”

Watch for: Crosswalks have been a huge lifesaver in helping clinicians transition to ICD-10, but don’t let them be your only support. Furniss predicts a key problem will be code choices that aren’t specific enough — and crosswalks are a key culprit. 

“Many of the most specific ICD-9 codes actually crosswalk to a section of codes or an ICD-10 code that is not specific enough to use for submitting a claim,” Furniss says. “In the example above, the ICD-9 code 342.01 crosswalks to G81.0 (Flaccid hemiplegia). However, G81.0 is not specific enough to use on a claim form; the therapist would need to continue to drill down and choose between G81.01 or G81.02.”

2. Vocal Pathologies

The diagnoses for vocal pathologies is one good example of ICD-10’s higher granularity in the realm of speech-language pathology, points out Nancy Swigert, MA, CCC-SLP, BCS-S, director of speech-language pathology & respiratory care at Baptist Health in Lexington, KY. (See box to the right)

“Nodules of the vocal cords, a common problem, will have its own code [in ICD-10], whereas in ICD-9 it was listed as one of the ‘other diseases of the vocal cords’ (478.5),” Swigert says. 

More examples of higher specificity include:

• 784.59 (Other speech disturbances) — which included dysphagia, slurred speech, and speech disturbance NOS — becomes three distinct codes in ICD-10: R47.81 (Slurred speech); R47.89 (Other speech disturbances); and R47.9 (Unspecified speech disturbances), Swigert notes.
• 784.69 (Other symbolic dysfunction) in ICD-9 has the examples of acalculia, agnosia, agraphia NOS, and apraxia, Swigert says, but in ICD-10, each has its own code: R48.1 (Agraphia); R48.2 (Apraxia); R48.8 (Other) — includes acalculia and agraphia, and R48.9 (Other).

Helpful: ASHA’s website has a tool that converts ICD-9 codes to ICD-10 codes: www.asha.org/icdmapping.aspx. “As an ICD-9-CM code is entered, the tool will display a dropdown menu with a list of the possible codes that are available for mapping. The selection of codes will narrow the reader as they continue to enter the code to higher levels of specificity,” Swigert says.